Dual Challenges of Diabetic Nephropathy and Atherosclerosis: CGM Facilitates Safe and Efficient Target Achievement

Medical History and Basic Information

Chief Complaint：

A 69-year-old male patient with dry mouth, polydipsia, and polyuria for 8 years, recurrence accompanied by foamy urine for half a year.

Present History:

The patient developed dry mouth, polydipsia, and polyuria 8 years ago without obvious incentives. He had gastrointestinal reactions after treatment with Metformin and discontinued it voluntarily. Recently, he received hypoglycemic treatment with "Glimepiride and Acarbose", but blood glucose control was poor. Half a year ago, the patient's symptoms of dry mouth, polydipsia, and polyuria recurred, accompanied by foamy urine. Urine Protein (+) and Glycated Hemoglobin (HbA1c) 12.3% were detected in another hospital.

Physical Examination:

Height: 165cm, Weight: 64kg, Body Mass Index (BMI): 23.5 kg/m²; Waist Circumference: 83cm, Hip Circumference: 94cm, Waist-Hip Ratio: 0.88; Conscious, no acetone odor in exhalation, mild dehydration sign; Clear breath sounds in both lungs, no dry or moist rales; Heart rate: 72 beats/min, regular rhythm, no murmurs heard in each valve area; Soft abdomen, no tenderness or rebound tenderness in the whole abdomen, no edema in both lower extremities.

Auxiliary Examinations:

Fasting Blood Glucose (FBG): 12.71 mmol/L, Glycated Hemoglobin (HbA1c): 12.3%, Serum Creatinine (Scr): 134.1 μmol/L, Urine Protein (+); Microalbumin/Urine Creatinine Ratio (ACR): 56.5 mg/g; Vascular Color Doppler Ultrasound: Carotid and Lower Extremity Arteriosclerosis with Plaque Formation.

Admission Diagnosis:

1. Type 2 Diabetes Mellitus(T2DM) with Peripheral Circulation Complications, Diabetic Nephropathy (CKD Stage G3a);

2. Renal Insufficiency;

3.Atherosclerosis with Plaque Formation.

Treatment Regimen Based on Continuous Glucose Monitoring (CGM) Interpretation

The patient had a long course of diabetes (8 years) and poor blood glucose control with two oral hypoglycemic drugs. At admission, the blood glucose level was high, accompanied by multiple chronic diabetic complications. After admission, on the basis of lifestyle intervention, short-term intensive insulin therapy was adopted to rapidly lower blood glucose and relieve hyperglycemic toxicity. Meanwhile, CGM was worn to dynamically observe blood glucose changes.

After short-term intensive insulin therapy, the patient's blood glucose decreased significantly. CGM revealed that the patient had the habit of late-night snacks. Diabetes education was conducted for the patient multiple times, and he also realized the importance of diet in blood glucose control and gradually corrected his bad habits. On the basis of diet and exercise combined with short-term intensive insulin therapy, the patient's hyperglycemic toxicity was gradually relieved, and blood glucose tended to be stable. Considering the patient had multiple chronic diabetic complications, the long-term hypoglycemic regimen after discharge needed to be simple and beneficial to the patient's heart and kidneys. The hypoglycemic regimen was adjusted 2 days before discharge until discharge.

After discharge, the patient continued to use the hypoglycemic regimen formulated at discharge on the basis of diet and exercise. The overall blood glucose control was good after discharge, and no hypoglycemia was monitored.

Case Summary

By analyzing glucose data and presenting reports in the form of charts and indicators, CGM can more intuitively reflect the patient's blood glucose variability, stability, exposure level, hyperglycemia, hypoglycemia and other conditions at different time periods. The patient in this case had a long course of diabetes, poor blood glucose control with two oral drugs, and multiple chronic diabetic complications. The treatment of diabetes is inseparable from the "two carriages" of diet and exercise. CGM can improve patients' understanding of blood glucose changes caused by lifestyle modifications such as diet changes and exercise, and help patients develop healthier living habits. After admission, the patient received short-term intensive insulin therapy on the basis of lifestyle intervention, and blood glucose decreased, but the patient's TAR was still high. On the basis of strengthening diabetes health education, the rules of the patient's blood glucose changes were explored, and insulin dosage was adjusted in a timely manner. As a result, the patient's TIR was prolonged, blood glucose gradually stabilized without hypoglycemia, and the patient's blood glucose reached the target safely as early as possible.