From the Personal Continuous Glucose Monitoring Implementation Playbook from ADCES and AphA. Contributors include: Patricia L. Scalzo, MSN, NP, RN, CDCES, Kelly A. Brock, PharmD, RPh and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES. This effort was supported by Dexcom & Abbott.
Continuous glucose monitoring (CGM) is a great tool that improves clinical outcomes for people with diabetes; these individuals are often happy to get this new technology.
To help their colleagues get up to speed, our diabetes care and education specialists and other experts put together answers for some of the most commonly asked CGM questions.
CGM is appropriate for all people receiving diabetes medication. It allows people with diabetes to play an active role in their diabetes care, which is so important in shared decision-making. CGM teaches people how their medications, specific foods, exercise, stress, work, and other factors influence their daily glucose results.
CGM can help motivate people to make positive lifestyle changes. Identifying the individual’s needs will ensure that appropriate expectations for the team are met.
Most CGM devices have excellent online videos and other materials from the manufacturers to help with a smooth start. However, clinicians have a key role in patient satisfaction and optimal usage.
It can, but there are many ways to reduce this risk. Make sure alarms and alerts are set appropriately to avoid alarm fatigue and data overload. Have the alerts go off when it matters most, like during hypoglycemia. Look at the device at key times only, like before meals, before bedtime, and before activities like exercising and driving, and use CGM to determine glycemic trends.
Particularly in primary care, the clinician needs to schedule adequate time to use CGM effectively, making it clear that the focus of the visit is to review CGM data. This makes it a priority over other issues that often are brought up in a primary care visit.
As an active participant, the person with diabetes is urged to scan as much as possible if using a CGM with a reader or wear the CGM consistently for at least 14 days to be able to see trends and ideally to upload the data to an online portal.
Alternatively, the clinician can use professional CGM. To be most efficient, data can be downloaded prior to the clinician entering the room. This allows the person with diabetes to review daily graphs that include ambulatory glucose profile (AGP) and time in range (TIR).
Having more detailed profile sheets also helps save time by making it simpler to recognize patterns.
Let the person see the size of different devices through demonstrations and show possible discreet places on the body where they can be worn.
To determine if your patient/client’s insurance will cover a CGM, try ADCES’s new CGM insurance look-up tool. It aggregates info on thousands of published policies. Or, visit our CGM affordability chart.
There are various resources available to help clinicians understand CGM technology and to assist in integrating CGM into their practice settings.
CONTRIBUTORS: Carla Cox, PhD, RD, FAADE Certified Diabetes Educator and Clinical Dietitian Mountain Vista Medicine South Jordan, Utah Vivian A. Fonseca, MD, FRCP Tullis-Tulane Alumni Chair in Diabetes Professor of Medicine Chief, Section of Endocrinology Tulane University School of Medicine New Orleans, Louisiana Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDE Clinical Pharmacy Specialist/CGM Program Coordinator Department of Endocrinology, Diabetes, and Metabolism Cleveland Clinic Diabetes Center Cleveland, Ohio Pamela Kushner, MD, FAAFP Clinical Professor University of California Irvine Medical Center Irvine, California Director Kushner Wellness Los Alamitos, California
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.