Continuous Glucose Monitoring
|
|
- Berenice Rose
- 6 years ago
- Views:
Transcription
1 Continuous Glucose Monitoring
2 What is Continuous Glucose Monitoring? Blood glucose meters measure glucose in your blood and glucose sensors measure glucose levels in the fluid around the cells They are not exactly the same numbers and that s normal Traditional blood glucose monitoring with a meter looks at only one point in time
3 The meter doesn t tell you where you ve really been or where you are going CGMs help understand glucose trends, rate and direction of change The results will give you information about what your blood sugar is doing at times when you don t normally check You will learn how diet, exercise, medication and your lifestyle are affecting your blood sugars
4 CGMS measures subcutaneous interstitial glucose levels CGMS continuously records on an average of every 5 minutes This technology will be crucial in developing a closed loop system The wearer can either see in real time BG values or use retrospective data to download for analysis
5 400 Typical Daily Patient Log Glucose (mg/dl) Target Range Glucose Measurement :00 a.m. Breakfast Lunch Dinner Bedtime
6
7 CGM Measures Interstitial Glucose CGM devices measure interstitial glucose Interstitial glucose is related to blood glucose, but not exactly the same CGM glucose values typically lag behind BG values The lag time is related to the physiologic delay of the glucose transfer between blood and interstitial compartments Interstitial fluid G G G G G G Blood Vessel
8 2 Main Categories of CGM* Professional CGM ipro2 Owned by clinicians, offices, hospitals Episodic, intermittent use (3 days) Blinded or masked evaluation Retrospective review by providers Minimal training and set-up time Personal CGM Revel, Dexcom, Guardian Owned by patients On-going use by patients Displays glucose values and alarms that allow for immediate therapeutic adjustments Continuous review of data by patients Requires patient education * AACE CGM Task Force. Statement by the American Association of Clinical Endocrinologists Consensus Panel on Continuous Glucose Monitoring. Endocrine Practice. 2010; 16(5):
9 CGM Category Names & Definitions Professional CGM Personal CGM Ownership Length of wear Display of glucose data Healthcare professionals, clinics, hospitals 3 5 days per evaluation; Episodic, intermittent use Blinded or masked data to allow for unbiased assessment of glucose control Typically owned by patients On-going use by patients Continuously displays glucose values and provides alarms that allow for immediate therapeutic adjustments Data analysis Retrospective review by providers Real-time review by patients Patient Training Minimal training and set-up time Requires education on glucose level targets and alarm thresholds
10 Personal CGM has 4 components Glucose Sensor: Inserted into subcutaneous tissue Transmitter: Connects to sensor Insulin Pump: Records and displays glucose data Software: Personal and Pro Organizes data into reports used for glucose evaluation Personal CGM System Components
11 See More Excursions with Professional CGM Kaufman Study* 47 pediatrics (A1C > 8.0%), intensive insulin therapy 3-day CGM evaluation + SMBG Number of Glucose Excursions Identified 191 Compared highs and lows identified with CGM and SMBG Overall Night-time CGM SMBG CGM revealed up to 7x more night-time excursions than SMBG * Kaufman F, Gibson L, et. al. A Pilot Study of the Continuous Glucose Monitoring System. Diabetes Care. 2001; 24(12): Adapted from Kaufman study.
12 See More Hypoglycemia with Professional CGM Munshi Study* 40 Elderly patients mean age = 75 70% had type 2 diabetes Avg. A1C = 9.3% Patients Who Experienced Hypoglycemia (as detected by CGM) 65% 48% Patient distribution by therapy: 30% Insulin only = 35% Insulin + Orals = 38% Orals = 8% Below 70 mg/dl Below 60 mg/dl Below 50 mg/dl 3-day ipro evaluation + SMBG 93% of hypoglycemic episodes were unrecognized by SMBG or symptoms *Munshi M, Segal A, et. al. Frequent Hypoglycemia Among Elderly Patients with Poor Glycemic Control. Arch Intern Med. 2011; 171(4): Adapted from Munshi study.
13 See More Post-Meal Highs with Professional CGM Boland Study* 56 type 1 children with satisfactory A1C 2 and pre-meal glucose near target range 3-day CGM evaluation + SMBG % of Peak Post-Meal Glucose Over Target Range 3 > 300 mg/dl mg/dl Evaluated peak post-meal glucose levels mg/dl 0 Breakfast Lunch Dinner CGM revealed that 90% of peak post-meal glucose was above target range 3 (~50% were > 300 mg/dl) * Boland E, Brandt C, et. al. Limitations of Conventional Methods of Self-Monitoring of Blood Glucose. Diabetes Care. 2001; 24(11): ) Average A1C of 7.7% ± 1.4%. 3) Post-meal target range of < 180 mg/dl. Adapted from Boland study.
14 See More Data To Help Reduce Risk of Macrosomia Murphy Study* 71 pregnant women with T1 or T2 Two Arms: CGMS and Control Lower A1C in third trimester with CGM Reduced risk of macrosomia with CGM The use of supplementary CGM as an educational tool during pregnancy is associated with improved glycemic control and reduced risk of macrosomia. * Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler D, Campbell PJ, Temple RC. Effectiveness of Continuous Glucose Monitoring in Pregnant Women with Diabetes: Randomized Clinical Trial. BMJ. 2008;337: a1680 Adapted from Murphy study.
