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 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 failure; thus, revising management plans to decrease glucose vari- ability is a goal 19 . Examples of AGP reports are displayed in Figures 5 through 7. In Figure 5, the results demonstrate excellent glucose management,
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 .
with results being in range 97% of the time and no hypoglycemia. In Figure 6, the GMI is optimal at 6.1%; however, the patient is experiencing too many episodes of hypoglycemia, indicating a need to change the management plan. Finally, in Figure 7, an el- evated GMI of 9.2% is observed and suboptimal TIR of 23% with excessive hyperglycemia, all demonstrating a need to change the management plan.
Figure 5. AGP Reflecting Excellent Glucose Management with a GMI of 6.1% Without Instances of Hypoglycemia
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