are designed to share results with family/friends, which may be an important consideration if the person with diabetes is a child Personal CGM devices Personal CGM devices are purchased for personal use to monitor blood glucose levels and help guide decision-making about food intake, physical activity, and medication use. In addition, CGM de- vices keep track of blood glucose data by sending information to Real-time versus intermittently scanned CGM devices Two types of personal CGM devices are available: real-time CGM (rtCGM) and intermittently scanned CGM (isCGM). The rtCGM devices indirectly measure blood glucose levels every 5 minutes and send glucose data automatically to a receiver or smartphone. The 2022 Standards of Medical Care from the ADA recommend use of an rtCGM device for people with type 1 diabetes who do not meet individualized glycemic targets and experience hypogly- cemia unawareness 4 . These rtCGM devices also can sound alerts and alarms in response to rising or falling blood glucose levels. Some patients get frustrated with the frequent alarms if they ex- perience significant variability with their blood glucose levels 16 . If the alarms are too frequent, some wearers feel like their diabetes is controlling their lives. CGMs can be customized by setting the alarms at different glucose levels to limit alarms during work activ- ities or school. Use of an isCGM device to retrieve blood glucose data, which requires manually scanning the sensor 16 , is another approach to limiting frequent alarms. The rtCGM devices provide real-time feedback to patients. There are select times, however, when a provider may choose to blind Interpreting CGM data CGM systems are based off rtCGM or isCGM, which measure blood glucose levels in interstitial fluid. CGM systems also pro - vide insight into direction, magnitude, duration, frequency, and rate of change (ROC) by displaying the information as a trend arrow on the sensor next to the actual blood glucose value. Such a feature is vital in helping patients anticipate future blood glu- cose levels. In addition, the visual representation of information in the form of arrows enables patients to take action to adjust their blood glucose levels promptly 15,17 . Each CGM system has a different representation of trend arrows but generally represents blood glucose levels changing at a rate of <1 mg/dL per minute (horizontal arrow) to up to >2–3 mg/ dL per minute (single or double vertical arrows pointing upward), with the opposite for declining blood glucose levels (horizontal arrows pointing down). However, with no standardized guidelines or protocols for interpreting blood glucose values provided by trend arrows, healthcare providers need to make recommenda- Time in range (TIR) TIR is the percentage of time a person’s blood glucose level re- mains in a proposed target range 3 . The ADA recommends a tar- get range of 70 to 180 mg/dL. It may be helpful to explain the concept of TIR to persons with diabetes by having them think about the “number of hours per day” their glucose is within the desired range. For example, 75% TIR refers to a person’s glucose Glucose management indicator (GMI) GMI is a term related to estimating the mean glucose level from continuous glucose monitoring data 3 . It may differ from the A1C slightly, as it is using data from a shorter time interval than the 90 days reflected in an A1C value. The GMI can be helpful when assessing the effectiveness of changes to the diabetes manage- ment plan. For example, if a person’s GMI decreased from 9 to 7.5% over the course of 2 weeks and they are not experiencing hypoglycemia, the change to the management plan is working. Glucose variability (GV) This refers to how much the glucose reading varies from the mean and the frequency of variations 3 . GV is associated with cardio- vascular events such as cardiovascular disease, stroke, and renal
or has cognitive impairment. The monitoring sensor should be replaced every 7 to 14 days depending on the CGM device.
a receiver or smart device. The use of CGM devices identifies the need to respond to blood glucose variability and increase their confidence in blood glucose management for many 15 .
the wearer to the data and have the person use a professional CGM from the office. This can be useful when the person is not changing their behavior based on the blood glucose readings; instead, the data are being collected so that the healthcare pro- vider can look at patterns then make recommendations. Having the individual wear a professional CGM from the office, may be indicated if someone’s insurance will not cover the cost of a per- sonal CGM on a regular basis. The professional CGM can be used intermittently to help with decision making regarding therapy rec- ommendations. The isCGM devices require the person to pass or swipe a scan- ner over the sensor/transmitter to receive blood glucose data. First-generation isCGM devices did not include alarms or alerts for high or low blood glucose readings. Newer CGM devices now offer added safeguards and alerts. isCGM devices may be helpful to patients who have a difficult time performing BGM with a glu - cometer and fingersticks as recommended because of dexterity issues or other related problems 16 . tions and clinical decisions by reviewing information provided by individual CGM systems 17 . The use of an ambulatory glucose profile (AGP) provides valu - able information to health care providers and patients related to interpreting visual and statistical summaries of glucose metrics 18 . It is a practical tool and easy to read, providing a comprehensive assessment of patterns of glycemic variation and time spent in various blood glucose targets. For those who use a dedicated CGM reader with their CGM system, the reader is plugged into a remote computer for data downloading. When using a mobile device as the CGM reader, data can be au- tomatically uploaded to the cloud, with the ability to share data with family members or health care providers. On the AGP report, there are many helpful blood glucose metrics from continuous glucose monitoring.
level being within the target range for approximately 18 hours a day. The ADA defines the standardized CGM metric for TIR as 70 to 180 mg/dL for >70% of the time. For older adults or frail patients at risk for hypoglycemia, the TIR target range is >50% of the time 3 .
Time in Hypoglycemia. This metric reports glucose levels <70 and >54 mg/dL and includes a separate report of glucose levels <54 mg/dL 3 . Time in Hyperglycemia. This metric reports glucose levels be- tween 181 and 250mg/dL and includes a separate report of glu- cose levels >250 mg/dL 3 .
failure; thus, revising management plans to decrease glucose vari- ability is a goal 19 .
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