Kristine Batty, PHD, APRN, BC-ADM, CDCES, FADCES joins this episode of Danatech Talks–a special series from The Huddle– to provide a high-level overview on continuous glucose monitors (CGMs). Kristine touches on the basics of how CGMs work, what CGM devices are out there today, what the different devices measure, and how CGM technology impacts clinical decision making. This episode was supported by educational grant funding from Abbott. Explore the latest in diabetes technology as well as trainings and resources on danatech: danatech l Diabetes Technology Education for Healthcare Professionals Listen to the first episode of our Danatech Talks diabetes technology series: https://thehuddle.simplecast.com/episodes/basics-diabetes-technology-for-health-care-professionals
Kristine Batty, PHD, APRN, BC-ADM, CDCES, FADCES joins this episode of Danatech Talks–a special series from The Huddle– to provide a high-level overview on continuous glucose monitors (CGMs). Kristine touches on the basics of how CGMs work, what CGM devices are out there today, what the different devices measure, and how CGM technology impacts clinical decision making.
This episode was supported by educational grant funding from Abbott.
Explore the latest in diabetes technology as well as trainings and resources on danatech: danatech l Diabetes Technology Education for Healthcare Professionals
Listen to the first episode of our Danatech Talks diabetes technology series: https://thehuddle.simplecast.com/episodes/basics-diabetes-technology-for-health-care-professionals
Dana Moreau
Welcome to Danatech Talks, a special series from ADCES's The Huddle: Conversations with the Diabetes Care Team, powered by ADCES. I'm Dana Moreau of Danatech, and in this series, we dive into the latest in diabetes technology, bringing you expert insights, clinical strategies, and the innovations shaping patient care. Whether you're new to diabetes tech or looking for the next level of expertise, Danatech Talks is your source for real-world knowledge.
Today's podcast is funded thanks to an educational grant from Abbott. Today, we're joined by Kristine Batty, who's going to be talking to us about all things CGM: what devices are out there today, what they measure, and how technology impacts clinical decision-making. Kristine, welcome to The Huddle.
Kristine Batty
Thanks so much for having me. I'm excited to be here.
Dana
We're glad to have you and I know we've had you on this show a few times, so we're always happy to have you back. For those who haven't heard you speak before, which I'm sure is a very small number, before we get into the discussion, what would you like to tell our audience about yourself and also any insights on why this topic is important to you?
Kristine
I have been a diabetes nurse practitioner and certified diabetes care and education specialist for about 20 years. I have had the opportunity to see the growth of technology and it is truly a passion of mine. I really do believe that every person with diabetes needs to have a CGM and that's what brings me to this podcast.
Dana
That's great. We obviously believe the same things here. For this podcast, we're kind of going back a little bit to the basics. So let's start there. For health care professionals who are brand new to CGMs, what do you think is the simplest way to explain what they are and what they do?
Kristine
CGMs honestly are one of the biggest advances in diabetes care, diabetes treatment. Simply, they are devices that are worn on the body. There's a small monofilament that goes under the skin, measuring glucose in the interstitial fluid. It measures the glucose every few minutes and gives a much more comprehensive picture of glucose trends, obviously over about 24 hours.
Dana
And that's a good foundation, sort of sets the stage for understanding the rest of the discussion. What are the most common CGMs in use today? How do they differ? How would you think about one versus another?
Kristine
I think that most people identify the names Dexcom and Freestyle Libre, but there's certainly others. Medtronic is another company that has a few options of CGM. There is the Eversense CGM, and now we have over-the-counter CGMs. One is called Stelo, made by Dexcom, and the other is the Lingo, made by Abbott. The differences between these devices truly is about the accuracy, the connectivity, are they connecting to your phone app, or do they have a handheld receiver, are they connected to insulin pumps? Wear time is another big component. Some are seven-day wear, some are 15-day wear. So those are the things that people need to consider when they are asking a person with diabetes about whether they are interested in a CGM, and to help make that determination of what their needs are.
Dana
And you mentioned, I mean, the Dexcom G7 versus like a Dexcom Stelo. What are the core differences between those types of CGMs?
Kristine
The over-the-counter devices specifically, they're not indicated for people with type 1 diabetes. They really are indicated for people with type 2 diabetes, or with pre-diabetes. If the person is having problematic hypoglycemia, say, you would not want to use the over-the-counter devices because they do not have alarms to warn the person that their blood glucose is dropping. So that is a big safety issue when you're thinking about using an over-the-counter device versus say the Dexcom G7 or the Libre devices, they will give the warning. They will say you're dropping or rising too fast or you are going to have low blood sugar in 20 minutes. Those other devices are also able to integrate with different insulin pump devices or smart pens. So they are very different even though they are both continuous glucose monitoring.
