Clinical Diabetes Digital Publication
Continuous Glucose Monitoring: Optimizing Diabetes Care
Stephen Brunton, MD, FAAFP, CDCES, Editor in Chief, Clinical Diabetes, Executive Director, Primary Care Metabolic Group, Winnsboro, South Carolina | James R. Gavin III, MD, PhD, Emory University, Atlanta, Georgia | Davida Kruger, MSN, APN-BC, BC-ADM, Henry Ford Health System, Detroit, Michigan | Eden Miller, DO, Diabetes Nation, Diabetes and Obesity Care, Bend, Oregon
Continuous glucose monitoring (CGM) systems are small medical devices used to measure blood glucose continuously over the course of a person’s day and, importantly, also throughout the night. More than with A1C or fingerstick blood glucose monitoring, the data gained from CGM offer tremendous insights into glycemic control and enable both clinicians and people with diabetes to make informed adjustments to treatment plans through shared decision-making.
In this series of short videos, experts discuss the advantages of using CGM, the presentation and interpretation of CGM data, strategies to modify treatment plans, access, and affordability, and more. The discussions are designed to help clinicians determine which patients are best suited for CGM, the available options for devices and coverage, and how to use the resulting data for more informed treatment decisions and a more empowered patient.*
The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at https://doi.org/10.2337/cd22-0043 or by clicking the image to the left.
This peer-reviewed publication was developed in adherence with Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.
*Since the recording of these videos, Abbott Freestyle Libre 3 has been approved by the FDA, Dexcom's G7 is under review by the FDA, and latest Eversense CGM extends from the wear period to 90 to 180 days.
Learning Objectives
- Identify patients who are good candidates for CGM versus fingerstick blood glucose monitoring
- List the types of information provided by CGM systems
- Identify and interpret CGM data using the ambulatory glucose profile (AGP) to assess if the patient is achieving targets established by the International Consensus on Time in Range
- Modify the treatment plan based on CGM data to improve patient outcomes
Accreditation and Certification
Primary Care Education Consortium is accredited by the ACCME to provide continuing medical education for physicians. Each video episode is certified for 0.25 AMA PRA Category One Credit(s)™. This enduring material is designated for a maximum of 1 credit for viewers of all four episodes. Healthcare professionals should claim only the credit commensurate with the extent of their participation in the activity. CME is available from August 1, 2022, to July 31, 2023.
To receive 1 CME credit for viewing all four videos, click Get Credit below.
Part One Survey: Overview
Part Two Survey: Options for CGM
Part Three Survey: The Ambulatory Glucose Profile
Part Four Survey: Billing/Coding and FAQs
About the Authors
Stephen Brunton, MD, FAAFP, CDCES, is the Executive Director of the Primary Care Metabolic Group and Executive Vice President for the Primary Care Education Consortium. He works in a group practice in rural South Carolina. He holds the faculty rank of Adjunct Associate Clinical Professor at Touro University in Vallejo, California. He currently also serves as the Editor in Chief for Clinical Diabetes.
Dr. Brunton earned his medical degree at Monash University Medical School in Melbourne, Australia, and completed his residency in family practice at Long Beach Memorial Medical Center in California. He is a board-certified family physician, with a certificate of added qualifications in geriatrics. He is a former president of the California Academy of Family Physicians and the Association of Family Medicine Residency Directors and has held many positions within the American Academy of Family Physicians. He served as director of the Division of Education in the early 1980s and was a family practice residency director in California for 13 years.
A frequent lecturer, Dr. Brunton also has published numerous articles, chapters, and monographs on family medicine and related clinical topics. He has served as a reviewer for American Family Physician, CMRO, Southern Medical Journal, Expert Review of Endocrinology and Metabolism, and the Journal of Family Practice.
James R. Gavin III, MD, PhD, is a clinical professor of medicine at Emory University. He serves as Chief Medical Officer of Healing Our Village, Inc., and is Past President of the Morehouse School of Medicine in Atlanta. He also served as the senior scientific officer at the Howard Hughes Medical Institute (HHMI).
Dr. Gavin is a Past President of the ADA and Past Chair of the National Diabetes Education Program (NDEP). He served as National Program Director of the Harold Amos Program and is a Trustee Emeritus of the Robert Wood Johnson Foundation. He is also Chairman Emeritus of the Partnership for a Healthier America (PHA). He belongs to many organizations, including the National Academy of Medicine of the National Academies of Sciences. He has received numerous awards and honors, including being named a “Living Legend in Diabetes” by the American Association of Diabetes Educators (AADE), and received the Laureate Mentor of the Year Award for 2021 from the Endocrine Society. He serves on the board of trustees for Emory University, Livingstone College, and is on the board of the Association of Diabetes Care and Education Specialists (ADCES). He has published more than 150 articles and 3 books. He received a BS in chemistry from Livingstone College, a PhD in biochemistry from Emory University, and his MD from Duke University.
