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Diabetes Management Using Professional Continuous Glucose Monitoring to Modify Eating Behavior in Patient on ‘Heart Healthy’ Diet Howard Wolpert, MD Senior Physician, Joslin Diabetes Center, and Assistant Professor, Harvard Medical School, Boston, Massachusetts, US Abstract Diabetes management is often complex and requires the involvement of various team members and technology for behavior change and successful outcomes. This paper shows how one provider utilized a team approach and the use of professional continuous glucose monitoring to help this patient identify needed behavior change to improve outcomes. Keywords Type 2 diabetes, professional continuous glucose monitoring, diabetes therapy management software Disclosure: The author has no conflicts of interest to declare. Acknowledgment: Manuscript preparation was funded through an educational grant from Medtronic Diabetes. Received: September 19, 2012 Accepted: October 29, 2012 Citation: US Endocrinology, 2012;8(2):74–6 Correspondence: Howard Wolpert, MD, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215-5306, US. E: Howard.Wolpert@joslin.harvard.edu Support: The publication of this article was funded by Medtronic Diabetes. The views and opinions expressed are those of the author and not necessarily those of Medtronic Diabetes. Professional continuous glucose monitoring (CGM) is an effective tool that helps identify glucose variability in patients with diabetes. Minute-by-minute variability is not revealed by glycated hemoglobin (HbA 1c ) measurements and is often missed by fingersticks. The result is that patients are unaware of their individual glucose variability and how their daily activities (exercise, eating habits, and general lifestyle) affect their blood glucose and may put them at risk for short-term problems as well as long-term complications. Professional CGM continues to improve over time and provides data in formats that are easy to access, interpret, and share with patients. Providing this data to patients can assist them to modify behaviors and see successes in their management of this complex disease. Case Study Henry is a 67-year-old vice president of sales and marketing at a large telecommunications company. Diagnosed with type 2 diabetes 23 years ago, he has sought to keep his blood glucose, weight, and other cardiovascular risk factors in check through the following measures: • checking his blood glucose every morning and evening; and • walking 90 minutes per day. Despite these healthy habits, Henry’s HBA 1c is 8.2 %, higher than the widely accepted target of 7.0 %. At the same time, his self-monitoring of blood glucose (SMBG) logbook indicates pre-breakfast and pre-dinner average of 90–110 mg/dl, consistent with published guidelines. 1,2 The handwritten entries also reveal regular breakfasts of cold cereal with a banana each morning, followed by frequent ‘pick-me-ups’ of fruit throughout the day. Scanning the pages, the physician notes the lack of mid-day readings compared with other time periods. Henry explains that he often takes clients out for extended lunch meetings and feels uncomfortable checking his blood glucose in these situations. He adds that because carbohydrate counting is ‘hit-or-miss’ in restaurants, he deliberately restricts his orders to lean meats and vegetables. Furthermore, with lunch as his major meal of the day, his dinner often consists of a salad, with fat-free dressing, prepared after a 5-mile ‘speed walk’ every evening. Recommendation • using a basal-bolus insulin regimen: bed time insulin glargine (20 units); and o pre-meal insulin lispro, dosed according to an Insulin:Carbohydrate ratio of 1:15 and correction factor of 50 (1 unit of insulin for every 50 mg/dl above his target blood glucose of 120 mg/dl). • taking atorvastatin (10 mg) with low-dose aspirin (81 mg) daily; • maintaining a ‘heart-healthy’ diet, containing large quantities of fruits and vegetables; o 74 Commending Henry’s generally healthy regimen of diet, exercise, and pharmacotherapy, the physician asks whether he would like to address his out-of-target HbA 1c level. Although this is a matter of some concern to Henry, he expresses doubt about the feasibility of changing his carefully structured routine. The physician suggests that a reasonable first step might be identifying and, if necessary, treating early post-meal hyperglycemia. To capture post-meal glucose values missed by twice-daily SMBG, he asks whether: Henry would consider a blood glucose check © TOUCH MEDICAL MEDIA 2012