Case Study. Patient Profile. Baseline Report - Daily Patterns. Insights
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1 Case Study Patient Profile Sex/Age: Female, 48 years old Disease diagnosis: Type 2 for past 13 years, coronary artery disease for 3 years, complains of severe tiredness HbA1c: 9.0% Diabetes medication profile: Long-acting insulin degludec 24 units, rapid-acting insulin aspart units, metformin 500 mg 1-1-1, DPP-4 inhibitor 100 mg Current glucose monitoring: Laboratory fasting blood glucose 156 mg/dl, postprandial blood glucose 284 mg/dl Rationale for sensor monitoring: To assess the reason for glucose fluctuations Baseline Report - Daily Patterns Insights 1. Are the readings within target range? The glucose profile is well above the target range. 2. What are the patterns of hypoglycemia? No episodes of hypoglycemia are noted. 3. What is the shape of the median curve? The median curve is above target range and the shape of median indicates moderate intra-day glycemic variability in the evening. 4. What is the width of the IQR? The IQR is widely spread, indicating a high degree of inter-day glycemic variability. ID: IN-FSLP The case study is intended for medical information/education purposes only. It is not intended to be used for medical diagnosis or treatment or as a substitute for professional medical advice. Individual symptoms, situations and circumstances may vary. Information contained herein for distribution outside of the US ONLY. Local legal and regulatory approval is required to publish any content. ADC v1.0 06/ of 5
2 Actionable Insights Target Range Considerations Next Steps Is she taking her medications as prescribed? What is her carbohydrate intake at meals and snacks? Ask the patient for a recall of her medication regime, complete with medication names, dosages, and times. Conduct a dietary recall to assess the amount of carbohydrate from all sources and amounts at meals and snacks. Patterns of Hypoglycemia None at this time n/a Shape of Median Curve Does the amount of carbohydrate at lunch and dinner match the amount mealtime insulin? Based on dietary and mealtime insulin recall, assess her insulin to carbohydrate ratio at lunch and dinner. Width of IQR Does the amount of mealtime carbohydrate meal vary from day to day? Based on dietary recall, assess consistency or variability of carbohydrate intake on different days. Do meal times vary from day to day? Based on dietary recall, assess meal consistency or variability on different days. 2 of 5
3 Baseline Report - Glucose Pattern Insights Insights 1. Where is the risk of hypoglycemia the greatest as indicated by the likelihood of low glucose assessment? There is low likelihood of low glucose at this time. 2. Where is the highest deviation from the median glucose goal indicating the need for greater clinical attention? There is a moderate deviation from the median glucose goal throughout the entire 24 hour period indicating a moderate impact on A1c level. 3. W here is the variability below the median greater than a level that would support achieving the median goal without potentially causing low blood glucose? Indications for variability below the median are highest through out the entire 24 hour period. Changes to therapy that would potentially result in glucose lowering should be cautiously considered. Modifications (as a result of report interpretation): Based on the findings of the baseline AGP, the patient was started on an insulin pump with a variable basal rate. 3 of 5
4 Subsequent Report - Daily Patterns 1. Are the readings within target range? Although the glucose profile has improved, it is still above the target range. 2. What are the patterns of hypoglycemia? No episodes of hypoglycemia noted. 3. What is the shape of the median curve? The shape of median indicates moderate intra-day glycemic variability. 4. What is the width of the IQR? The IQR is narrow, indicating a low degree of inter-day glycemic variability. 4 of 5
5 Subsequent Report - Glucose Pattern Insights 1. Where is the risk of hypoglycemia the greatest as indicated by the likelihood of low glucose assessment? There is low likelihood of low glucose at this time. 2. Where is the highest deviation from the median glucose goal indicating the need for greater clinical attention? There is a moderate deviation from the median glucose goal through out the entire 24 hour period indicating a moderate impact on A1c level. 3. Where is the variability below the median greater than a level that would support achieving the median goal without potentially causing low blood glucose? Variabililty below the median is moderate 13:00 to 04:00 and low 04:00 to 13:00. Modifications (as a result of report interpretation): On the basis of subsequent AGP 3 months later, the insulin pump basal rates were increased and an alpha glucosidase inhibitor was added 0.2 mg three times per day. 5 of 5
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