Welcome to the ATTD 2022 Interactive Program
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Medical and psychological approaches towards enhancing the value of personal CGM in the type 2 population
Abstract
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Real-time continuous glucose monitoring (RT-CGM) has become the standard of care for people with type 1 diabetes (T1D) and it is the rare individual who would not benefit greatly from it. With the advent of hybrid closed loop systems, RT-CGM has taken on an even greater level of importance. However, the use of RT-CGM in people with type 2 diabetes (T2D) remains very limited.Currently, only patients with T2D treated with 3 or more injections a day or insulin pump therapy are able to obtain a CGM that is covered by insurance or Medicare in the United States. However, we believe that every patient with T2D, no matter what their current antidiabetic medication regimen may be, could potentially benefit from RT-CGM. The key will be to provide both HCPs and patients with the necessary guidance, education and support to interpret and respond effectively to RT-CGM data. In this presentation, we will put forward a series of practical strategies designed to promote a more successful introduction to RT-CGM for both HCPs and individuals with type 2 diabetes, and also to enhance ease of use and patient enthusiasm regarding RT-CGM as well as long-term glycemic success.
THE MEANING OF GLUCOSE CONTROL IN DIABETES TODAY: IT`S TIME FOR A PARADIGM SWITCH
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Glycated haemoglobin (HbA1c) is the most used parameter to assess glycaemic control. However, recent evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA1c levels as soon as possible, but to obtain this result by reducing postprandial hyperglycaemia, glycaemic variability and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved avoiding hypoglycaemia and, if this happens, hypoglycaemia should be reverted to normoglycaemia. Modern technology, i.e. intermittently-scanned glucose monitoring and continuous glucose monitoring together with the new available drug therapies (e.g. ultra-fast insulin, SGLT-2i, and GLP-1RAs) may help to change the paradigm of glycaemia management based on HbA1c in favour of a holistic approach considering all the different aspects of this commonly oversimplified pathological feature of diabetes.