Obtaining the info
Several code programs permit clinicians to get key statistics and examine CGM information during a graphic and customised format. Some conjointly allow discourse analysis by merging the CGM information with data from endocrine pumps, glucose meters, and fitness pursuit devices.
Most CGM transfer code focuses on presenting information during a significant method. However, there’s a gradual movement toward giving target-hunting help with the analysis of the info furthermore. A outline of presently obtainable programs is provided in .
Qualification and Preparation
Before evaluating a collection of CGM information, it’s vital to qualify the data. this suggests confirming that the info are reliable and representative of the user’s true patterns. Specifically:
1.?confirm the clock and date are set properly on the receiver (and all alternative devices being downloaded).
2.?Verify that enough calibrations were performed.
3.?raise concerning the conditions below that the info were collected. Were there exculpatory circumstances like stress, travel, uncommon physical activity, illness, or use of steroid medications?
4.?make sure that the info are moderately correct. In Medtronic’s CareLink Personal, take a glance at the mean absolute distinction share (MAD%) for every full week on the sensing element Daily Overlay report. If the head over heels in is over 1518%, the info might not be price reviewing. On the Dexcom Daily Trend reports, observe the discrepancy between the standardization values (denoted as red diamonds) and therefore the synchronous sensing element values (the blue dots). If there are several giant discrepancies, think about passing au courant the info analysis.
Another way to confirm high-quality information and helpful interpretation is to solicit the patient’s involvement. once employing a skilled CGM device (a system worn briefly for diagnostic purposes), it helps to possess details to travel together with the aldohexose data. Instruct the CGM device user to stay written or computerised logs of things that influence his or her aldohexose levels, such as
?Timing and content of meals
?Duration and nature of exercise
?Doses of endocrine and alternative polygenic disease medications
?Noteworthy events (restaurant meals, illnesses, uncommon stress, pump infusion set changes, menses, etc.)
Similarly, those mistreatment personal CGM systems will facilitate their care team perform a significant analysis by recording key information (insulin doses, meals/snacks, exercise) for every week or 2 before clinic appointments.
Data Interpretation: applied mathematics Summaries
Because CGM devices generate aldohexose values day-and-night, the info don’t seem to be skew by checking a lot of typically during times of high or low aldohexose or by solely checking before meals. The statistics generated by CGM devices are so a lot of valid than those garnered from glucose meters.
The mean (average) sensing element aldohexose represents a reasonably true average, albeit slightly under reality thanks to a natural tendency for the systems to err on the aspect of lower instead of higher values, furthermore because the prolonged lag time that happens once sick from hypoglycaemia. Adding 23% to a CGM average may be a great way to correct for these system deficiencies. A1c will then be calculable by mistreatment the eAG equation ([CGM average +46.7]/28.7).3
Another helpful data point is that the variance (SD). A high SD means there are several aldohexose values that are considerably higher than or below the common. an occasional SD indicates a comparatively low variety of outliers. From my expertise, Associate in Nursing SD that’s but thirty three of the common is mostly fascinating. Associate in Nursing SD that’s over fiftieth of the common indicates excessive variability. as a result of aldohexose variability could also be related to each risk of long-run complications and preventative short quality of life, efforts to attenuate, measure, and manage glycemic excursions are worthy additionally to management of hemoprotein A1c.4
A extremely sensible data point is that the share of your time spent higher than, below, and among one’s target aldohexose vary. The practice range may be tailored on every code program and will be personalised for every patient. a serious goal of polygenic disease treatment is to pay the maximum amount time as potential among the practice range and as very little time higher than and below target. In our follow we tend to endeavor to realize seventieth or longer in vary and fewer than fifth of your time below vary for many of our clients recognizing that this could take time to attain. measurement time in vary may be helpful for evaluating therapeutic changes and motivating patients to continue with behaviors that are manufacturing desired results.
Data Interpretation: Trend Graph/Pattern Analysis
These are the money reports that CGM devices are far-famed. they’re conjointly the supply of tension for several clinicians. As helpful as trend graphs are, they will even be quite confusing and time intense to review. that is why it’s vital to possess a solid game set up. instead of going into the graphic reports with Associate in Nursing open mind, set yourself up with a solid agenda.
There are many valuable insights to derive from CGM trend graphs. My top 10 embrace the following:
1.?Assessing the magnitude (and timing) of postprandial aldohexose peaks
2.?crucial the effectiveness of (or want for) time of day endocrine doses
3.?Quantifying the correction factor/insulin sensitivity
4.?confirming that basal endocrine doses are set properly
5.?measurement the length of the endocrine action curve
6.?Uncovering patterns of hypoglycaemia
7.?Evaluating the treatment of hypoglycaemia
8.?Titrating glucose-lowering medications
9.?Discovering the impact of life-style events and activities
10.?Revealing system abuses or behaviors which will be sabotaging one’s management
The only factor more durable than obtaining patients to test their glucose before every meal is obtaining them to test once meals. Besides, there’s no telling precisely once the glucose level can hit its apex following a given meal. postprandial peaks seem on the CGM trend graphs (and downloaded reports) irrespective of once they happen. In most cases, it’s comparatively straightforward to identify the postmeal peaks during a trend graph report. To be sure, have your patients use the event markers in their CGM device, or match the sensing element graph with bolus/carbohydrate information from their endocrine pump. In Figure one postprandial peaks are marked with arrows on a Dexcom Daily Trends report.
n Figure two aldohexose values following a week’s price of meal boluses seem during a sensing element Overlay By Meal report from Medtronic’s CareLink Personal program.
2.?time of day coverage
For people who take time of day endocrine, observant the aldohexose pattern over the subsequent 34?h provides a decent assessment of the dose. For people who don’t take time of day endocrine, observant the postmeal pattern might indicate the requirement to switch/add glucose-lowering medications or initiate time of day endocrine dosing. In Figure three the medical care Management Dashboard (from CareLink Pro) indicates low aldohexose values following lunch (less endocrine required at lunch) and highs following dinner (more required at dinner).
3.?Correction Dose Analysis
In most cases a personality’s correction issue (or endocrine sensitivity) is reciprocally associated with the whole quantity of endocrine taken per day.57 varied conventional approaches may be accustomed estimate the correction issue, however the formulas do not work for everybody. additionally, many folks notice that their sensitivity to endocrine varies by time of day. For these reasons, it’s prudent to verify correction factors through empirical observation supported sensing element tracings. once a correction bolus is given while not a synchronous meal dose (and no food is consumed and no a lot of bolus endocrine given) for many hours, the resultant aldohexose level ought to indicate whether or not the correction issue is ready properly