15 Star 3 Clinical Trial-provides evidence to support the use of CGMS-multicenter, Type 1 ages times greater reduction in A1C No increase in severe hypoglycemia More usage-better control Early and sustained results
16 AACE Reviews Clinical Evidence on CGM Professional CGM Can identify undetected hyperglycemia in pregnant women Professional CGM identified minutes/day of undetected hyperglycemia in studies 1,2,3 Effective in improving maternal glycemic control, infant birth weight, and macrosomia risk in women with type 1 or type 2 diabetes 4,5 Personal CGM Can reduce A1C in adult and pediatric patients with type 1 diabetes and A1C > 7.0%, without increasing hypoglycemia in adult and pediatric patients 6,7 In adults and adolescents, more consistent use predicts successful A1C reductions 7 Can reduce hypoglycemia in well-controlled adult and youth patients (A1C<7.0%) with type 1 diabetes, without increasing A1C 8 1 Jovanovic L. The role of continuous glucose monitoring in gestational diabetes mellitus. Diabetes Technol Ther. 2000;2(Suppl 1):S67-S71. 2 Yogev Y, Chen R, Ben-Haroush A, Phillip M, Jovanovic L, Hod M. Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus. Obstet Gynecol. 2003;101: Chen R, Yogev Y, Ben-Haroush A, Jovanovic L, Hod M, Phillip M. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2003;14: Murphy HR, Rayman G, Duffield K, et al. Changes in the glycemic profilies of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care. 2007;30: Murphy HR, Rayman G, Lewis K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes:randomised clinical trial. BMJ. 2008;337:a Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Ramborlane WV, Beck RW, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359: Chase HP, Beck RW, Xing D, et al. Continuous glucose monitoring in youth with type 1 diabetes: 23-month follow-up of the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. Diabetes Technol Ther. 2010;12: Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care. 2009;32:
17 AACE Consensus Statement on CGM 2010 AACE supports broad range of ideal candidates for Professional CGM* Professional CGM Patient selection and usage: Patients with type 1 or type 2 diabetes who: are not at their A1C target. have recurrent hypoglycemia or hypo unawareness. All pregnant women with type 1 diabetes. CGM may also facilitate treatment adherence for women with type 2 diabetes or insulin-requiring gestational diabetes. Intermittent use may be useful for youth with type 1 diabetes who are changing their diabetes regimen or are experiencing nocturnal hypo, dawn phenomenon, hypo unawareness, or post-prandial hyperglycemia. Recommended to use Professional CGM on an episodic basis. * AACE CGM Task Force. Statement by the American Association of Clinical Endocrinologists Consensus Panel on Continuous Glucose Monitoring. Endocrine Practice. 2010; 16(5):
18 ADA 2010 Standards in Glucose Monitoring Three primary techniques to evaluate control- SMBG, A1C,CGM CGM in conjunction with intensive managment can be a useful tool to lower A1C in Adults w/type 1 Ongoing use may also be helpful in children, teens and younger adults CGM maybe a supplemental tool for SMBG CGM may also be beneficial to maintain glycemic control
19 Success in lowering A1C correlates to an individual s ongoing use of CGM
20 Ideal Candidates for CGM Professional CGM Patient selection and usage: Patients with type 1 or type 2 diabetes who: are not at their A1C target. have recurrent hypoglycemia or hypo unawareness. All pregnant women with type 1 diabetes. CGM may also facilitate treatment adherence for women with type 2 diabetes or insulin-requiring gestational diabetes. Intermittent use may be useful for youth with type 1 diabetes who are changing their diabetes regimen or are experiencing nocturnal hypo, dawn phenomenon, hypo unawareness, or post-prandial hyperglycemia. Recommended to use Professional CGM on an episodic basis.
21 Ideal Candidates for CGM Personal CGM Patients with type 1 diabetes with: Hypoglycemia unawareness or frequent hypoglycemia. A1C above target or with excess glucose variability. Requires lowering A1C without increased hypoglycemia. During preconception and pregnancy. Children and adolescents who have met A1C targets (<7.0%) and who may be highly motivated. Youth with A1C levels 7.0% and are able to use the device on a near-daily basis. The following might be good candidates and a trial period of 2-4 weeks is recommended: Youth who frequently monitor their blood glucose levels. Committed families of young children (younger than 8 years) especially if the patient is having problems with hypoglycemia.
22 Other candidates Blood glucose variability Gastroparesis Insulin-requiring diabetes with or without a pump Behavior modification Type 2 patients on intensive insulin therapy Patients desiring more time in target range Intermittent CGM with Type 2 DM
23 Insurance Coverage CMS Medicare Part B Coverage in Washington, Idaho, Oregon( CPT codes & 95251) Blue Cross of Washington/Idaho Blue Shield Medicaid Aetna/US Healthcare United Healthcare Tri West BCBS of Minnesota/Idaho
24 Ameriben Solutions BCBS of Illinois/Washington Cigna Healthcare All cover for different criteria, Types of Diabetes, sensing allowed per year Check each individual plan
25 Part 2
26 Expectations Tracking and trending/pattern management Immediate feedback on diet, exercise and medication Reducing hypo/hyperglycemia Help in understanding A1c, glucose variability Increase time in target range Assessing magnitude of glucose excursions
27 Expectations Ongoing use in reductions of A1C CGM supports proactive rather than reactive management Can empower patients to optimize control and improve well being
28 What Not To Expect From CGM Not a technology that can be used to dose insulin CGM can be used as an adjunct to glucose meter NOT a replacement for a glucose monitor Not a device to put on and forget about Not a system that replaces or substitutes for existing diabetes management tools It does not think for the patient!
