How should I use Dexcom (Continuous Glucose Monitoring System) documents to adjust my treatment plan and manage hyperglycemia?

Using Dexcom Continuous Glucose Monitoring Data to Manage Hyperglycemia

Dexcom continuous glucose monitoring (CGM) data should be systematically analyzed to identify glucose patterns, set achievable goals, and make targeted adjustments to your treatment plan for effective hyperglycemia management. 1

Understanding Dexcom CGM Data Analysis

• Dexcom CGM provides real-time glucose readings, trends, and pattern tracking to help detect episodes of hypoglycemia and hyperglycemia, enabling immediate and appropriate responses to mitigate acute glycemic events 2, 1
• The Ambulatory Glucose Profile (AGP) report is essential for creating a standardized visualization of your glucose data, showing Time in Range (TIR), Time Above Range (TAR), and Time Below Range (TBR) metrics 2
• For optimal benefit, wear your Dexcom sensor consistently with minimal interruptions, changing sensors every 10 days for the G6 or G7 models to maintain accuracy 3, 4

Step-by-Step Approach to Using Dexcom Data

1. Assess Data Quality and Sufficiency

• Ensure at least 70% of possible CGM data is available (minimum 14 days) for meaningful pattern analysis 2
• Check that sensor is properly calibrated if using older models (newer G6/G7 models are factory-calibrated) 1, 3

2. Identify Hypoglycemia Patterns (Priority)

• Review the AGP report to identify times of day when low glucose events (<70 mg/dL) are occurring 2
• Use Dexcom alerts for hypoglycemia prevention - studies show these features are associated with more favorable glycemic outcomes 5

3. Analyze Hyperglycemia Patterns

• Examine periods of high glucose (>180 mg/dL), noting the timing, duration, and potential triggers 2, 1
• Look for post-meal spikes and overnight trends that may require treatment adjustments 1

4. Set SMART Goals for Improvement

• Set Specific, Measurable, Achievable, Relevant, and Time-bound goals based on your CGM data 2
• Focus on small, achievable improvements in Time in Range rather than attempting dramatic changes 2

Making Treatment Adjustments Based on Dexcom Data

For Insulin Users

• Adjust basal insulin doses based on overnight and fasting glucose patterns - if consistently high, consider increasing evening basal dose 6
• Modify mealtime insulin based on post-meal glucose trends, considering pre-meal glucose levels and anticipated carbohydrate intake 6
• Use Dexcom trend arrows to make proactive insulin corrections - upward arrows may require additional correction insulin 1

For All Treatment Regimens

• Identify the impact of specific foods on glucose levels by reviewing post-meal glucose patterns 1
• Assess the effect of physical activity on glucose levels - note that CGM accuracy may decrease during exercise, typically overestimating glucose by approximately 14-20 mg/dL 7
• Evaluate medication timing effectiveness by analyzing glucose patterns before and after medication administration 2

Utilizing Advanced Dexcom Features

• Enable real-time alerts for high and low glucose levels - users who utilize more alert features show better Time in Range outcomes 5
• Use the Share feature to allow caregivers or healthcare providers to remotely monitor your glucose levels 1, 5
• Engage with the CLARITY software for retrospective pattern analysis - more extensive engagement is associated with higher Time in Range 5
• Consider using the virtual assistant feature for hands-free glucose checks, as frequent use is associated with higher Time in Range and lower mean glucose values 5

Common Pitfalls to Avoid

• Don't rely solely on A1C for diabetes management - CGM metrics like Time in Range provide more actionable information about day-to-day glucose control 2, 1
• Avoid extending sensor wear beyond the recommended 10-day period, as this may lead to decreased accuracy of glucose readings 3
• Be aware that certain medications (high doses of acetaminophen >4g/day, salicylic acid, ascorbic acid) and conditions (hypoxemia, severe dehydration) can affect CGM accuracy 2, 1
• Don't ignore the impact of physiological factors like stress, illness, or hormonal changes on glucose patterns 6

Special Considerations

• For patients on dialysis, CGM can help detect asymptomatic glucose excursions related to dialysis treatments 2
• During pregnancy, CGM can be particularly valuable with specific target ranges (63-140 mg/dL) recommended for this population 2
• For exercise management, be aware that CGM accuracy decreases during moderate aerobic exercise, typically overestimating capillary glucose 7
• When using CGM data to make treatment decisions, consider that sensitivity for detecting hypoglycemia (85.7%) is lower than for hyperglycemia (97.45%) 8