Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile

This content originally appeared on diaTribe. Republished with permission.

By Cindy Takigawa and Frida Velcani

What’s an AGP report, and what does it show? Why does my AGP matter? How can I use an AGP report to improve my blood glucose levels and time in range?

Having diabetes is a full-time job: you have to simultaneously monitor your diet, activity, stress, and even sleep. On top of that, you need to calculate and manage the number of carbs you consume in each meal, and keep careful tabs on your blood sugar levels. The Ambulatory Glucose Profile (AGP) report, developed by the International Diabetes Center, is a tool that provides a simplified way to look at data on your blood glucose patterns and trends. It has been recognized as a standard of care for reporting continuous glucose monitor (CGM) data by the American Diabetes Association. In this article, we explain what an AGP report is and how you can use the information to help you navigate your diabetes management.

CGM App

Image source: diaTribe

What is an ambulatory glucose profile report?

An AGP report is a standardized, single-page report that includes glucose statistics like time in range, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on at least seven days of CGM data, with 14 days of data (or more) considered ideal. Currently, many CGMs include a version of the AGP report in their devices and reporting software.

An AGP report that summarizes data provided by self-monitoring of blood glucose (SMBG) is currently being developed. This article focuses on CGM AGP reports.

Why does my ambulatory glucose profile matter?

The AGP report is the same no matter what device you use – it allows your healthcare team to assess blood glucose levels and trends in a standard way for everyone they see. Below you’ll find sample AGP reports from Abbott, Dexcom, and Senseonics.

The AGP report shows patterns in a user-friendly way so that people with diabetes can easily identify the times of day when glucose levels are consistently low, high, or fluctuating. The general goal for people with diabetes is to have their glucose levels stay within the target range of 70 to 180 mg/dL for at least 70% of the day, spending less than 4% of their time in hypoglycemia (under 70 mg/dL). The information from an AGP report can help you have a discussion with your healthcare team about goals for your diabetes management and ways you can achieve them. The data offered by this report can help make your care far more precise and effective.

What exactly does your AGP show?

The standard AGP (designed by the International Diabetes Center and shown above) will show your data like this:

  • Glucose Statistics and Targets: This section displays metrics including average glucose, glucose variability, and Glucose Management Indicator (GMI), which can be thought of as your predicted A1C. It also includes the dates and number of days in the report, as well as the percent of time that the CGM was used to collect data. While time in range goals can be individualized, the expert-defined goals for various groups of people with diabetes can be found in this section. You can read more about time in range targets here.
  • Time in Ranges: This color-coded bar chart helps you visualize the percentage of time spent above and below your target range.
  • Ambulatory Glucose Profile: This graph combines all of your glucose readings over time to display your trends across a 24-hour period. At the end of this article you can find examples of what this will look like for your specific CGM.
    • Black line: the median of all the readings. Half of your glucose values are above the middle black line and half are below.
    • Green lines: this is your target glucose range.
    • Dark blue area: 50% of glucose values lie in this area.
    • Light blue area: 90% of glucose values lie in this area. This percentage may differ between AGP reports. The International Diabetes Center report includes 90% of glucose values, while the Eversense report shows 80% of glucose values.
    • Dotted blue lines: 5% of the highest and lowest glucose values are above and below this line, respectively.
  • Daily Glucose Profiles: Each box shows your glucose pattern from a single day.
    • Yellow area: instances of high glucose (hyperglycemia).
    • Red area: instances of low glucose (hypoglycemia).

How can I interpret an ambulatory glucose profile report?

An AGP report combines several days of blood glucose readings into one snapshot. Once you have identified daily patterns, you can work with your healthcare team to adjust your medications and insulin dosing to spend more time in range. You may also discuss timing of food or physical activity, what you are eating, or ways to reduce stress. Here are some steps you can take to understand your data:

1.     Look at your time in range. The goal is to shift the numbers into the 70 – 180 mg/dl target range while having fewer lows and extreme highs. Each AGP report includes a bar chart of your time in range; one way to see this goal in action is to aim for more “green” and less “red” on the bar chart.

2.    Keep track of the usual times you wake up, go to sleep, eat meals and snacks, and are physically active. Food, activity, medication doses, and dozens of other factors can affect your blood glucose levels. Recording these activities and their timing will help you understand your AGP report and the patterns you see.

3.    Identify times when your glucose levels are lowest and highest, and look for times of more variability. Speak with your healthcare professional about what factors may be causing highs, lows, and variability in your AGP and how you can reduce them. The wider the shaded blue areas on your report, the more variability there is in your glucose levels.

4.    If you can, compare your current and past AGP reports, and create an action plan with your healthcare team. What strategies did you use previously to make changes? Identify a few steps to improve your glucose patterns moving forward.