29 Remember All CGMS must be calibrated using SMBG and all treatment decisions are based on the meter BG not the CGM BG due to lag time CGMS can be useful in improving glucose control CGMS is a trending device not a treatment device
30 Patient Teaching Points
31 Patient Training patpatei Patient success includes: Practice using CGM Experience learning how to react to CGM feedback (highs, lows) Continuing education Follow-up Addressing questions Providing practical solutions Encouragement Success comes with time & experience
32 Greater Differences In BG & PSG Expect greater differences in BG & SG when glucose is changing rapidly, such as: After a meal, giving an insulin bolus or exercising or When up or down arrows are showing on the pump Teach patients to focus: Less on the actual sensor glucose number and More on the glucose trend (direction / speed of glucose change)
33 Balance the frequency of alerts and a patient s tolerance for alerts with the value of the information they receive Choose alerts that benefit patient s control Individualize each alert setting to match patient needs Utilize software reports and patient feedback to help with decisions on adjusting CGM settings Start adjustments within a few days of initialization
34 BG and SG Rarely Match Exactly BG & SG are not expected to match, but Typically the readings are reasonably close (15% to 20% variance) The disparity of 15% to 20% is larger in higher readings: BG = 250 mg/dl (Range difference: 300 mg/dl to 200 mg/dl) BG = 65 mg/dl (Range difference: 52 mg/dl to 86 mg/dl)
35 Calibrations are Required for CGM to Work What is a calibration? Adjusting a measurement to match an industry reference or standard Industry reference for measuring glucose: BG Meters YSI (Yellow Springs Instrument) How is CGM calibration done? 1 st patient checks BG using glucose meter Next, BG is entered into pump or receiver (manually or wirelessly) Patient determines if BG reading should be used for calibration
36 CGM is An Adjunctive Therapy to BG Readings Teach patients to always use a BG reading when: Determining any treatment decision Insulin bolus amount Treatment of low glucose
37 Strategies for Success at Initialization It is difficult to anticipate how an individual will react in response to alerts until they are actually experiencing them. Therefore, it is usually best to minimize alerts at first: Allowing patients to become familiar with CGM, glucose trends and how insulin, food and exercise affect glucose Easing the patient into the CGM experience. This seems to increase patient understanding, success and adoption of therapy Set alert ranges wide at first Concept: Alert patients only when action is needed As patient s knowledge and ability to interpret graphs increases: Tighten alert ranges to allow patient to obtain full benefit of CGM Turn additional alerts ON (one at a time) as needed Timely follow-up in evaluating and adjusting alert settings is key. 37
38 Anticipating and Alleviating Patient Concerns
39 # 1 Patient Concern SG Does Not Match BG Possible questions to ask Are calibrations done at right times? Are 2 down arrows showing when they calibrate? Calibrating 3 to 4 times / day? Calibrating on rise or fall? Calibrating too frequently? Are BG meter readings done correctly? Washing hands? Coding meter properly? Large enough sample? Remind patient: BG readings entered within 15 minutes of a previous reading, will replace the earlier reading
40 # 1 Patient Concern continued Does patient understand SG BG concepts? SG typically lags behind BG Trending of glucose can be more relevant than actual glucose value A 10% to 20% difference is greater in high BG range than in Low range
41 # 2 Patient Concern: Too Many Alerts! Frequent alerts may be due to inappropriate alert settings or too many sensor alert features being used Check to see if alerts are applicable and if ranges are set appropriately Make sure patient is referring to sensor alerts and not pump alerts e.g. low reservoir, low battery alerts Questions to ask Is patient taking action immediately after first alert? Is the length of time before the repeat alert occurs too short? Is the sensor taped correctly? Could the sensor be moving / pulling-out / electrode drying? If sensor pulls out (>2 mm) the transmitter will shut off, and cause a Lost Sensor alert
42
43
44
45
46
47
48
49 Key Take-Aways Leave all alerts OFF, except Low Glucose, at first Turn pertinent alerts on as understanding of CGM increases Allows patient to become aware of glucose fluctuations, trends, patterns Allows patient to observe effects of food, insulin, and exercise Helps prevent information overload Not all alerts and features have to be used! Select which features best meet individual needs Customize settings based on patient feedback & history When first starting a feature - set alert ranges wide Tighten ranges gradually as patient obtains better control Balance benefit of feedback from alerts & live data with frequency of alerts Helps to minimize alerts and alarm fatigue
50 The Future My Sentry(relay CGM info to a hub ) Animas Vibe(pump and CGM combo) Paradigm Veo Symphony tcgm(sensor above skin) Apps for phones Closed Loop system
Diabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond)
Diabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond) 9501366-011 20110401 Objectives Understand the need for insulin pumps and CGMS in managing
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Insulin pump use: ~ 20% - 30% of patients with T1DM < 1% of insulin-treated patients with T2DM 2007 FDA estimates ~375,000 insulin pumps for
More informationCorporate Medical Policy
Corporate Medical Policy Continuous Monitoring of Glucose in the Interstitial Fluid File Name: Origination: Last CAP Review: Next CAP Review: Last Review: continuous_monitoring_of_glucose_in_the_interstitial_fluid
More informationQUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3?
