Vol. 6, Issue 4 (2020)
Glycemic impact on wound healing with basal bolus therapy versus Premix Insulin therapy – documented with FGM
Author(s): Riyaz Mohammed, Dilip Kumar Kandar
Abstract: Aim: To assess the impact of strict glycemic control on Wound healing in established type 2 diabetes mellitus patients using various combinations of Insulin. The glycemic control was assessed by Flash Glucose monitoring. Material and Method: Inclusion criteria: know Diabetic Type 2 with wound (Grade 1 to 2), Exclusion criteria: Type 1 DM, Cardiac failure, hepatic failure, renal failure. In the present study continuous glucose monitoring was done for 54 diabetic patients who presented with wound. The patients were put on Basal Bolus therapy plus Metformin 2gm/per day in Group 1 and in Group 2, patients were placed on Premix Insulin plus Metformin 2gm/per day. The response to glucose levels and healing was observed for a period of 15 days. Results: In the present study it was observed that the mean overall glucose in group I was observed to be 155.3± 40.9 which was significantly lower than when compared to group II 237.7 ± 66.3 p <0.05. estimated Hba1c was observed to be 7.05 ± 1.4 which was significantly better than when compared to group II 9.9 ± 2.3 p <0.05. Presence of variability was correlated with estimated hba1c, it was seen that patients who had shown variability in glucose levels had higher hba1c levels r= 0.405, p <0.05. In group I patients Low glucose levels and variability was correlated with targets observed in continuous glucose monitoring. It was seen that patients who had shown low glucose levels had significant positive correlation with percentage of times glucose level below the target p <0.05. in patients who has shown minimal variability in glucose levels had higher percentage of times their glucose levels within target (r=0.652, p =0.012), in patients who had shown a higher variability in glucose levels had higher percentage of times their glucose levels above target (r= -0.589, p = 0.024). Linear regression analysis was done to assess the prediction of good wound healing in relation to average glucose levels above the target. it was seen that the overall average daily glucose goes down by 41.24 it would predict good wound healing with an odds of 1.11 times. Conclusion: In our study it shows that offering the FGM technology to patients with type 2 diabetes mellitus with wound helps in identify the glycemic surges and peak glycemic levels, which can be promptly tackled with adjustment of insulin dosage eventually leading to strict and good glycemic control which can help in good wound healing and rapid recovery of patients. It has shown in our study that patient on Basal bolus therapy group of patients had better wound healing than the other group. The compliance was better in group 1 than compared to group 2. The risk of hypoglycaemia was seen in both the arm groups. In India as the cost of management plays an important role, it is pivotal to follow strict measures to get glycemic level under control or else it may lead to severe infection of wound and eventually may lead to amputation. Our study has confirmed that if strict glycemic levels are maintained it can get good results.