IDENTIFICATION OF NOCTURNAL HYPOGLYCEMIA BY FLASH GLUCOSE MONITORING IN PRIMARY CARE: A CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Objective: To explore the clinical value of flash glucose monitoring (FGM) in community-based diabetes management through analysis of a case of nocturnal hypoglycemia identified by FGM. Methods: A retrospective analysis was conducted on the clinical data of a 74-year-old male patient with type 2 diabetes mellitus. Because of persistently elevated fasting blood glucose levels (7.0-9.0 mmol/L), the patient had been self-adjusting multiple oral hypoglycemic agents over a prolonged period, including acarbose, sitagliptin phosphate, glipizide controlled-release tablets, dapagliflozin, and pioglitazone/metformin. FGM revealed nocturnal hypoglycemia, confirming the presence of the Somogyi phenomenon. Assessment using the Chinese version of the Diabetes Management Self-Efficacy Scale (C-DMSES) indicated low self-efficacy. Results: Based on the FGM findings, the glucose-lowering regimen was adjusted by discontinuing glipizide controlled-release tablets and pioglitazone/metformin. Individualized dietary and exercise prescriptions, smoking cessation counseling, and psychological support were also provided. After intervention, the antidiabetic regimen was simplified, and no hypoglycemic events were detected on follow-up FGM. At 3 months, fasting blood glucose was 6.8 mmol/L, 2-hour postprandial blood glucose was 9.4 mmol/L, and glycated hemoglobin (HbA1c) was 6.9%. In addition, the C-DMSES score improved significantly. Conclusion: FGM can effectively identify unrecognized nocturnal hypoglycemia in community-dwelling patients with diabetes and provide an objective basis for individualized and precise comprehensive management. For patients receiving multiple glucose-lowering agents and demonstrating low self-efficacy, FGM combined with a general practitioner-specialist collaborative care model may facilitate safe achievement of glycemic targets.