500 1 QUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3? WHAT ADDITIONAL DATA ARE NEEDED? AACE/ACE CGM Consensus Conference:
More informationREPORT INTERPRETATION
REPORT INTERPRETATION: Interpreting ipro Professional Continuous Glucose Monitoring (CGM) Reports and Making Therapy Adjustments TARGET AUDIENCE The audience for this section is physicians, mid-level practitioners,
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Roughly 20% - 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the US FDA estimated
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationDiabetes and Technology. Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE
Diabetes and Technology Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE Disclosure Speaker s Bureau: Janssan Pharmaceuticals Current Technology V-Go by Valeritas Continuous Sensors (personal
More informationContinuous Glucose Monitoring Devices Pharmacy Policy
Line of Business: All Line of Business Effective date: August 16, 2017 Revision date: August 16, 2017 Continuous Glucose Monitoring Devices Pharmacy Policy This policy has been developed through review
More informationContinuous Glucose Monitoring (CGM)
Continuous Glucose Monitoring (CGM) Date of Origin: 02/2001 Last Review Date: 07/26/2017 Effective Date: 07/26/2017 Dates Reviewed: 04/2004, 04/2005, 03/2006, 11/2006, 12/2007, 03/2008, 09/2008, 04/2009,
More informationWhat is a CGM? (Continuous Glucose Monitor) The Bionic Pancreas Is Coming
The Bionic Pancreas Is Coming Montana Diabetes Professional Conference October 23, 2014 H. Peter Chase, MD Professor of Pediatrics University of Colorado Barbara Davis Center Stanford: Bruce Buckingham,
More informationInsulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness
Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness Prepared for: Agency for Healthcare Research and Quality (AHRQ) www.ahrq.gov Outline of Material Introduction
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationClinical Value and Evidence of Continuous Glucose Monitoring
Clinical Value and Evidence of Continuous Glucose Monitoring 9402313-012 Objective To review the clinical value and the recent clinical evidence for Professional and Personal CGM Key Points CGM reveals
More informationState of California Health and Human Services Agency Department of Health Care Services
State of California Health and Human Services Agency Department of Health Care Services JENNIFER KENT Director EDMOND G. BROWN JR Governor DATE: N.L.: 03-0317 Index: Benefits TO: ALL COUNTY CALIFORNIA
More informationCONTINUOUS OR INTERMITTENT GLUCOSE MONITORING IN INTERSTITIAL FLUID
FLUID Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs are dependent
More informationAdvances in Diabetes Care Technologies
Advances in Diabetes Care Technologies 1979 2015 Introduction Roughly 20% to 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the U.S. FDA
More informationReal-Time Continuous Glucose Monitoring: From Application to Evaluation
Real-Time Continuous Glucose Monitoring: From Application to Evaluation Gary Scheiner MS, CDE Owner/Director, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 24 Wynnewood, PA 1996 (877) 735-3648
More informationWelcome to CareLink Pro
Reference Guide Welcome to CareLink Pro This guide was developed to serve as a reference for obtaining patient data and reviewing CareLink Pro reports. Getting Started with CareLink Pro Adding New Patients
More informationContinuous or Intermittent Monitoring of Glucose in Interstitial Fluid. Original Policy Date
MP 1.01.15 Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid Medical Policy Section Durable Medical Equipment Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed
More informationFirst steps for success.
First steps for success. Getting to know continuous glucose monitoring (CGM). The Animas Vibe System is approved for persons age 2 and older. Important Safety Information The Animas Vibe Insulin Pump and
More informationMaking the Most of Continuous Glucose Monitoring
Making the Most of Continuous Glucose Monitoring Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC Wynnewood, PA AADE 2014 Diabetes Educator of the Year gary@integrateddiabetes.com
More informationDescription. Section: Durable Medical Equipment Effective Date: July 15, 2014 Subsection: Original Policy Date: December 7, 2011 Subject:
Last Review Status/Date: June 2014 Page: 1 of 13 Description Tight glucose control in patients with diabetes has been associated with improved outcomes. Several devices are available to measure glucose
More informationReport Reference Guide
Report Reference Guide How to use this guide Each type of CareLink report and its components are described in the following sections. Report data used to generate the sample reports was from sample patient
More informationCurrent Glucometers. Junior s s Glucose Log. All have advantages and disadvantages Answer 2
Diabetes Dilemmas: Using Technology To Solve Clinical Conundrums Stephen E. Gitelman, MD UCSF A teenager with type 1 diabetes for 5 years comes into your office for a follow- up visit. You want to review
More informationContinuous Glucose Monitors for Diabetes Management
Continuous Glucose Monitors for Diabetes Management Ryan Huang, DO PGY II, Sonia Garcia-Jayne, DO PGY II Mandeep Gill, DO PGY I, Justin Leeka, DO, PGY I, Catherine Nguyen OMS IV Family Medicine Residency,
More informationToday s Goals 10/6/2017. New Frontiers in Diabetes Technology. Disclosures
New Frontiers in Diabetes Technology Marie E. McDonnell, MD Director, Brigham and Women's Diabetes Program Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Today s Goals
More informationNext steps for success.
