Figure 7. AGP Reflecting a TIM of 23% and a GMI of 9.2% but Excessive Hyperglycemia Requiring a Change in Management Plan
Interpreting CGM data can be challenging and overwhelming. Healthcare providers are essential to help patients understand and use the data to optimize their glucose management. While technology can pose a barrier for some, diabetes self-manage- ment education and support (DSMES) can overcome these bar- riers and improve the lives and health of people with diabetes. Helping individuals with diabetes gain the knowledge, skills, and confidence to manage their symptoms and prevent complications is a goal of all who provide DSMES. Scenario David is 31 years old with a 12-year history of type 1 diabetes. His A1C has been increasing (most recently it was 8.8%) despite some success with a healthy meal plan and walking three times a week. Upon initial diagnosis of type 1 diabetes, David would routinely check his blood glucose levels three times a day. However, over the past several years, David has not been consistent with BGM because of a busy travel schedule. David also acknowledged that he does not want to stop his life by constantly checking his blood glucose. During David’s last office visit, his health care provider discussed the possibility of using a CGM. David reluctantly agreed to try a CGM so he would not have to prick his finger as frequently during the day. Three weeks later, David met with his health care provider and reviewed his blood glucose patterns. David was BGM and glycemic targets Correlating BGM to achievement of glycemic targets may help patients appreciate the value and importance of regular BGM. Glycemic goals for pre-prandial and postprandial blood glucose values for nonpregnant adults with diabetes and without limited life expectancy are based on recommended guidelines through the American Diabetes Association. Stringent glycemic targets are appropriate for patients if they are achieved without significant hypoglycemic or adverse events. Be - ing less stringent with glycemic targets is individualized based on hypoglycemic risk, duration of diabetes, life expectancy, comorbid- ities, established vascular complications, patient preference, and resources and support system 4,21 . Recommended glycemic targets for nonpregnant adults with diabetes and without limited life ex- pectancy are shown in Table 4.
The use of a CGM device can educate and empower the wearer in real-time 20 . Access to blood glucose data has clearly been shown to decrease hypoglycemia and provide immediate feedback that reinforces positive behaviors related to food intake, physical ac- tivity, and medication-taking. People also become aware of the negative behaviors that worsen glycemic control, and this can be a motivator to change behavior as well.
able to see a connection between his glucose levels and food intake, physical activity level, and use of medications. Many have commented that a CGM is a “game changer” as it provides the real-time data necessary to optimize blood glucose levels more closely. Also, having confidence that the CGM will alert the wearer to a potential hypoglycemic episode early enough to act (ingest carbohydrates) has encouraged many to maintain more euglyce- mic levels without fear of experiencing a significant hypoglycemic episode. David left his 3-week office visit armed with knowledge that will enable him to manage his blood glucose more easily, free him from cumbersome fingersticks, and have more confidence and freedom living with and managing his diabetes. Healthcare Consideration: In addition to monitoring blood glucose levels among patients with type 1 and type 2 diabetes, healthcare providers must promote a person-centered approach to increase patient engagement in self-care behaviors. Putting the patient at the center of all we do lends itself to shared deci- sion making between patient and healthcare provider regarding glycemic targets that need to be individualized. In addition, a person-centered approach customizes the diabetes care plan, considering the patient’s preferences, cultural values, and indi- vidual needs.
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