Predicting Diabetes Damage

Since the first FDA approval of Medtronic’s MiniMed continuous glucose monitoring (CGM) device back in 1999, the use of such devices have become part of the standard care package for patients with both type 1 and insulin-treated type 2 diabetes.

The devices have evolved dramatically since the introduction of the initial system, which recorded a patient's glucose values over a three-day period and then required the healthcare provider to download the gathered data for post hoc analysis.

Current CGM devices feature advanced sensor technology and give clinicians access to real-time patient glucose data over a sustained period of time – for example, the Eversense 365, developed by Senseonics, can be implanted in US patients for up to one year – increasing their ability to predict disease trends and achieving more accurate readings.

In a recent Diabetes Technology & Therapeutics study – which developed a machine learning procedure to add virtual CGM data to existing Diabetes Control and Complications Trial (DCCT) data – researchers from the University of Virginia Center for Diabetes Technology indicate that CGM data could be used to predict a number of complications caused by type 1 diabetes, including damage to the eye.

According to Roy Beck, study author and Executive Director of the Jaeb Center for Health Research, “It has been well known that [glycated hemoglobin] HbA1c levels are a strong predictor of the risk of the development or progression of diabetic retinopathy. Ophthalmologists are familiar with HbA1c. It is important that they [now] become familiar with CGM measures of glucose variability.”

The study findings show that there is strong data to support using CGM data as an important tool for identifying retinopathy risk in diabetic patients, adds Beck. “The findings won’t necessarily inform future treatments, but rather are important to support better management of glucose levels using CGM to prevent the development of retinopathy.”

He goes on to say there should be close collaboration between ophthalmologists and diabetes care providers – whether that be endocrinologists or other primary care providers – to improve patient outcomes. “Optimizing diabetes control is very important for reducing risk of progression of retinopathy, so it is important for diabetes care providers to understand the risk from ophthalmologists.”