Next steps for success. More tips for using CGM* training course. The Animas Vibe System is approved for persons age 2 and older. *Continuous Glucose Monitoring Important Safety Information The Animas
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid Page 1 of 26 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Continuous or Intermittent Monitoring
More informationContinuous Glucose Monitoring (CGM)
Continuous Glucose Monitoring (CGM) Date of Origin: 02/2001 Last Review Date: 08/22/2018 Effective Date: 08/22/2018 Dates Reviewed: 04/2004, 04/2005, 03/2006, 11/2006, 12/2007, 03/2008, 09/2008, 04/2009,
More information1. Continuous Glucose Monitoring
1. Continuous Glucose Monitoring 1. Physiology of interstitial fluid glucose 2. Comparison of CGM and self-monitored blood glucose (SMBG) data 3. Insulin dosing indication in BGM vs. CGM & the FDA 4. Protection
More informationContinuous Glucose Monitoring System
Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2016 Section: DME Place(s)
More informationClinical Policy Title: Continuous interstitial glucose monitoring (CGM)
Clinical Policy Title: Continuous interstitial glucose monitoring (CGM) Clinical Policy Number: 06.02.03 Effective Date: September 1, 2013 Initial Review Date: April 23, 2013 Most Recent Review Date: June
More informationName of Policy: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid
Name of Policy: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid Policy #: 038 Latest Review Date: December 2016 Category: DME Policy Grade: B Background/Definitions: As a general
More informationContinuous Glucose Monitoring System
Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 4/1/2018 Section: DME Place(s)
More informationContinuous Glucose Monitoring System
Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2017 Section: DME Place(s)
More informationCGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
CGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER Case 1: CGM use during pregnancy 29 yo G1P0000 at 10 5/7 weeks gestation presents to set
More informationRELEASED. Clearing your active insulin
To clear all your settings: 1. Make sure the pump is not connected to your body. 2. Go to the Manage Settings screen. Menu > Utilities > Manage Settings 3. Simultaneously press and hold and until the Manage
More informationIncorporating CGM Into Clinical Decision Making. Etie Moghissi, MD, FACE Clinical Associate Professor, David Geffen School of Medicine UCLA
Incorporating CGM Into Clinical Decision Making Etie Moghissi, MD, FACE Clinical Associate Professor, David Geffen School of Medicine UCLA 1 Limitations of Current Glucose Monitoring Methods A1c Standard
More informationClinical Policy Title: Continuous interstitial glucose monitoring (CGM)
Clinical Policy Title: Continuous interstitial glucose monitoring (CGM) Clinical Policy Number: 06.02.03 Effective Date: September 1, 2013 Initial Review Date: April 23, 2013 Most Recent Review Date: April
More informationContinuous Glucose Monitoring
Continuous Glucose Monitoring Information about fully-subsidised continuous glucose monitoring for children and young people with type 1 diabetes Continuous glucose monitoring (CGM) can help in managing
More informationReport Reference Guide. THERAPY MANAGEMENT SOFTWARE FOR DIABETES CareLink Report Reference Guide 1
Report Reference Guide THERAPY MANAGEMENT SOFTWARE FOR DIABETES CareLink Report Reference Guide 1 How to use this guide Each type of CareLink report and its components are described in the following sections.
More informationControl of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim
Control of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine Conflict of interest
More informationContinuous Glucose Monitoring: Changing Diabetes Behavior in Real Time and Retrospectively
Journal of Diabetes Science and Technology Volume 2, Issue 3, May 2008 Diabetes Technology Society CONTROVERSIES in Continuous Glucose Monitoring Continuous Glucose Monitoring: Changing Diabetes Behavior
More informationssociation of Children s Diabetes Clinicians Clinicians Continuous Glucose Monitoring (CGM) Training for Healthcare Professionals and Patients
ssociation of Children s Diabetes Continuous Glucose Monitoring (CGM) Training for Healthcare Professionals and Patients 1 ssociation of Children s Diabetes Contents Chapter Page no. STEP 1...3 Getting
More informationUpdates in Diabetes Technology
Updates in Diabetes Technology Jessica Kirk, MSN, RN, CPN, CDE Nurse Manager, Endo ECHO No disclosures Disclosures 1 Objectives Distinguish patients appropriate for continuous glucose monitoring and insulin
More informationContinuous Glucose Monitoring (CGM) Dexcom G6 Training for Healthcare Professionals and Patients
ssociation of Children s Diabetes Continuous Glucose Monitoring (CGM) Dexcom G6 Training for Healthcare Professionals and Patients 1 ssociation of Children s Diabetes Contents Chapter Page no. Chapter
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes Individuals: With type 1 diabetes
Protocol Artificial Pancreas Device Systems Medical Benefit Effective Date: 07/01/18 Next Review Date: 01/20 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18, 05/18, 01/19 Preauthorization
More informationLong-term effects of continuous glucose monitoring on HbA 1c levels: An audit
Long-term effects of continuous glucose monitoring on Julie Brake Continuous glucose monitoring (CGM) has become a common and useful tool in diabetes care. To understand whether a 72-hour glucose profile
More informationInsulin Pumps and Continuous Glucose Sensors- Embracing Technology. Susan Cavalier, BS, RN, CDE Manager, Diabetes Educator Sanford Diabetes Education
Insulin Pumps and Continuous Glucose Sensors- Embracing Technology Susan Cavalier, BS, RN, CDE Manager, Diabetes Educator Sanford Diabetes Education Diabetes Management Tools in 1974 Insulin pump history
