The Impact of remote Continuous glucose monitoring and Insulin management performed by resident physicians under the supervision of endocrinologists on serum HbA1c

In our article, we describe what we believe to be the first prospective trial in the USA evaluating the impact of continuous glucose monitoring (CGM) and insulin management performed by resident physicians under the supervision of an endocrinologist on serum HbA1c. We have previously published our experience with a retrospective, cohort observational study, and now we aim to validate our concept through a prospective trial. The study aims to demonstrate that, with appropriate education and supervision by an endocrinologist, internal medicine residents in both specialized endocrinology and general internal medicine clinics can effectively interpret CGM data and improve patients' HbA1c levels by adjusting their treatment. We plan to recruit patients with Type 1 and Type 2 diabetes who are using 3-4 insulin injections per day, possibly combined with other antidiabetic medications, and who self-monitor their blood glucose (SMBG) at least four times daily. These patients typically have poor glycemic control, with HbA1c levels ranging from 7.5% to over 14%. The goal is to show that switching from SMBG to CGM, with residents monitoring and adjusting insulin doses, leads to improvements in HbA1c, time in range (TIR), hypoglycemia frequency, average blood glucose levels, hyperglycemia, and patient satisfaction with the CGM device. Ultimately, we aim to demonstrate that CGM can be safely integrated as a management tool in general internal medicine residency clinics across the USA, incorporated into the internal medicine residency curriculum, and help improve diabetes care and education for internal medicine residents.