dromlakhani Assess factors influencing success with CGM
STEP 1 — Gather Information
Collect patient understanding that CGM does not replace SMBG, self-care behaviors influencing success, knowledge of CGM components (receiver, sensor, transmitter), comprehension of how CGM data differ from SMBG, ability to use trend data for insulin adjustments, SMBG calibration practices, sensor site selection and care skills, alarm settings preferences, and psychosocial factors (motivation, lifestyle, barriers).
STEP 2 — Rule In / Rule Out
Determine if the patient understands CGM is adjunctive to SMBG and is willing to perform required SMBG calibrations; if not, rule out CGM initiation until education addresses this gap.
STEP 3 — Classify or Stratify
Classify readiness: (A) Ready – understands adjunctive role, willing to calibrate, has adequate dexterity/site care ability, motivated; (B) Conditional – deficits in knowledge or site care but correctable with training; (C) Not suitable – unwilling/unable to perform SMBG, severe cognitive/physical impairment preventing use, or lack of insurance/access.
STEP 4 — Decide
If Ready: proceed with CGM prescription and initial training. If Conditional: schedule targeted education sessions addressing specific gaps before initiation. If Not suitable: defer CGM and explore alternative glucose monitoring strategies.
Clinical Guardrails / Mimics / Pitfalls
Do not assume CGM eliminates need for SMBG; avoid overlooking alarm fatigue by not customizing alerts; neglect sensor rotation leading to skin irritation; fail to assess financial/insurance coverage for sensors; ignore psychosocial barriers like depression or low motivation that impair adherence.
Concrete Clinical Example
A 34‑year‑old with T1DM, A1C 8.6%, expresses interest in CGM, understands it complements fingersticks, agrees to twice‑daily calibrations, has good dexterity, no cognitive impairment, and insurance covers sensors → classified as Ready; CGM prescribed and training scheduled.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2534