Continuous Glucose Monitoring and Time in Range: Improving Data for Diabetes Management

Nursing roles in diabetes management.

A continuous glucose monitor reader (or a smartphone app) scans the sensor attached to the patient’s body for interstitial fluid glucose level and can provide data such as average blood glucose level or percentage of time spent in a target range over a given period of time.

Knowledge is power. When a person with diabetes knows their blood glucose levels, they can better self-manage lifestyle choices and medications and be an active participant in preventing complications. Glucose information can be obtained through a variety of methods. The majority of people with known diabetes receive reports on their glucose from the health care provider who is able to do lab work to obtain fasting or random blood glucose level, hemoglobin A1c (HbA1c, or just A1c) level, and urine glucose.

Nurses play an integral role to partner with the patient about their diabetes and provide education on the meaning of glucose measurement. In the outpatient setting, nurses can help the patient adjust insulin dosages and work on glucose monitoring skills and interpretation. Inpatient, nurses oversee and utilize glucose results and help with self-management skills in anticipation of care at […]

What Nurses Need to Know About Continuous Glucose Monitoring

Case 1. A 27-year-old man has had type 1 diabetes for 19 years. His hemoglobin AIc level prior to starting RT-CGM [real-time continuous glucose monitoring] was 9.4%. . . . Over the 15 months of RT-CGM use, he was able to decrease his hemoglobin AIc level to 7.7% and maintain it at that level for several months. After he stopped using RT-CGM because his insurance didn’t cover sensors, his hemoglobin AIc level rose to 8.5%. When he got a new job and was able to resume use of RT-CGM, after three months his hemoglobin AIc level had once again decreased, this time to 7.9%.

Case 2. A 10-year-old girl has had type 1 diabetes for almost three years. Her hemoglobin AIc level before starting RT-CGM was 9.8%. By five months after starting RT-CGM her hemoglobin AIc level had decreased to 7.2%. After discontinuing sensor use because of the high cost of RT-CGM supplies and a lack of insurance coverage, her hemoglobin AIc level rose to 8.2%.

The above are composite cases of patients with type 1 diabetes who used real-time continuous glucose monitoring devices as a tool to improve their blood sugar control. They’re from an article in the April issue of AJN that gives a balanced overview of this technology, including how it works, its current uses (as a diagnostic tool, a warning system for hypo- and hyperglycemia, and a way to improve long-term glycemic control), its coverage and costs—and its advantages and disadvantages, […]

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