More informationCareLink. software REPORT REFERENCE GUIDE. Management Software for Diabetes
CareLink Management Software for Diabetes software REPORT REFERENCE GUIDE How to use this guide Each type of CareLink report and its components are described in the following sections. Report data used
More informationPaolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna. Ipoglicemie e Monitoraggio Glicemico
Paolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna Ipoglicemie e Monitoraggio Glicemico Management of Hypoglycaemia.if hypoglycemia is a problem, the principles
More informationNEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP
NEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP No commercial support or sponsorship was received for this project I have nothing to disclose OBJECTIVES Identify at
More informationCurrent Trends in Diagnosis and Management of Gestational Diabetes
Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives
More informationDiabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections. Aaron Michels MD
Diabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections Aaron Michels MD Outline SMBG & CGM by age group JDRF CGM Trial Sensor Augmented Insulin Pump Therapy for A1c Reduction
More information1 Dexcom G4 Platinum User Guide May 2012
1 Dexcom G4 Platinum User Guide May 2012 Page 1. Dexcom G4 PLATINUM Continuous Glucose Monitoring System. CE marked for use in 1Dexcom G4 User Guide, May 2012. LBL-011277 Rev04. color display. Dexcom G4
More informationContinuous or Intermittent Glucose Monitoring in Interstitial Fluid
Continuous or Intermittent Glucose Monitoring in Interstitial Fluid Policy Number: 1.01.20 Last Review: 9/2014 Origination: 11/2001 Next Review: 9/2015 Policy Blue Cross and Blue Shield of Kansas City
More informationContinuous Glucose Monitoring (CGM)
Continuous Glucose Monitoring (CGM) Background Info A1c Average glucose levels over previous 2-3 months Currently remains gold standard for determining control Indicator of risk for development of complications
More informationAbbott FreeStyle Libre Pro System
Professional CGM Abbott FreeStyle Libre Pro Reader Kit includes: Reader, USB cable, interactive tutorial on USB, and power adapter, user s manual, Quick Start Guide, Quick Reference Guide Kit includes:
More informationNDSS Helpline
Continuous GLUCOSE MONITORING A guide to using CGM for children and young people with type 1 diabetes NDSS Helpline 1300 136 588 ndss.com.au The National Diabetes Services Scheme is an initiative of the
More informationTHE MINIMED 670G SYSTEM SCHOOL NURSE GUIDE
THE MINIMED 670G SYSTEM SCHOOL NURSE GUIDE Indicated for type 1 patients 14 and over. Prescription required. WARNING: Medtronic performed an evaluation of the MiniMed 670G system and determined that it
More informationPumps & Sensors made easy. OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University
Pumps & Sensors made easy OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University DeFronzo RA. Diabetes. 2009;58:773-795. Ominous Octet Relationship of b-cell Dysfunction and Development
More informationEffective Health Care Program
Comparative Effectiveness Review Number 57 Effective Health Care Program Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness Executive Summary Background Diabetes mellitus is
More informationEVALUATION OF GLUCOSE MONITORING TECHNOLOGIES FOR COST EFFECTIVE AND QUALITY CONTROL/MANAGEMENT OF DIABETES
EVALUATION OF GLUCOSE MONITORING TECHNOLOGIES FOR COST EFFECTIVE AND QUALITY CONTROL/MANAGEMENT OF DIABETES David P. Paul, III Monmouth University Stacy Ashworth, Leslie Salyers, Sarah Saldanha and Alberto
More informationTHERAPY MANAGEMENT SOFTWARE FOR DIABETES
THERAPY MANAGEMENT SOFTWARE FOR DIABETES Report Report Interpretation Reference Guide Guide 2007 Medtronic MiniMed. All rights reserved. 6025274-0U2 120707 CareLink Pro Report Reference Guide 0 p.2 Sensor
More informationDiabetes Management: Current High Tech Innovations
Diabetes Management: Current High Tech Innovations How Far We ve Come in the Last 40 Years William V. Tamborlane, MD Department of Pediatrics Yale School of Medicine Disclosures I am a consultant for:
More informationUSING THE MINIMED 670G SYSTEM
USING THE MINIMED 670G SYSTEM Instructions for the Experienced MiniMed 630G System User USING THE MINIMED 670G SYSTEM: INSTRUCTIONS FOR THE EXPERIENCED USER Checklist for starting on your MiniMed 670G
More informationContinuous or Intermittent Glucose Monitoring (CGMS) in Interstitial Fluid Corporate Medical Policy
Continuous or Intermittent Glucose Monitoring (CGMS) in Interstitial Fluid Corporate Medical Policy File name: Continuous or Intermittent Glucose Monitoring (CGMS) in Interstitial Fluid File code: UM.DME.07
More informationAbbott FreeStyle Libre Pro System
, the Professional CGM Abbott FreeStyle Libre Pro Reader Kit includes: Reader, USB cable, interactive tutorial on USB, and power adapter, user s manual, Quick Start Guide, Quick Reference Guide Kit includes:
More informationGetting Started. with Continuous Glucose Monitoring. Learning Guide
Getting Started with Continuous Glucose Monitoring Learning Guide Getting Started with Continuous Glucose Monitoring Keys to Success Getting Started with CGM: Learning Guide TRENDS CGM finally lets you
More informationFAQs for HCP segment New Instructions for Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System Non-Adjunctive Indication
FAQs for HCP segment New Instructions for Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System Non-Adjunctive Indication Q1. The Dexcom G5 Mobile System is the first CGM System to receive FDA approval
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes. pump. pump
Protocol Artificial Pancreas Device Systems (10130) Medical Benefit Effective Date: 04/01/18 Next Review Date: 01/19 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18 Preauthorization is required.
