First CGM Basal-Bolus Insulin Titration Study Shows Future Potential For Remote Patient Monitoring

Checking, tracking and adjusting blood glucose levels, administering multiple daily injections and meeting regularly with physicians to discuss changes in insulin doses can be difficult for the 34 million Americans living with diabetes - especially in a COVID world. Remote patient monitoring and insulin titration using CGM  may be a solution for some.

Thanks to research introduced at the American Diabetes Association’s 80th Scientific Sessions, new evidence suggests the future could look very different. Over the weekend, Dr. Bruce Bode presented the poster titled, “Evaluating the Impact of Glucommander on Improvement in Time-in-Range (TIR) in Type 2 Diabetes Using Continuous Glucose Monitoring.” It is the first proof-of-concept study that combines FDA-cleared insulin titration software with data from continuous glucose monitoring (CGM) systems. And the results show promise. 

Attendees learned how FDA-cleared, cloud-based remote insulin titration software could increase the speed and consistency of individuals achieving their target glucose range if they use a CGM. This research and its transformative results come nearly a year after the American Diabetes Association endorsed time-in-range as a metric for people with diabetes.

In just four weeks, time-in-range for patients in the study improved from 48% to 74%. For context, the median time in range for 500,000 people using only Abbott's FreeStyle Libre CGM system was 56%, according to data released by the company. 

The four-week study began with a nurse educator helping participants set up the Abbott Freestyle Libre 14-day CGM system while collecting baseline data. Participants visited the Atlanta Diabetes Associates office every two weeks for CGM sensor changes, and insulin titration was done during these visits or by phone on the weeks not requiring visits. 

Historically, insulin titration is an iterative process where patients work closely with a licensed provider and rely on finger pricks and meters to achieve their optimal dosing regimen. Achieving in-range glucose levels can take years because patients meet with providers in person every few months to review data and adjust doses. The study’s protocol allowed nurse educators to review participant CGM data, remotely generate dose updates from Glucommander (Glytec’s cloud-based insulin titration software), examine the recommendation and pass it on to the patient. No intervention by the licensed provider was necessary.

Dr. Bode’s research suggests a simplified method to glucose management that reduces the burden on patients and providers. For patients, CGM removes the need for multiple finger pricks a day. Continuous tracking also provides a large amount of patient glucose data for Glucommander to titrate personalized doses, which in turn delivers better patient outcomes and a higher quality of life. Since no intervention is needed by a licensed provider, physicians can focus their time and resources on top priority cases.

The study suggests that the combination of CGM and remote insulin titration software has the power to change the way providers and millions of people with Type 2 diabetes manage their diabetes. And in a post-COVID world, the ability to receive insulin updates at home is important for high-risk patients now more than ever. 

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