Dana
And that makes sense, pretty big differentiators there. And that would be why, again, not all CGMs are indicated for all types of diabetes.
Kristine
Exactly, exactly.
Dana
Let's talk about the data that CGMs provide. What data specifically is it giving to the person with diabetes or the health care provider? And how does that data influence how you might care for a patient?
Kristine
Well, I think when C-CHAMPS came out, it really was awe-striking to see all the data. You think about the patient that comes in the office, provides a log book of, here are my blood glucose, and they're doing a point of in the moment testing, little finger stick, and eight o'clock every morning, the blood glucose is 120. But their A1C is 8.4. Well, my numbers are always normal. There's a mismatch.The data that these devices provide reveals where the problem areas or the areas that need improvement are. So I think that as you're able to see all that data, it really does help identify where the treatment modification has to go.
Dana
So give me maybe like a practical example of that, like something you would see and how that might change how you'd assist the patient.
Kristine
Well, there's a couple of different things, but one specifically is identifying hidden hypoglycemia. You know, hypoglycemia is one of the most important aspects of diabetes treatment. We have to identify it. We have to mitigate it. That can't be allowed in this treatment plan. But the other piece is looking at, say, the post-parandial hyperglycemia that's occurring that no one realized was there before. That's usually a very startling thing when people first see those trends.
Dana
Interesting. So one of the things that we talk about a lot is time in range, and it's an important metric. Can you talk about time in range and how CGM affects time in range or how it's related?
Kristine
Sure, time in range is really one of the biggest things we look at truly on these devices. It measures how often or gives the data on how often the blood glucose is in target range, hence the name. But the target range is usually between 70 and 180, and that can be modified based on the person's needs. Looking at those numbers, looking at that percentage, and then comparing the percentage to, again, where the problems are, it helps the person with diabetes make an adjustment in, you know, their behavior for the moment. I'm not going to eat such and such, or I am going to eat such and such, or how their exercise may impact their glucose. But then it also helps the provider and the person with diabetes really look at how their medications may be impacting and where the adjustments may be made.
Dana
Yeah. And clearly time and range is an important metric. But are there other must-know metrics in CGM data that you need to understand that you're looking for, and how do those numbers impact?
Kristine
Yes, absolutely. It seems like I'm really harping on hypoglycemia, but..
Dana
It's an important topic.
Kristine
It's certainly an important topic. And truly finding those hidden hypoglycemic events is really essential. So one of the first things you look at is how often is the hypoglycemia occurring? You're looking at the overall picture. What is the percentage of hypoglycemia indicated by low or very low categories? The other thing that I have a tendency to look at next is variance. Is there a big swing? Is the person with a blood glucose at one point, say 300, and then very suddenly or precipitously dropping into hypoglycemia or low target range? Those two pieces are really a safety issue. So that's what I really focus on when I'm talking to people with diabetes, but also providers who are learning about CGM interpretation.
Dana
Okay. So in thinking about this from a health care provider or professional who is truly new to CGM and thinking about the CGM downloads–what’s the first thing that they should be looking at when they're taking a look at the downloaded reports?
Kristine
There is a model, it's called DATAA, D-A-T-A-A is the acronym, and it really does walk through step by step how to look at these reports. But first thing to look at, honestly, is how often is the device being used? Because you're looking at the overall report, and it's, wow, you're 99% in target range, but you only wore the device one day. So you have to be aware of what you're looking at.
Dana
Okay.
Kristine
The next, again, assessing for safety, which is the first A in the data acronym. Again, hypoglycemia. The next would be time and range and areas of improvement and then action plan. Keep it simple. Then as different issues are coming up or the person with diabetes is learning more about their trends, then you can get into the nitty gritty. Then you can say, oh on weekends your trending is this, or when you're at work your trending is that. Right now, when you're starting out, keep it simple and look for the target areas, the highlighted safety issues.
Dana
But moving, like more into what you're saying. So then you've got the basics and then you start digging in. You've got trend arrows and you've got alerts and this sort of helps bring that data to life. What role do trend arrows and alerts play in clinical decision making?
