Chapter 5: Monitoring Techniques for Optimal Diabetes Management and Control 2 Contact Hours
By: James A. Fain, PhD, RN, BC-ADM, FADCES, FAAN Author Disclosure : James A. Fain and Colibri Healthcare, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number (UAN) : 0607-0000-22-047-H01-P Activity Type : Knowledge-based Target Audience: Pharmacists in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers either by mail, fax, or online at EliteLearning.com/Book Initial Release Date : December 27, 2022 Expiration Date : December 27, 2025 Questions regarding statements of credit and other customer ser- vice issues should be directed to 1-888-666-9053. This lesson is $14.95. Learning objectives After reading this monograph, pharmacists should be able to: Distinguish the purpose, glycemic target levels, and recommended frequency of blood glucose monitoring for persons with diabetes using an intensive insulin regimen. Analyze the benefits and practices of blood glucose monitoring using a glucometer.
Colibri Healthcare, LLC is accredited by the Accredi- tation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Partici- pants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 2 contact hours (0.2 CEU) submit-
ted to CPE Monitor as early as within 10 business days after course completion and no later than 60 days after the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time. The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days.
Examine the advantages and disadvantages of continuous glucose monitoring (CGM) in facilitating achievement of managing glycemia. Select best practice tips for using CGM to facilitate patient engagement.
INTRODUCTION
Glycemic management is critical in preventing acute and chronic diabetes-related complications for people with type 1 and type 2 diabetes (Diabetes Control and Complications Trail Research Group 1,2 . Successful management of diabetes requires recogni- tion of monitoring as a critical component of the treatment plan. However, with diabetes being a self-managed chronic illness, people still need healthcare professionals’ Course content Appropriate treatment for people with diabetes is based on per- sonal characteristics and needs. A high level of engagement with therapy facilitates the achievement of treatment goals. Monitor- ing the person’s condition, and focusing on regular assessment of glycemic targets, such as blood glucose levels, time in range, and A1C levels, should be performed with the most appropriate personalized, cost-effective method of delivering care. Glycemic targets are assessed by blood glucose monitoring (BGM), A1C measurement, and continuous glucose monitoring (CGM) using either time in range (TIR) or the glucose management indicator (GMI). With evidence-based clinical guidelines available to assist with managing type 1, type 2, and gestational diabetes, it is still essential to realize that “one size does not fit all.” The use of clini - cal guidelines needs to be based on patients’ attitudes, disease burden, comorbidities, and resources. This course will address
help, advice, and support in understanding parameters requiring monitoring. The 2022 Standards of Medical Care in Diabetes by the American Diabetes Association (ADA) provides direction for best practices when monitoring diabetes management. Significant evidence ex - ists that supports a variety of interventions to improve optimal diabetes management and outcomes 3,4 . issues related to assessing glycemic targets, focusing on using blood glucose monitoring with traditional glucometers and con- tinuous glucose monitoring. Healthcare Consideration: Appropriate language in diabe- tes care and education is essential when communicating with people with diabetes. Healthcare providers need to use termi- nology consistent with an empowerment approach 5 . In moving toward patient-centered care, health care providers need to use respectful, nonjudgmental, neutral language. For example, when discussing diabetes management activities, the word control places responsibility on the patient while also implying the need to strictly follow the advice of the health care provider who holds authority and power. Similarly, adherence and compliance sug- gest doing what someone else wants.
BLOOD GLUCOSE MONITORING
Home blood glucose monitoring (BGM) began in the late 1970s, with the first glucose meters marketed for home use in the early 1980s. Significant developments over the years in the design and technology of BGM have ensured the optimal and most cost- effective use. For example, glucose meters have become small- er, more precise, and accurate, sometimes even connecting to a cloud-based glucose data management system or automated counseling systems that contain messages to improve care. Blood glucose monitoring is an integral part of diabetes manage- ment. BGM provides information to patients to help them under- stand how food, activity, and medications affect their blood glu-
cose levels. In addition, BGM offers valuable information about the status of glycemic management. However, monitoring alone is not enough to achieve glycemic targets. Patients performing BGM need to know how to properly operate a blood glucose meter, their target blood glucose values, how to interpret the re- sults, and when to call the healthcare provider. As a survival skill, all newly diagnosed patients with type 1, type 2, or gestational diabetes should learn BGM tailored to the individual and their treatment plan 6 .
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