More informationTHERAPY MANAGEMENT SOFTWARE FOR DIABETES
THERAPY MANAGEMENT SOFTWARE FOR DIABETES Report Report Interpretation Reference Guide Guide 2009 Medtronic MiniMed. All rights reserved. 6025274-012_a CareLink Pro Report Reference Guide 0 p.2 Adherence
More informationMaking Sense of Glucose Monitoring. My Journey with Glucose Monitoring Over the Last 37 Years 8/7/2017
HSW1 Disclosure to Participants Making Sense of Glucose Monitoring Alison B. Evert, MS, RD, CDE UW Neighborhood Clinics UW Medicine Seattle, WA Conflict of Interest (COI) and Financial Relationship Disclosures:
More informationUNDERSTANDING THE BASIC FEATURES AND MANAGEMENT IN THE SCHOOL SETTING CHRISTINE HERTLER RN BSN CDE & MARY MCCARTHY RN CDE
UNDERSTANDING THE BASIC FEATURES AND MANAGEMENT IN THE SCHOOL SETTING CHRISTINE HERTLER RN BSN CDE & MARY MCCARTHY RN CDE The insulin pump Replaces injections Delivers insulin through a soft cannula
More informationUSING THE MINIMED 670G SYSTEM. Instructions for the Experienced MiniMed 630G System User
USING THE MINIMED 670G SYSTEM Instructions for the Experienced MiniMed 630G System User This is a supplemental guide. For complete instructions and safety information, please see your MiniMed 670G System
More informationLimitations of Conventional Methods of Self-Monitoring of Blood Glucose
Clinical Care/Education/Nutrition O R I G I N A L A R T I C L E Limitations of Conventional Methods of Self-Monitoring of Blood Glucose Lessons learned from 3 days of continuous glucose sensing in pediatric
More informationWhat is the role of insulin pumps in the modern day care of patients with Type 1 diabetes?
What is the role of insulin pumps in the modern day care of patients with Type 1 diabetes? Dr. Fiona Wotherspoon Consultant in Diabetes and Endocrinology Dorset County Hospital Fiona.Wotherspoon@dchft.nhs.uk
More informationProtocol. Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid
Continuous or Intermittent Monitoring of Glucose in Interstitial (10120) Medical Benefit Effective Date: 01/01/18 Next Review Date: 09/18 Preauthorization Yes Review Dates: 07/07, 07/08, 07/09, 01/10,
More informationParadigm/Guardian CGM Screens. CareLink Online Reports. Make Your Own Jackson Pollack. CGM by Jackson Pollack. How To Read CGM Screens/Reports
CGM by Jackson Pollack One Pollack sold for $140 million in 1996! Make Your Own Jackson Pollack How To Read CGM Screens/Reports For only $1,000! Paradigm/Guardian CGM Screens On-Screen Reports 3 / 6 /
More informationAnneloes Kerssen, a Harold W. de Valk, b Gerard H.A. Visser a. D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology
BJOG: an International Journal of Obstetrics and Gynaecology September 2004, Vol. 111, pp. 919 924 DOI: 10.1111/j.1471-0528.2004.00203.x Day-to-day glucose variability during pregnancy in women with Type
More informationPREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS)
PREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS) Pathways for Future Treatment and Management of Diabetes H. Peter Chase, MD Carousel of Hope Symposium Beverly Hilton, Beverly
More informationThe Realities of Technology in Type 1 Diabetes
The Realities of Technology in Type 1 Diabetes May 6, 2017 Rosanna Fiallo-scharer, MD Margaret Frederick, RN Disclosures I have no conflicts of interest to disclose I will discuss some unapproved treatments
More informationDiabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical
Diabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical Practice Guideline Task Force Members Anne Peters, MD (Chair)
More informationInsulin Pump Therapy in children. Prof. Abdulmoein Al-Agha, FRCPCH(UK)
Insulin Pump Therapy in children Prof. Abdulmoein Al-Agha, FRCPCH(UK) aagha@kau.edu.sa Highlights Evolution of insulin pump Pumps mimics Pancreas Goals of diabetes care What lowers HbA1c Criteria for selection
More informationPredicts and helps prevent lows with. zero fingersticks NOW FEATURING BASAL-IQ TECHNOLOGY
Predicts and helps prevent lows with * zero fingersticks NOW FEATURING BASAL-IQ TECHNOLOGY Basal-IQ Technology is not a substitute for active self-management of your diabetes. Please see back cover for
More information10/9/2017 OBJECTIVES DIABETES REVIEW
OBJECTIVES MECHANICAL MADNESS: TECHNOLOGY, DIABETES AND PREGNANCY ALYSON BLUM, PHARMD, CDE CLINICAL PHARMACIST IN OBSTETRICS SACRED HEART MEDICAL CENTER, CENTER FOR MATERNAL FETAL MEDICINE WASHINGTON STATE
More informationPump and Sensor Data Interpretation. Irl B. Hirsch, MD University of Washington School of Medicine
Pump and Sensor Data Interpretation Irl B. Hirsch, MD University of Washington School of Medicine Dualities Research: Medtronic Diabetes Consulting: Abbott Diabetes Care, BD, Bigfoot, Roche Raise Your
More information10:20 AM March 5, B 100% 235 u. 124 mg/dl 3 HRS INSULIN ON BOARD:
DEXCOM G5 MOBILE CGM COMPATIBLE B 100% 235 u INSULIN ON BOARD: OPTIONS 10:20 AM March 5, 2017 400 350 300 250 200 150 100 50 1.1 u 1:09 hrs BOLUS 124 mg/dl 3 HRS The pump that gets updated, not outdated.
