From the Guidelines
Yes, a Dexcom continuous glucose monitoring (CGM) system can be used for blood sugar monitoring in a patient with well-controlled diabetes who has multiple comorbidities, including a large pelvic mass and moderate hydronephrosis. The Dexcom CGM provides real-time glucose readings every 5 minutes without requiring multiple fingerstick tests, which is particularly beneficial for patients with complex medical conditions, as seen in this patient with a pelvic mass and hydronephrosis 1. The system involves inserting a small sensor under the skin (typically on the abdomen or upper arm), which measures glucose levels in the interstitial fluid and transmits data to a receiver or smartphone. For a patient with a pelvic mass and hydronephrosis, the CGM offers the advantage of continuous monitoring without additional physical stress from frequent fingersticks. The system can detect trends and patterns in glucose levels, providing alerts for high or low readings, which is valuable for maintaining stable glucose control despite the physiological stress of comorbidities. The patient should still perform occasional fingerstick tests for calibration and verification, especially when symptoms don't match CGM readings or before making treatment decisions, as recommended by the American Diabetes Association standards of medical care in diabetes 1. Regular follow-up with healthcare providers remains essential to adjust diabetes management in the context of their other medical conditions, considering the latest guidelines on diabetes management in chronic kidney disease 1 and hospital settings 1. Key benefits of using a Dexcom CGM in this context include improved glycemic control, reduced risk of hypoglycemia, and enhanced patient safety, aligning with the goals of minimizing morbidity, mortality, and improving quality of life.
From the Research
Patient's Condition and Request
- The patient has multiple comorbidities, including a large pelvic mass and moderate hydronephrosis, and is currently being managed by Nephrology and Urology teams.
- The patient's blood sugar levels are well-controlled, with previous readings of 94 and 103.
- The request is to use a Dexcom continuous glucose monitoring system for blood sugar checks.
Accuracy of Dexcom for Blood Sugar Checks
- A study published in 2022 2 found that the Dexcom G7 continuous glucose monitor provides accurate glucose readings with a mean absolute relative difference (MARD) of 8.2% and 9.1% for arm- and abdomen-placed sensors, respectively.
- Another study published in 2023 3 evaluated the accuracy of Dexcom G6 and Abbott Freestyle Libre 1 glucose monitoring systems in people with diabetes undergoing hemodialysis, and found that the overall MARD for Dexcom G6 was 22.7%.
- A review article published in 2022 4 discussed the usefulness of continuous glucose monitoring devices in managing diabetes, including their ability to detect glycemic variability and improve prognosis in patients with advanced chronic kidney disease.
Clinical Applications and Limitations
- A study published in 2002 5 highlighted the importance of understanding the clinical and technical aspects of continuous glucose monitoring systems, including calibration and quality control, to ensure accurate readings and optimal insulin therapy.
- An article published in 1981 6 described an approach to using patient-determined blood glucose measurements to adjust insulin dosage and achieve glycemic control.
Decision on Using Dexcom for Blood Sugar Checks
- Based on the available evidence, it appears that Dexcom can be a useful tool for blood sugar checks, especially in patients with well-controlled blood sugar levels and multiple comorbidities.
- However, it is essential to consider the specific patient's condition, the accuracy of the Dexcom device, and the potential limitations and clinical implications of using continuous glucose monitoring systems 3, 2, 5.