Using Stella CGM in Diabetes Management
Continuous glucose monitoring (CGM) is primarily recommended for patients with type 1 diabetes and those with type 2 diabetes on intensive insulin therapy or who experience dramatic glycemic variability, as it provides real-time insights into glucose patterns that can significantly improve glycemic control and reduce hypoglycemia risk. 1
Primary Indications for CGM Use
Type 1 Diabetes
- All adults with type 1 diabetes who are capable of using CGM daily 1
- Children and adolescents with type 1 diabetes, especially those with:
- HbA1c <7% (to maintain good control without increasing hypoglycemia risk)
- HbA1c ≥7% who can use the device daily 1
Type 2 Diabetes
- Patients requiring intensive insulin therapy (≥3 daily injections or insulin pump) 1
- Patients with specific challenges despite standard monitoring:
- Unexplained severe or recurrent hypoglycemia
- Asymptomatic or nocturnal hypoglycemia
- Unexplained hyperglycemia (especially fasting)
- Significant glycemic variability
- Fear of hypoglycemia leading to intentionally high glucose levels
- HbA1c above target despite multiple medications 1
Special Populations
- Gestational diabetes and pregnant women with diabetes 1
- Hospitalized patients on insulin therapy in non-ICU settings 1
- Perioperative glycemic control in type 2 diabetes 1
- Patients with gastroparesis or other conditions causing dramatic glycemic variability 1
Clinical Benefits of CGM
CGM offers several advantages over traditional self-monitoring of blood glucose (SMBG):
- Provides continuous data on glucose trends and patterns 2
- Reduces hypoglycemia frequency and severity 3
- Decreases glycemic variability 2
- Improves HbA1c levels (approximately 0.3% reduction) 1
- Offers immediate feedback on glucose trends for informed decisions about food and insulin 3
- Enables early detection of impending hypo/hyperglycemia through alerts and alarms 1
- Facilitates identification of previously undetected nocturnal hypoglycemia 3
Practical Implementation of CGM
Device Selection and Setup
- Choose between real-time CGM (continuous data transmission with alarms) or intermittently-scanned CGM (requires scanning for readings) based on patient needs 1
- Ensure proper sensor placement (typically on the back of upper arm) 3
- For systems requiring calibration, use the same glucose meter and test strip batch 1
- Enter calibration values immediately after obtaining readings 1
Patient Education Requirements
- Proper sensor insertion and maintenance
- Interpretation of glucose data, trends, and patterns
- Response to alerts and alarms
- Recording of diet, exercise, medication, and other events during monitoring 1
- Understanding the lag time between interstitial and blood glucose levels
Data Interpretation and Use
- Review key metrics:
- Time in range (percentage within target glucose range)
- Time below range (hypoglycemia exposure)
- Glycemic variability measures 3
- Schedule follow-up within 2-4 weeks of starting CGM to review data and adjust therapy 3
- Use CGM data to guide adjustments to:
- Insulin dosing (particularly prandial insulin)
- Meal planning and carbohydrate intake
- Exercise timing and intensity
- Hypoglycemia prevention strategies 1
Important Considerations and Limitations
- CGM measures interstitial fluid glucose, which lags behind blood glucose by 5-15 minutes 1
- Accuracy may be reduced during:
- Rapid glucose changes
- Exercise
- First and last days of sensor wear 3
- Some medications and substances may interfere with readings:
- High-dose vitamin C
- Salicylic acid
- Some devices affected by acetaminophen 3
- Not recommended for ICU use due to potential inaccuracies with:
- Skin edema (diluted interstitial fluid)
- Vasoconstrictor drugs
- Hypotension or hypoxemia 1
- Patients with chronic kidney disease should use CGM with caution and may need to confirm readings with fingerstick tests 3
Advanced Applications
- Integration with insulin pumps for sensor-augmented therapy 2
- Low-glucose suspend features that automatically stop insulin delivery during hypoglycemia 2
- Hybrid closed-loop systems that adjust insulin delivery based on CGM readings 2
- Data sharing capabilities for remote monitoring by healthcare providers or family members 4
CGM technology represents a significant advancement in diabetes management by providing comprehensive glucose data that enables more informed decision-making, reduces complications, and improves quality of life for people with diabetes.