Table 1.

Advice and Recommendations for Safe, Effective CGM Use.

1.  Users should be encouraged to wear the CGM as much as possible and look at the receiver frequently. The clinical benefits of rtCGM are only realized with frequent, persistent use. 2.  Users should set reasonable expectations for their CGM. CGM is an excellent tool, but it is not perfect. It is important to calibrate as instructed by the manufacturer to minimize false readings and alarms. 3.  Confirmation with SMBG is sometimes needed. If the CGM device does not display a sensor glucose reading or is displaying inconsistent readings, users should perform a fingerstick blood glucose value for diabetes treatment decisions. Fingerstick testing should also be performed if glucose alerts and readings do not match symptoms or expectations. 4.  Alerts and alarms should be viewed as critical components of CGM use. Users should be encouraged to use the high and low alerts and modify them over time. However, setting the alarms too aggressively at initiation can result in alarm fatigue. Therefore, it is recommended that as control improves, the alarms can be narrowed to encourage tighter control. 5.  Users should have a plan for preventing or responding to low glucose. Users should be instructed to respond immediately to low glucose but not overreact. Users may not see the effects of treatment with carbohydrates for more than 15 minutes. Additionally, as CGM devices alert caregivers, a discussion with friends and family on how to respond to alarms is encouraged. 6.  Respond to high glucose between meals but avoid “stacking” insulin. Constantly seeing high glucose values can lead to frustration and inclination to bolus repeatedly. Therefore, users should be reminded that rapid-acting insulin can take up to 90-120 minutes to peak and may still be working 3-5 hours after their last injection. Stacking insulin poses a high risk for hypoglycemia; whereas, administration of conservative insulin doses, guided by CGM data, mitigates this risk. 7.  Users should be encouraged to utilize the ROC information to make treatment decisions. As mentioned in this article, this trend affects meal timing, insulin dosing, and many other aspects of T1D management. Doing “correctly” takes time, but will come with experience and guidance from their clinician.

Seven important points that HCPs should review with their patients using CGM. The success of the patient will be much greater with education regarding the best practices for CGM.