More informationDIAGNOSIS OF DIABETES NOW WHAT?
DIAGNOSIS OF DIABETES NOW WHAT? DISCUSS GOALS FOR DIABETES CARE IDENTIFY COMMON COMPLIANCE- ADHERENCE ISSUES DESCRIBE TECHNOLOGY TO ASSIST AND / OR IMPROVE DIABETES CARE WHAT DO WE WANT OUR PATIENTS TO
More informationINSPIRED BY GIVE HIM MORE. The MiniMed 670G system is the world s first insulin delivery system that automatically adapts to your child s needs.
INSPIRED BY GIVE HIM MORE. The MiniMed 670G system is the world s first insulin delivery system that automatically adapts to your child s needs. * NOW APPROVED FOR AGES 7 AND UP. Waterproof to a depth
More informationFigure 2.1: Glucose meter
CHAPTER TWO: MONITORING TECHNOLOGIES 2.1 Introduction Glucose monitoring is a method of self-testing glucose (blood sugar) levels for the management of diabetes. Traditionally, it involves pricking the
More informationMedical Education. Personal Continuous Glucose Monitoring Protocol. Innovating for life.
Personal Continuous Glucose Monitoring Protocol A Guide to Continuous Glucose Monitoring Integrated with Insulin Pump Therapy Includes Alert and Trend Management as well as Threshold Medical Education
More informationOptimizing Therapy and Clinical Outcomes Using Real-Time Continuous Glucose Monitoring (AADE PRODUCT THEATRE) August 7, 2014 Orlando, FL
Optimizing Therapy and Clinical Outcomes Using Real-Time Continuous Glucose Monitoring (AADE PRODUCT THEATRE) August 7, 2014 Orlando, FL Welcome and Introduction Orlando, FL August 7 th, 2014 Keri Weindel,
More informationCGM: Continuous Glucose Monitoring Making Sense of It All AW: ANCO/GEND/1016/0117
CGM: Continuous Glucose Monitoring Making Sense of It All Objectives Review how to do a time effective interpretation of CGM and insulin pump download data Review how medications, lifestyle, and current
More informationAbstract CLINICAL APPLICATIONS. Objectives: Methods: Results: Conclusion: Journal of Diabetes Science and Technology
Journal of Diabetes Science and Technology Volume 1, Issue 3, May 2007 Diabetes Technology Society CLINICAL APPLICATIONS Combined Insulin Pump Therapy with Real-Time Continuous Glucose Monitoring Significantly
More informationINSPIRED BY GIVE HER MORE. The MiniMed 670G system is the world s first insulin delivery system that automatically adapts to your child s needs.
INSPIRED BY GIVE HER MORE. The MiniMed 670G system is the world s first insulin delivery system that automatically adapts to your child s needs. * NOW APPROVED FOR AGES 7 AND UP. MORE TIME HERE TO USING
More informationCoverage Guidelines. Continuous Glucose Monitors (CGMs)
Coverage Guidelines Continuous Glucose Monitors (CGMs) Disclaimer: Please note that Baptist Health Plan Coverage Guidelines may be updated throughout the year. A printed version may not be most up to date
More informationPOLICIES AND PROCEDURE MANUAL
POLICIES AND PROCEDURE MANUAL Policy: MP071 Section: Medical Benefit Policy Subject: Continuous Subcutaneous Glucose Monitor CSGM I. Policy: Continuous Subcutaneous Glucose Monitor (CSGM) II. Purpose/Objective:
More informationExternal Insulin Pumps Corporate Medical Policy
File Name: External Insulin Pumps File Code: UM.DME.02 Origination: 04/2006 Last Review: 11/2018 Next Review: 11/2019 Effective Date: 04/01/2019 External Insulin Pumps Corporate Medical Policy Description/Summary
More information