Information Overload! CGM, Navigating for Success. Presented by: Kathi Milton RD, CDE and Amy Foreman RN, CDE

Transcription

1 Information Overload! CGM, Navigating for Success Presented by: Kathi Milton RD, CDE and Amy Foreman RN, CDE

2 CGM-What is it? Continuous Glucose Monitor: a device that provides measurement of glucose data, using interstitial fluid. A sensor is placed under the skin and gives readings every few minutes. Glucose readings can be used to make decisions in real-time, or management of dosing. First device was approved in 1999 in the USA.

3 Measuring Glucose A small sensor that measures glucose levels just under the skin A transmitter that fits onto the sensor and sends data wirelessly to your display device A small receiver or compatible smart device that displays real time glucose information

4 CGM Benefits Predicts the future Provides trending information in real time Shows rapid fluctuations Alarms for high and low blood sugars Assists in evaluating dose testing Some are able to share data Shows effect of foods and activity Identify hypoglycemia in those who are hypo-unaware Security for those who live alone Before driving checks

5 Considerations for Therapy Adjustment Hypoglycemia Honeymoon Stage Insulin on Board Therapy Adjustment Considerations Change in activity level Direction of Trend Type of food consumed

6 Navigating the Data

7 Reports Overview Patterns Data Compare Statistics AGP The Overview report has two parts. The upper dashboard provides a high level overview of the patient s glycemic control. The lower patterns summarize the identified clinically relevant patterns. Dive deeper into each of the four clinically relevant patterns. Each pattern provides graphs of the days that contribute to that pattern. Trends and Overlay graphs show aggregate data with filtering options. Daily graphs are a detailed view of every glucose data point for each day selected. The Compare report provides side-by-side comparison of dashboard statistics and Trends, Overlay, and Daily graphs for the selected date range. The Statistics page provides focused insight for both daily and hourly glucose metrics. Advanced metrics can be selected for deeper analytics. The standardized Ambulatory Glucose Profile (AGP) report provides a big picture view of diabetes management.

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9 Compare Graphs Helpful when adding a new medication or adjusting an insulin dose Compare data

10 What is AGP? AGP provides a big picture view of diabetes management and is only one part of understanding glucose patterns. Three sections of the report: Average Blood Sugar Time in Range Variation

11 Navigating Real Time Data Before implementing the following methods please consult your healthcare provider.

12 Trend Arrows

13 Start Conservatively

14 Method Example CGM Blood Sugar pre meal reads 270 Trend Arrow = 330 CGM Blood Sugar pre meal reads 170 Trend Arrow = 80 CGM Blood Sugar pre meal reads 326 Trend Arrow 326 CGM Blood Sugar pre meal reads 150 Trend Arrows = 240

15 Other Methods DirecNet Method Use of the DirecNet Applied Treatment Algorithm (DATA) for Diabetes Management with a Real-Time Continuous Glucose Monitor (the Freestyle Navigator). Pediatr Diabetes Apr; 9(2): Gary Scheiner Method Practical CGM: Guide to Improving Outcomes Through Continuous Glucose Monitoring. American Diabetes Association Edelman et al. Method Recommendations for using Real-Time Continuous Glucose Monitoring (rtcgm) Data for Insulin Adjustments in Type 1 Diabetes. Journal Diabetes Science and Technology, August 2016.

16 Three Methods

17 References and Resources Dexcom Grazia Aleppo, Lori M Laffel, Andrew J Ahmann, Irl B Hirsch, Davida F Kruger, Anne Peters, Ruth S Weinstock, Dennis R Harris; A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes, Journal of the Endocrine Society, Volume 1, Issue 12, 1 December 2017, Pages , Gary Scheiner, MS CDE Practical CGM: Improving patient Outcomes through Continuous Glucose Monitoring Stephen W Ponder, MD FAAP CDE

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