To learn more about how people with diabetes and healthcare professionals can use AGP, click here. For more resources on time in range, check out diaTribe’s comprehensive library here.

Abbott AGP

CGM App

Image source: diaTribe

Dexcom AGP

Dexcom

Image source: diaTribe

Eversense AGP

AGP

Image source: diaTribe

Source: diabetesdaily.com

Interview with Type 1 Musician Austin James

This content originally appeared on Beyond Type 1. Republished with permission.

By Makaila Heifner

Austin James is a FreeStyle Libre Ambassador and this content was made possible with support from Abbott Diabetes Care.

Austin James is a multi-instrumentalist from Hartford, Connecticut whose music blends folk, rock, and soul to create a new genre-bending sound. He recently sat down with Beyond Type 1 to answer some rapid-fire questions about his life with diabetes and musical journey.

Tell us about your diagnosis.

AJ: I was 17, a senior in high school, getting ready to start my second semester of my senior year. And I got really sick, lost a lot of weight, all the signs for diabetes. A buddy of mine in my class had diabetes, so I ended up checking my blood sugar and it was well over 600 (mg/dL) so they rushed me to the hospital and it was an overnight change.

How did you know it was diabetes? Did someone suggest that it was diabetes?

I actually had looked up the symptoms. I had known about diabetes because I was close with my friend, so I was his accountability partner which is pretty funny, because I didn’t have diabetes at the time, so I was responsible for that. I knew something wasn’t right, I told my mom, “I think I’ve got diabetes.” She was like, “No, you’re fine. You’re fine.” She just kind of saw me withering away, slowly lost about 30 pounds. I was so sick, so thirsty. And I was preparing to go into the military and everything just changed. It was pretty wild.

What would you say was the hardest part about the diagnosis?

Just the change in the trajectory of my life. I came from a military family and not be able to do that was really hard for me at the time, ended up being a blessing in disguise that I got to chart my own path and become a musician. But yeah, that was probably the toughest part.

How has diabetes impacted your music?

Well, I mean, before I was on the FreeStyle Libre system, I was doing all finger pricks and it was just really painful. I’m a multi-instrumentalist so I’ve been playing violin for 20 plus years and I play guitar and your fingers are already pretty beat up from playing the instruments and then you have finger pricks on top of that and it can get pretty painful. So that’s been the biggest challenge. And then just peace of mind when you’re going on tour and making sure you have all these supplies and making sure you’re not running short on anything. And technology now helps so much, having the pump and continuous glucose monitor (CGM) are an added layer of security there.

When you’re preparing for a tour, how do you make sure you have everything and that you’re ready to go?

I have a checklist. I’m a pretty organized person so I have my checklist ready and everything good to go. And my mom, because my mom always checks in on me. She lives in Florida, and she’s still a mom even though I’m 31, she still checks in on me. So she makes sure I have everything and she goes through the checklist with me.

What’s your favorite and least favorite part about touring?

My least favorite part of a tour is the hotel, I can never sleep in them. I like my own bed, so that can be pretty tough, but my favorite part is the traveling. I like being in new spots. I like various things, different cities, different cultures.

Who is your biggest influence for your diabetes journey?

Funny enough, obviously with the music is watching Nick Jonas. I mean, how appropriate? But watching him live a very fulfilled life, it’s pretty cool. I mean, obviously he’s a musician as well, but it makes it that much more relatable. And I think Jay Cutler, the former quarterback in the NFL, definitely those two guys for sure.

Biggest influence on your music?

I’m a big Aerosmith fan. Steven Tyler, he’s my guy.

What advice would you give to someone recently diagnosed with diabetes?

That it is tough, it’s going to be a hard road. You’ve got to be honest with them, but at the end of the day, you can really live a fulfilled life. And the technology we have now has come so far and not to get too down. You can really live a full life and it is possible. And if you really do take care of yourself, you can live a healthy life as well.

Watch Austin speak about his CGM below, and check out his music HERE

Source: diabetesdaily.com

Ketoacidosis Rates Plummet with Continuous Glucose Monitoring Use (ADA2020)

Maintaining their target blood glucose levels as much as possible is critical to preventing various health complications for all people with diabetes. One deadly outcome of high blood glucose levels is diabetic ketoacidosis (DKA), which is a life-threatening emergency, but one that can typically be prevented with optimal glycemic management.

Checking blood glucose levels regularly and making the appropriate medication adjustments to keep in a safe blood glucose range is a challenge for many. Due to various factors, including sometimes a lack of access to a sufficient amount of test strips, patients may not be checking their blood glucose level as frequently as recommended.

