Recommendations for Documenting Compliance with Dexcom Continuous Glucose Monitoring System
Documentation of Dexcom CGM compliance should include integration of glucose data into electronic health records with validation of glucose values and summary reports, along with recording of calibration frequency, sensor wear time, and alert settings to ensure optimal clinical outcomes.
Key Documentation Components
Data Integration and Validation
- Continuous glucose monitoring data should be integrated into electronic health records (EHR) with validation of glucose values and comprehensive summary reports to ensure proper documentation of patient compliance 1
- For remote monitoring, documentation should include pairing status with device-specific apps (Dexcom G6 app) and confirmation of follower connections (via Dexcom Follow app) 1
- Comprehensive reports accessed via dashboards (Dexcom CLARITY) should be documented in patient records to monitor multiple patients effectively 1
Metrics to Document
- Average glucose level, percentage of time in hypoglycemia ranges (<54 mg/dL and 54-70 mg/dL), percentage of time in target range (70-180 mg/dL), and percentage of time in hyperglycemia range (>180 mg/dL) should be documented 1
- Calibration frequency should be documented, noting that calibration against a reference standard should be performed no more frequently than every 8 hours and preferably no more than twice per 24 hours 1
- Documentation should confirm that the CGM continuously measured glucose and displayed data in real-time >95% of the time for the duration specified in the product label 1
Alert Settings and Responses
- Documentation should include settings for real-time alerts and alarms for hypoglycemia, hyperglycemia, and rapid rates of change 1
- Records should confirm that visual and audible alerts were properly configured at the bedside for appropriate clinical response 1
- For patients using the Urgent Low Soon alert feature, documentation should confirm whether this feature was enabled, as it's associated with reduced hypoglycemia regardless of screen view frequency 2
Feature Utilization
- Documentation should include which optional features patients are using (alerts for hyperglycemia, existing hypoglycemia, impending hypoglycemia, data sharing, retrospective pattern analysis) as these are associated with improved glycemic outcomes 3
- For patients using remote monitoring capabilities, documentation should confirm that the receiver or smartphone remains within approximately 6 meters of the sensor for Dexcom systems 1
- For intermittently scanned CGM devices, documentation should confirm scanning frequency of at least once every 8 hours to avoid data gaps 4
Implementation Considerations
Technical Documentation
- When implementing Dexcom CGM in clinical settings, documentation should include sensor insertion site (arm or abdomen), as accuracy may vary slightly by placement location 5
- Documentation should note any potential interference from medications that might affect CGM accuracy, including high doses of acetaminophen, salicylic acid, and ascorbic acid 4
- For hospital settings, documentation should confirm that the CGM system maintains point accuracy with 98% of readings within 12.5% of a reference standard 1
Clinical Documentation
- Documentation should include any instances where the CGM withheld data or alerted clinicians when accuracy became questionable 1
- Records should note any skips in data acquisition, which should not exceed 30 minutes at a time 1
- For patients transitioning between care settings, documentation should ensure continuity of CGM data access across third-party payers 1
Pitfalls to Avoid
- Avoid relying solely on estimated HbA1c from CGM data without documenting how this correlates with laboratory HbA1c measurements 1
- Do not document CGM data without noting calibration status, as accuracy depends on proper and timely calibration 1
- Avoid incomplete documentation of alert settings, as proper configuration of alerts is essential for detecting and preventing hypoglycemia and hyperglycemia 1
- Do not fail to document instances where the CGM indicated false readings due to interference from medications or other factors 4
By following these documentation recommendations, healthcare providers can ensure proper compliance with Dexcom CGM systems, leading to improved glycemic control and better patient outcomes.