Davida F. Kruger, MSN, APN-BC, BC-ADM, has been a certified nurse practitioner in diabetes at Henry Ford Health System in Detroit, MI, for more than 35 years. She earned her Master of Science in Nursing degree from Wayne State University in Detroit and her Bachelor of Science in Nursing degree from Boston College, in Boston, MA. Her role includes both clinical practice and research, and she is board-certified in both primary care and advanced diabetes management. Ms. Kruger has been a co-investigator on numerous studies of diabetes interventions and care, including the National Institutes of Health-funded multicenter EDIC and ACCORD trials. She lectures extensively throughout the United States on maximizing outcomes in diabetes and diabetes management. She is a past Chair of the American Diabetes Association (ADA) Research Foundation and has served on the ADA Research Policy Committee. She is also an ADA Past President, Health Care and Education. She has published more than 50 abstracts, articles, and chapters on diabetes management and authored the 2006 second edition of The Diabetes Travel Guide. She has also served as editor-in-chief of two American Diabetes Association (ADA) journals, Diabetes Spectrum and Clinical Diabetes. Her awards include the Florence Nightingale Award for Excellence in Research; ADA’s Rachmeil Levine Award for Distinguished Service, Award for Outstanding Service in Diabetes Research Funding, Wendell Mays Award, and 2017 Outstanding Educator in Diabetes Award; the 2014 Clara Ford Award for Nursing Excellence in Research and Education, the 2014 Wayne State University School of Nursing Alumna of the Year Award, and the 2017 International Diabetes Center Donnell Etzwiler Memorial Award.
Eden Miller, DO, a board-certified family physician, received her medical degree from Kirksville College of Osteopathic Medicine in 1997. Returning to the Northwest, she completed her residency in family practice at East Moreland Hospital in Portland, Oregon. Recently completing her certification in obesity management, she is the founder of Diabetes Nation, a nonprofit organization, and is CEO and a practicing physician at Diabetes and Obesity Care in Bend, Oregon.
Dr. Miller has cultivated a special interest in diabetes since contracting type 1 diabetes while in medical school. Out of that personal experience, her practice has extended into a subspecialty in diabetes care. An impassioned speaker, Dr. Miller has given over 1,000 lectures in the field of diabetes, to health care professionals and patients alike, on subjects such as diabetes management, continuous glucose monitoring technology, insulin pump therapy, obesity, metabolism intervention, clinical research, and health care policy. Her adage for care is that she “only succeeds as a clinician if she turns patients into experts on their own disease.” Dr. Miller believes that a “physiologic patient-individualized approach to diabetes intervention is crucial to success.”
Information
Disclosures
Primary Care Education Consortium adheres to the conflict-of-interest policy of the ACCME and the AMA. All individuals in a position to control the content disclose any relationships they may have with commercial companies whose products or services may be mentioned so that participants may evaluate the objectivity of the presentations. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Only participants who have no conflict of interest or who agree to an identified mitigation process prior to their participation were involved in the CME activity.
Stephen Brunton, MD, FAAFP—Advisory Board and/or Speaker’s bureau: Abbott Diabetes, AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, Sanofi, Xeris. Stock options with Paracrine.
James R. Gavin, MD, PhD—Speaker’s Bureau and/or Consultant: Boehringer-Ingelheim, Eli Lilly, Novo Nordisk, Xeris, Abbott Diabetes Care, Salix Pharmaceuticals, Intuity Technology Inc.
Davida F. Kruger, MSN, APN-BC, BC-ADM—Advisory Board and/or Speaker’s Bureau: Abbott Diabetes, Dexcom, Eli Lilly, Novo Nordisk, Sanofi, Xeris, Medical Modular. Stock options in Pendulum.
Eden Miller, DO—Advisory Board and/or Speakers Bureau: Abbott Labs, AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Novo Nordisk, Merck. Research: Abbott Labs, Pendulum.
Gregory Scott, PharmD, RPh, editorial support; disclosed no relevant financial relationship or interest with a proprietary entity producing, marketing, reselling, or distributing health care goods or services.
All relevant financial relationships have been mitigated.
Sponsorship
This activity is sponsored by the Primary Care Metabolic Group, and the Primary Care Education Consortium.
Support
This activity is supported by an educational grant from Abbott Diabetes Care.
Acknowledgements
The authors received writing/editorial support in the preparation of video and manuscript content from Greg Scott, PharmD, of Primary Care Education Consortium. The content for this article and the associated video series were produced according to the policies of the Accreditation Council for Continuing Medical Education (ACCME). Abbott Diabetes Care had no input into the topic, forum discussion, or any content for this article and the accompanying videos.