Continuous glucose monitoring (CGM) technology is a relatively new development in diabetes care, but has already been shown to benefit many patients as related to glycemic management, mental wellbeing, and overall quality of life. By providing users with almost real-time data of their glucose levels, couples with the ability to set alarms to address blood sugar values that are out of range, prior to developing an emergency situation appears to be a critical tool to help people with diabetes better manage their condition and help safeguard against critical situations like severe hypoglycemia or DKA.

A new study conducted by a team of French researchers has just revealed striking results that underscore the benefits of CGM access for patients. The researchers just presented the major outcomes of the study at the American Diabetes Association (ADA) 80th Scientific Sessions this weekend.

Study Design

The researchers conducted a retrospective analysis of nationwide DKA records for patients with type 1 and type 2 diabetes one year prior to the initiation of the use of Abbott’s Freestyle Libre system and compared it to the recorded DKA rates one year after the initiation of CGM use in this population. Data from a total of 33,203 patients with type 1 diabetes and 40,955 with type 2 diabetes were included in the study.

Major Outcomes

The differences in the DKA rates before and after CGM use were striking. Overall, the rate of DKA decreased by 52% among those with type 1 diabetes and by 47% among those with type 2 diabetes. Furthermore, the researchers evaluated the impact of CGM technology on patients with different self blood glucose monitoring (fingerstick frequency) habits. The data revealed that the reduction in DKA rate was the most dramatic for those who do not check their blood glucose level daily, as well as for those who check their blood glucose more than five times per day. In fact, the baseline DKA rates were the highest for these two groups. This may seem counterintuitive, but it is likely that patients who check frequently may be doing so because of difficulty in managing their condition.

Roussel et al. (Presented at ADA 2020)

Conclusions

This retrospective analysis of data from a large cohort of patients prior to and after the use of CGM technology suggests that CGM use can help to dramatically decrease the incidence of DKA. The observed improvements in DKA rates were the most pronounced for those who check their blood glucose very little, but also for those who check frequently (more than five times per day). Overall, the study results highlight the potential health benefits of CGM use in preventing DKA in a very large group of patients. Unfortunately, today, access and affordability of CGM systems still remains a challenge for many patients.

Source: diabetesdaily.com

What’s Coming and What’s Delayed in Continuous Glucose Monitoring?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

Updates and delays from Abbott, Dexcom, Medtronic, and Senseonics

With several clinical trials on hold due to the COVID-19 pandemic, we’re bringing you a roundup of the latest updates on future continuous glucose monitors (CGM). Understandably, the FDA also announced a few months ago that it would focus its efforts on devices related to COVID-19. With the disclaimer that it’s impossible to know exactly when the pandemic will subside, when trials might resume, and how FDA reviews might be affected, here is the latest news we’ve heard from companies.

Click to jump to a product, which are organized alphabetically.

Abbott FreeStyle Libre 2

CGM

Image source: Abbott FreeStyle

What’s new? FreeStyle Libre 2 keeps the same “scanning” feature as the original FreeStyle Libre, but adds Bluetooth connectivity. This is important because it enables optional high and low glucose alerts. Users who enable these alerts will be able to get a notification on their reader or phone whenever their glucose reading goes above or below their specified ranges. Looking ahead, the Bluetooth feature will also allow FreeStyle Libre 2 to be part of automated insulin delivery systems (AID), like Insulet’s Omnipod Horizon.

Like the original FreeStyle Libre, FreeStyle Libre 2 has 14-day wear, is factory-calibrated (no fingerstick calibrations required), and can be scanned with either a phone or a reader device (the reader for FreeStyle Libre 2 is blue, instead of black). Importantly, FreeStyle Libre 2 will be offered at the same price as the original FreeStyle Libre.

When’s it coming? The FreeStyle Libre 2 has already launched in a few European countries (we know of Germany and Norway) and will launch in others soon. In the US, FreeStyle Libre 2 has been under FDA review for over a year. In March, Abbott said that it was working through “some finishing items” and was “very confident” the device would be cleared soon.

Dexcom G7

Dexcom

Image source: Dexcom

What’s new? Dexcom’s G7 will be fully disposable (the transmitter and sensor are combined and thrown away together) and have longer wear (we believe somewhere around 14-16 days). Remember that the Dexcom G6 sensor lasts for 10 days but has a transmitter that is re-used for 90 days. The G7 will be considerably slimmer than G6 and will have a lower cost of manufacturing in bulk, though consumer pricing is not yet determined – we imagine it will be similar. The G7 will keep the same accuracy, no fingerstick calibrations, and Bluetooth connectivity as the G6.

Dexcom has been developing G7 in partnership with Verily, the division of Alphabet formerly known as Google Life Sciences. There has been mention from Verily that an accelerometer may also be built-in to the G7 device, but we aren’t sure if that feature made it into the final version of G7. Having a built-in accelerometer could allow the G7 to also track physical activity, like a Fitbit or other fitness tracker.

