We report the case of a woman with T2DM who presented hemolytic anemia (HA). The treatment with corticosteroids led to a great variability of her BG, as well as difficulty to manage her BG and falsely low A1c. A FGM was installed to allow better evaluation of her glucose profile.
HA treatment was made with Prednisone and a pulse of 3 days of Methylprednisolone. Her BG had great variations and her A1c was falsely low. We put a FGM system to evaluate the behaviour of glucose levels in her hospitalization and compared them with the BG results.
Her A1c was 4.5%, but considering HA, it was considered unreal. After 3 days with the FGM, she had an estimated A1c of 9.6% (mean glucose of 229mg/dl) and time in-range (TIR) of 37%, while the mean BG was of 253mg/dl in the same period. After 3 days of insulin management, she had an estimated A1c of 7.5% (mean glucose of 163mg/dl) and TIR of 64%, with the mean of BG of 151mg/dl.
The case is the first one we know in which the hemoglobinopathy was acquired and treated with corticosteroids hindering T2DM management. It is one of the few cases in which the FGM was used in hospitalar environment for optimal diabetes management. The FGM is little studied in intra-hospitalar environments, but, the success of our case suggests that further studies should be conducted in order to evaluate the feasibility of this tool to help the management of challenging cases, not only outside, but even inside the hospital.