8In My OpinionPhysicians treating people with diabetes (PWD) are often placed in the position of making treatment and medication adjustments solely on hemoglobin A1C (A1C) levels. A1C and finger stick blood glucose data were the best options we had for many years but lacked important detail such as high and low glucose excursions, trends, and variabilities to allow informed management decisions. Continuous Glucose Monitors (CGM) enables not only providers but PWD this data to be used retrospectively and real time. CGM systems consist of a tiny electrode or a sensor placed under the skin with an inserter, a transmitter and a receiver. The receiver can be a smart phone, an insulin pump, or a designated receiver for the CGM system. Most sensors last 10 to 14 days and are inserted by the user. Sensor reading include trend arrows which let the user know glucose trends at all times. The glucose trends include:· Glucose is steady· Glucose is moderately trending up/down = changing 30 to 60mg/dL in the next 30 minutes· Glucose is rapidly trending up/down = 60 to 90 mg/dL in the next 30 minutes· Glucose is extremely rapidly trending up/down = more than 90mg/dL in the next 30 minutes.The ability of sensors to monitor glucose trends has allowed them to be integrated with insulin pumps to create "smart pumps". The pumps have algorithms that determine automated insulin adjustments based on the current glucose level and their trends.CGMS can be downloaded and multiple reports can be generated by the healthcare professional and users. For busy providers, the CGM ambulatory glucose profile (AGP) report allows assessment of multiple metrics over a defined period on one page. Standardized targets for most adults with diabetes have been established for these metrics. The Time in Range (TIR) section of the report allows a quick view of all the glucose levels and excursions divided into 5 categories.· Time in Range (TIR) is defined as the percentage of time the glucose readings were between 70 ­ 180 mg/dL with a clinical target of over70 percent.· Time Above Range (TAR) level 1 is defined as the percentage of time the glucose readings were between 180 ­ 250 mg/dL with a clinical target of under 25 percent.· TAR level 2 is defined as the percentage of time the glucose readings where greater than250mg/dL with a clinical target of less than 5 percent. · Time Below Range (TBR) level 1 is defined as the percentage of time the glucose readings were 54 ­ 69mg/dL with a clinical target of less than 4 percent. · TBR level 2 is defined as the percentage of time the glucose GLUCOSE MONITORING WITH MEANINGBarbara Onumah, Medical Director, Diabetes and Endocrinology, Anne Arundel Medical CenterByBarbara Onumah
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