When’s it coming? Dexcom planned on launching G7 in “early 2021,” but with most clinics placing new trials on hold, Dexcom is expecting a “minimum delay of approximately six months.” It’s difficult to know when clinics will be able to conduct trials (and when people will feel comfortable enrolling in trials), but assuming a six-month delay, G7 could be on the US market sometime in the second half of 2021.

Medtronic “Project Zeus” CGM

Abbott FreeStyle

Image source: Medtronic

What’s new? Medtronic’s next CGM, referred to as “Project Zeus,” will reduce the number of required fingerstick calibrations and have improved accuracy (compared to its current offering, Guardian Sensor 3). The new CGM will require day-one calibration (unclear on the number of fingersticks that will be required on day one), compared to Guardian Sensor 3, which requires at least two fingerstick calibrations every day. Medtronic expects Project Zeus to launch with a “non-adjunctive” indication, meaning users will be able to bolus insulin based on CGM reading alone, and not have to perform a confirmatory fingerstick. the new CGM will keep the same seven-day wear, size and shape, and reusable transmitter component as the Guardian Sensor 3 (pictured above).

When’s it coming? The trial for Project Zeus began in June 2019 and is expected to wrap up within the next month. Medtronic expects to submit the CGM to the FDA by the “end of the summer.”

Senseonics Eversense XL (180-day)

Eversense XL

Image source: Eversense XL

What’s new? The “XL” extended life-version of Senseonics’ Eversense in the U.S. will have the same size and features as the original Eversense, but the Eversense XL is implanted for 180 days, rather than the 90-day Eversense. As a reminder, the Eversense sensor is implanted in the users’ upper arm in a clinic and remains there for the sensor duration; a silver-dollar sized on-body transmitter is worn on the outside of the arm to deliver readings to a smartphone. Senseonics is targeting reducing calibrations from 2 per day to 1 per day with same non-adjunctive indication.

When’s it coming? Eversense XL is already available in Senseonics’ European markets. The trial for Eversense XL in the US wrapped up in late March, and Senseonics has previously aimed for FDA clearance in “late” 2020. We aren’t sure whether that timeline has been pushed back due to COVID-19, but the fact that the trial has already completed is encouraging.

Source: diabetesdaily.com

Omada’s Type 2 Diabetes Coaching Program Will Now Include Abbott FreeStyle Libre

This content originally appeared on diaTribe. Republished with permission.

By Emily Fitts

Omada Health and Abbott partner to bring FreeStyle Libre to Omada Health’s digital coaching program for people with type 2 diabetes

Under a new partnership between Omada Health and Abbott, participants in Omada Health’s type 2 diabetes program will receive the FreeStyle Libre continuous glucose monitor (CGM). Any person with type 2 diabetes who is enrolled in Omada’s program will be eligible to receive FreeStyle Libre following a personal online consultation with a doctor. The FreeStyle Libre will be delivered directly to the participant’s home.

When the FreeStyle Libre is scanned, glucose data will be sent to the Omada Health app and will be available for users to see patterns, track progress, and get personalized recommendations from their assigned coach. This technology enables coaches to give specific advice based on unique patterns and allows users better understand the way their daily decisions affect their blood sugar, as well as mood, weight, sleep, and more.

Omada’s type 2 diabetes program provides participants with an app, access to coaches, connected devices (including a wireless weight scale, blood pressure meter, glucometer, and now a FreeStyle Libre CGM), educational materials, and a peer support group, all of which aim to help people change their behavior using tailored coaching and care.

Beyond type 2 diabetes, Omada offers programs for prediabetes, hypertension, and anxiety and depression. In particular, Omada’s original program – a digital version of the Diabetes Prevention Program (DPP) – is the largest digitally-delivered DPP in the US and has shown positive results for participants in terms of weight loss and A1C reduction.

Omada’s programs are primarily offered through employers and health plans that cover the costs of the program, although individuals can sign up independently and pay for the program themselves. Take this short survey to see if you are eligible.

To find out about other similar programs, read our article on how to get unlimited test strips and personal diabetes coaching.

Source: diabetesdaily.com

How to Use FreeStyle Libre Trend Arrows to Adjust Insulin Doses

This content originally appeared on diaTribe. Republished with permission.By Jimmy McDermott, Maeve Serino, and Adam Brown New Endocrine Society guidelines for FreeStyle Libre users to adjust insulin doses based on trend arrows. Plus, additional guidelines on scanning time and frequency The Endocrine Society recently published guidelines on adjusting insulin dosing based on FreeStyle Libre continuous glucose monitor […]
Source: diabetesdaily.com

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