Search

The Role of CGM in Diabetes Management 

GettyImages-1332793217_700x400
CGM. What is it? Who is for? How can it help?

Written By ADCES staff, supported by Abbott. 

What is CGM? 

Continuous Glucose Monitor or CGM systems measure glucose levels continuously, displaying a glucose level every 1-5 minutes along with trend arrows to indicate the rate and direction of glucose change. CGM system components include:  

Sensor: Sense glucose in interstitial fluid through a thin, flexible, sensor inserted under the skin and adhered to the skin  with adhesive.  

Transmitter: Transmit sensor glucose information to a display device, which can include a wireless handheld device, smartphone application or a compatible insulin pump. 

 Benefits of CGM compared to Blood Glucose Monitoring (BGM) 

img-cgm-benefits

How can CGM Help Diabetes Management? 

Glucose trend information provides valuable context that helps the person with diabetes make proactive treatment decisions to mitigate hypoglycemia and hyperglycemia.

CGM reports synthesize large amounts of glucose data (up to 1440 glucose values per day) into reports and graphs, providing insights into glucose patterns.

Who is a Good Candidate for CGM? Any person with diabetes who requires: 

  • Insulin for treatment of their diabetes.
  • Can tolerate the CGM adhesive and is willing to wear an on-body device.
  • Desires more comprehensive information about their glucose values and trends
  • Is at risk for severe hypoglycemia or has hypoglycemia unawareness

CGM Across the Lifespan

img-cgm-lifespan

How Can I Ensure CGM Success? 

Problem: Skin irritation from the CGM adhesive  

Solutions: Use the following tips to prevent skin reaction and promote skin health.

  • Insert the sensor in a site approved by manufacturer and in an area with enough fat to "pinch" up. Clean the insertion site and allow to thoroughly dry.
  • Avoid inserting sensors in areas with broken skin, such as cuts or scabs, or areas where skin creases with bending, like the waistline.
  • Rotate sensor insertion sites to a different location with each change to give skin time to heal.
  • The user should remove the device and not continue using the device if skin irritation continues to occur.
  • Use a liquid barrier product to reduce skin exposure to CGM adhesive if skin irritation occurs. 

Problem: Alarm and alert fatigue

Solutions: Use personalized CGM alert settings.  

  • Users may not need to program all CGM alerts.
  • If alert frequency is burdensome to the user, consider setting only the hypoglycemia threshold alert and disabling all other alerts.
  • Ensure alerts are actionable and align with the individual’s goals for using CGM.  

Problem: Information overload-being overwhelmed by the data  

Solutions: Use these tips to systematically review the data.  

  • Focus on one actionable pattern at a time.
  • Deal with hypoglycemia first.
  • Set reasonable expectations (example: glucose levels are supposed to rise after meals). 
  • Focus on big picture, not on a particular day. 

References: 

  1. Rodbard, David. "Continuous glucose monitoring: a review of recent studies demonstrating improved glycemic outcomes." Diabetes technology & therapeutics 19, no. S3 (2017): S-25. Diabetes Technol Ther. 2017 Jun;19(S3):S25-S37. doi: 10.1089/dia.2017.0035
  2. Battelino, Tadej. "Continuous glucose monitoring efficacy in routine use." The Journal of Clinical Endocrinology & Metabolism 103, no. 6 (2018): 2414-2416.J Clin Endocrinol Metab. 2018 Mar 1;103(3):1224-1232
  3. American Diabetes Association. Diabetes Care 2021 Jan; 44(Supplement 1): S85-S99.https://doi.org/10.2337/dc21-S007
  4. Kristensen K, Ögge LE, Sengpiel V, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia 2019;62:1143–1153
  5. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group; Tamborlane WV, Beck RW, Bode BW, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008;359:1464–1476
  6. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017;40:1631–1640
  7. Beck RW, Riddlesworth T, Ruedy K, et al.; DIAMOND Study Group. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA 2017;317:371–378
  8. Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317:379–387
  9. Messer, Laurel H., et al. "Preserving skin integrity with chronic device use in diabetes. " Diabetes technology & therapeutics 20, no. S2 (2018): S2-54.Diabetes Technol Ther. 2018 Jun;20(S2):S254-S264. doi: 10.1089/dia.2018.0080
  10. Shivers, Joseph P., Linda Mackowiak, Henry Anhalt, and Howard Zisser. "Turn it off!”: diabetes device alarm fatigue considerations for the present and the future." Journal of diabetes science and technology 7, no. 3 (2013): 789-794.J Diabetes Sci Technol. 2013 May 1;7(3):789-94. doi: 10.1177/193229681300700324
  11. Aleppo, Grazia, and Kimberly Webb. "Continuous glucose monitoring integration in clinical practice: a stepped guide to data review and interpretation." Journal of diabetes science and technology 13, no. 4 (2019): 664-673.J Diabetes Sci Technol. 2019 Jul;13(4):664-673. doi: 10.1177/193229681881358

 


DISCLAIMERS:

This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit diabeteseducator.org/Find.

ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.