Kristine
Well, there's two parts of clinical decision making, and I keep emphasizing the person wearing the device living with diabetes and the clinical provider. Looking at trend arrows, there could be an immediate response by the person wearing the device, “oh my goodness, I am rising at a very rapid rate, therefore I can use my medication or habits to try and correct that problem”. As the provider looking at the data and seeing how many alarms are occurring. And then is it high, is it low? That will also help identify where they need to focus. If every afternoon there's alarm notifications on the report, that really will draw the attention to what needs to be done at that particular part of the day.
Dana
Any other kind of quick examples of how CGM data helps you adjust for specific patient care?
Kristine
I have several examples, of course after doing this for so long.
Dana
I didn't think you would be at a loss for words on this.
Kristine
Exactly. I remember very clearly back when CGMs first came out, truly. Gentleman of mine, he was in his late 80s. He was getting ready for knee replacement surgery. I put a professional CGM, let's see, we're really going back several years ago, to get him cleared for his surgery. Now, his A1C was appropriate for his age, but I just wanted to make sure things were okay. He was having blood glucoses of 50 every night when he was sleeping and never had any idea.
Dana
Oh wow.
Kristine
Right. His fasting blood glucose when he was doing his finger stick was, you know, totally within his range, but we never knew that he was sleeping through hypoglycemia. And it really was startling and I was able to identify the problem and adjust his medication. I also was able to demonstrate to the primary care provider by sending the report saying, this is what I did, this is why I did it, and please keep this in mind for the future when you are looking at his medicine.
Dana
And this is why I love CGMs because it's that old adage, if you can't measure it, you can't manage it. So all the information it provides is...
Kristine
You think back and you say, how did we live without these devices?
Dana
I know, and we never want to live without them again. Unless there's a cure, and then we'll look at that when we come to it.
Kristine
For sure.
Dana
So in thinking about, again, our health care professionals who are new to CGM, sometimes, again, all of this data can feel like a lot. So let's talk a little bit about managing that so it's not overwhelming. What can health care professionals do to avoid feeling that it's too much data and it's overwhelming, and I don't know if I want to deal with this?
Kristine
Well, first and foremost, I want to really make sure that everybody is working with a CDCES. You have to create a team for working with the person with diabetes, everything from assessing what the patient's need is to assessing the data. So if there's a team component for everybody to take their role in uploading the data, talking with the patient, what are those problems, then looking at the data together, that will make it much less overwhelming. And again, just going step by step in that particular data model really does break it down so that you're really focusing on what's needed in that moment. Later on, you can go into the nitty gritty, and that comes with learning. The other thing that I would strongly recommend is going onto danatech and looking at the information about these devices. How to interpret the data is an option to learn on danatech. There's videos, there's links to the companies. Make sure you're reading up on that and becoming educated. Don't go out and just decide to do it without that education because it makes it much more difficult.
Dana
I completely agree. So as we wrap this up, any parting thoughts, anything you want to leave people with?
Kristine
Prescribe CGMs for everybody.
Dana
Yeah. Everybody’s a good candidate.
Kristine
Exactly. Work with the team identifying what's the appropriate device for that patient. But also, again, focus on looking out for the hypoglycemia. Eliminating hypoglycemia will help hyperglycemia. It's a cause and effect. These devices create a safety net. They are a safety net, and we need to make sure that we are using them as such and then again moving into the more advanced assessment for the hyperglycemia and different trending. But this is a huge safety net for people and we need to make sure that everybody has it and we know how to use it for that point.
Dana
Perfect. Well, Kristine, you know, I always love talking to you. So hopefully we'll have many other podcasts in the future.
Kristine
I look forward to it, yes.
Dana
So thank you again for joining us. For our listeners, if you're looking to learn more about CGMs and diabetes technology, as Kristine kindly pointed out, please explore the resources we have available to you at danatech.org, specifically under glucose monitoring and in our education areas as well as in our tools section. We're building new ones, some that are now AI augmented every day to make sure you've got the information and the education that suits where you are on your journey into diabetes technology.
Thank you for listening to this episode of Danatech Talks, part of The Huddle: Conversations with the Diabetes Care Team. We'll include links to key resources in the show notes. And remember, being an ADCES member gives you access to exclusive education and tools to support your practice. Learn more at adces.org/join.
As a disclaimer, the information in this podcast is for informational purposes only and may not be appropriate or applicable for your individual circumstances. This podcast does not provide medical or professional advice and is not a suitable substitute for consultation with a professional. Please consult your health care professional for any medical questions. Thanks so much.