Continuous Glucose Monitoring Integration in Clinical Practice: A Stepped Guide to Data Review and Interpretation

Abstract

Background: The advent of continuous glucose monitoring (CGM) technology has transformed the approach to diabetes care. Multiple CGM systems are commercially available and increased accuracy has allowed development of hybrid and automated insulin delivery systems. Evidence of CGM clinical benefits has also increased exponentially in the last decade. Methods: Literature search, review of professional guidelines, and consensus statements were used to guide the preparation of this article. The clinical benefits of both professional and personal CGM in clinical practice as well as barriers to wider adotpion were explored. A stepped approach to review and interpretation of CGM data is suggested for use in the clinician’s office regardless of the software used. Results: Although increasing, the use of CGM in patients with diabetes is still not widespread; multiple barriers are still in place, despite the approval of CGM systems for patients above the age of 2 years old, the extension of coverage for Medicare beneficiaries and the integration of CGM with multiple insulin pump systems. Integration of CGM technology in clinical practice presents various challenges, from concerns relative to time constraints during office visits to lack of systematic approach to interpretation of the data. Conclusions: Understanding the usefulness of personal and professional CGM, appropriate patient selection as well as patient and provider training are crucial for the expansion of CGM therapy use in clinical practice. Utilizing the proposed stepped approach to CGM review and interpretation may allow wider adoption of CGM with more effective and efficient office visits.

Actual as well as Future Technologies and Noninvasive Devices for Optimal Management of Diabetes Mellitus and Chronic Heart Failure

“…Improving the skills and the capacities of algorithms, by using the database setup (Big Data analysis), optimizing their self-learning capacity and their patientspecific adaptation capacity, and supplementing their information with multiple sensors collecting parameters other than blood glucose levels could allow early detection of food intake, physical activity, stress, and adaptation of the system to specific situations (children, pregnancies, highly unstable diabetes) [21]. The connection of the system to a telemedicine and coaching platform is an evolution that is already underway in the system Diabeloop™ (Figure 3).…”

“…In the TeleSage study, T1D patients were randomized to usual quarterly followup (G1), home use of a smartphone recommending insulin doses (Diabeo™ software) with quarterly visits (G2), or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end (G3) [12,21]. At 6-month, the mean HbA1c level is 8.41 ± 1.04% in G3 versus 8.63 ± 1.07% in G2 versus 9.10 ± 1.16% in G1 (p = 0.0019 for G1-G3 comparison) (Figure 7) [16,26].…”

The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services

“…Additionally, Tidepool and Glooko are data management platforms that assist in visualizing integrated diabetes-related data. 48 Figure 3 provides a guide to using the Insights by InPen integrated data management report with details about key clinical considerations.…”

Optimizing Postprandial Glucose Management in Adults With Insulin-Requiring Diabetes: Report and Recommendations

“…Managing the quantity and variety of information these devices provide remains challenging for both patients on insulin pump or multiple daily insulin (MDI) therapy and their providers, however. We suggest that providers consider a stepped approach to reviewing and interpreting reports, focusing on data sufficiency, CGM use, time-in-range, and GV, as well as ambulatory glucose profile and daily view [91]. Patients may require even more guidance than their providers in interpreting data, as well as in using trend arrow data safely and practically [92, 93], making certified diabetes educators who can demonstrate new devices and help patients interpret CGM more valuable than ever [94].…”