How to monitor for Continuous Glucose Monitoring (CGM) use?

From the Guidelines

To monitor for continuous glucose monitoring (CGM) use, check the sensor site daily for redness, irritation, or infection, and ensure the adhesive remains secure, as recommended by the most recent guidelines 1. When using CGM, it is essential to calibrate the device according to manufacturer instructions, typically by performing fingerstick blood glucose tests at recommended intervals. Reviewing glucose data regularly is crucial, paying attention to trends, patterns, and time spent in target range (typically 70-180 mg/dL), as well as setting appropriate alerts for high and low glucose levels based on healthcare provider's recommendations 1. Replacing sensors according to the manufacturer's timeline (usually every 7-14 days) and transmitters as indicated (typically every 3 months to a year) is also vital. Additionally, keeping backup supplies, including extra sensors, transmitters, and batteries, and maintaining regular communication with the healthcare team, sharing CGM data to guide treatment decisions, is necessary for effective CGM use 1. Key metrics to follow include average glucose level, percentage of time in hypoglycemia ranges, percentage of time in the target range, and percentage of time in the hyperglycemia range, as outlined in the guidelines 1. Overall, CGM monitoring provides real-time glucose readings and trends, allowing for prompt intervention to prevent severe hypo- or hyperglycemia, and helps in making informed decisions about medication, diet, and activity to improve overall diabetes management. Some important considerations when using CGM include:

• Being aware of medications and other factors that can interfere with glucose meter accuracy, such as high-dose vitamin C and hypoxemia 1
• Using only U.S. Food and Drug Administration–approved meters with unexpired strips, purchased from a pharmacy or licensed distributor 1
• Receiving ongoing instruction and regular evaluation of technique, results, and ability to use data from self-monitoring of blood glucose to adjust therapy 1

From the Research

Monitoring for CGM Use

To monitor for CGM use, several key points should be considered:

• CGM Devices: CGM devices are available in various forms, including professional (retrospective), personal (real-time), and sensor-integrated pumps 2.
• Outcomes: Outpatient CGM outcomes focus on hemoglobin A1c (A1C), hypoglycemia, and quality of life 2.
• Accuracy and Detection: Issues affecting accuracy and detection of glycemic variability are crucial for optimal CGM use 2.
• Strategies for Optimal Use: Strategies for optimal CGM use include appropriate patient education and consideration of cybersecurity 2.

Clinical Trials and CGM Use

In clinical trials, CGM use has been shown to:

• Improve Glycemic Control: CGM can lead to improved glycemic control in patients with type 2 diabetes 3, 4.
• Reduce Hypoglycemia: CGM can reduce hypoglycemia, particularly in patients using higher hypoglycemic risk therapies 3.
• Enhance Glucose Metrics: CGM-derived metrics can provide additional information on glucose control, including time in range, glucose variability, and hypoglycemia 5.

Disparities in CGM Use

Disparities in CGM use exist, particularly in:

• Racially and Ethnically Diverse Populations: Lower socioeconomic populations and racially and ethnically diverse populations may experience underutilization of CGM 6.
• Factors Contributing to Disparities: Factors contributing to these disparities include access to healthcare, education, and socioeconomic status 6.

Recommendations for CGM Use

Recommendations for CGM use in clinical trials include:

• Standardized Reporting Formats: Standardized reporting formats for CGM-derived metrics can enhance interpretability and encourage use 5.
• Specific Glucose Metrics: Specific glucose metrics, such as time in range and glucose variability, should be evaluated in clinical trials 5.