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Clinical Diabetes 26:134-137, 2008
DOI: 10.2337/diaclin.26.3.134
© 2008 by the American Diabetes Association
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Case Study

Leveraging Continuous Glucose Monitoring in the Clinical Management of Adjunctive Pramlintide Therapy

Jeffrey S. Freeman, DO, FACOI, David M. Capuzzi, MD, PhD and Karen Rockwell, MSN, CDE

The first 300 words of the full text of this article appear below.


   PRESENTATION
 
D.B. is a 51-year-old African-American woman referred for an evaluation of type 2 diabetes. She has been on several oral agents and insulin without achieving her blood glucose or hemoglobin A1c (A1C) targets. She was diagnosed with type 2 diabetes by her primary care provider during a routine examination 20 years ago. Her random glucose at that time was ~ 300 mg/dl. Her medical history also includes obesity, degenerative arthritis, hypertension, sleep apnea, hyperlipidemia, and two Cesarian section births. She denies a history of gestational diabetes, alcohol consumption, or cigarette smoking. Her medications include metformin/glyburide, 500 mg/5 mg three times daily; rosiglitazone, 8 mg daily; 60 units of 70/30 premixed insulin before dinner; hydochlorothiazide, 50 mg daily; quinapril, 20 mg daily; fenofibrate, 54 mg daily; and multiple vitamins.

Initial clinical examination reveals a blood pressure of 130/82 mmHg and a BMI of 46.7 kg/m2. Her cardiac, respiratory, and abdomenal examinations are unremarkable; funduscopic examination reveals no evidence of retinopathy. Her lower extremity examination reveals no evidence of ulcerations. There is adequate peripheral pain sense.

The patient reports self-monitoring of blood glucose (SMBG) before and after breakfast, with readings averaging in the 100-mg/dl range before the meal and 300 mg/dl after the meal. Her A1C is 9.0%. D.B. expresses motivation to intensify her pharmacological therapy regimen and to follow a meal plan and attend diabetes education classes, all of which she hopes will improve her diabetes control.


   QUESTIONS
 

  1. What are the shortcomings of intensive insulin therapy and possible consequences uniquely associated with uncontrolled postprandial hyperglycemic excursions?
  2. What has the introduction of home continuous glucose monitoring (CGM) revealed about the dynamics and limitations of A1C as a measure of glycemic control?
  3. What role does amylin play in regulating glucose homeostasis, and what are the clinical effects of using pramlintide, a synthetic analog of . . . [Full Text of this Article]


   COMMENTARY
 

   CLINICAL PEARLS
 

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Copyright © 2008 by the American Diabetes Association.