Continuous glucose monitoring and time in range: improving diabetes management data

The role of the nurse within the treatment of diabetes.

Knowledge is power. When an individual with diabetes knows their blood glucose level, they will higher make their very own lifestyle and drugs selections and actively take part in stopping complications. Information about glucose levels might be obtained in quite a lot of ways. Most individuals with diabetes receive glucose reports from a physician who’s capable of perform laboratory tests to find out fasting or random glucose levels, hemoglobin A1c (HbA1c or just A1c) levels, and urine glucose levels.

Nurses play an integral role by working with patients about their diabetes and providing education on the importance of glucose measurement. In the outpatient setting, nurses might help the patient adjust insulin doses and work on glucose monitoring and interpretation skills. Nurses within the hospital monitor and use glucose test results and show you how to learn self-management skills while waiting for care at home or with family.

Limitations of capillary blood glucose monitoring.

Blood glucose levels are measured at specific times of the day, similar to on an empty stomach, before a meal, two hours after a meal, at bedtime, and when symptoms of low or high glucose levels occur. However, glucometers that analyze a drop of blood taken from a fingerstick return a blood glucose value, but don’t indicate the direction of the glucose level – stable, rising or falling. Additionally, many patients only perform glucose testing occasionally or by no means as a consequence of lack of access to monitoring equipment, inability to perform a glucose test, lack of expertise of what to do with the result, or affordability issues.

A1c test.

The hemoglobin A1c test examines your red blood cells to present you a worth that reflects your average blood glucose level over the previous three months. The HbA1c value is a normal glucose monitoring measure that might help predict the danger of diabetes complications over time. While A1c is an important tool, it really works best at the side of periodic home glucose monitoring.

The A1c value will proceed for use to find out whether a patient’s average glucose level is meeting the established goal, however the principal limitation of the A1c value is that it doesn’t reveal a history of hyperglycemia and hypoglycemia. Because the A1C value is barely a mean, an individual with diabetes and their doctor have no idea whether the common glucose level is as a consequence of relatively stable blood glucose levels within the goal range over this era or whether it reflects a mean with many ups and downs. Ideal control would mean maintaining a continuing glucose level with few glucose extremes that might be dangerous and distressing to an individual with diabetes and indicate areas for improvement in glycemic self-control.

The positives of continuous glucose monitoring.

Now that continuous glucose monitoring (CGM) is obtainable, this manner of monitoring is very helpful for individuals with type 1 diabetes, who must continuously adjust their insulin doses to account for activity and carbohydrate intake. It can also be useful for determining at what times of the day your glucose levels are higher or worse controlled. People with type 2 who take insulin, have very variable glucose levels, or need to alter their medication dosage might also profit from using a CGM. Tailoring treatment is way easier for each patient and physician when data beyond the common or a single cut-off date is obtainable.

An additional advantage of CGM is that it has alarms that warn the user of impending and actual hypo- and hyperglycemia. Alarms are especially necessary for individuals who have difficulty recognizing potentially dangerous low blood glucose levels.

CGMs can measure “time in range.”

The use of CGM provided an extra measure of glycemic control. The measure is time in range (TIR), which is the time, percentage, or time that your glucose levels stay inside your goal range during a given period. Ideally, glucose levels are within the range a minimum of 70% of the time. The goal range for preprandial glucose for adults with diabetes who will not be pregnant is normally 80-130 mg/dl (3.9-10 mmol/l)but goals might be individualized based on need or lowered based on age and risk.

Applying data.

CGM data with time-in-range percentages and graphs might be viewed by the person with diabetes and a healthcare skilled for detailed interpretation and treatment guidance. Studies have shown that point in range provides information that, when combined with HbA1c levels, gives patients the chance for higher knowledge, higher control and ultimately fewer complications.

When faced with a difficult disease that requires a lot independence, effective tools similar to CGM and expert nurses as caregivers can increase motivation and make the difficult task of glycemic control manageable.

Author: Susan Renda DNP, ANP-BC, CDCES, FNAP, FAAN, Associate Professor, Associate Director, DNP Advanced Practice Program, Johns Hopkins University School of Nursing; srenda1@jhu.edu