How Much Monitoring is Too Much?

Jun 26, 2018
4,523 views

What I love about going to conferences is the realization that what I’m doing in my practice is in line with what others I respect are doing. That is meaningful, and I always learn a new pearl. If that’s all I gain from these conferences, it’s okay, but it’s usually more than that.

I have just returned from the 2018 ADA Conference, where there was so much about new technology, particularly continuous glucose monitoring.

I do recommend the use of CGMs for most if not all of my patients who have diabetes, and some who have prediabetes but just want to know more about their health. Although I do look at the data, I was not counting on how often patients look at their numbers. I am aware that some people just learn from the data they receive; they look often and make changes. Then there are others who change the way they eat and their activity level on their own, while there are others who will work closely with us to help them with their food, activity, and medication changes.

What I learned goes with the Standards of Care and the way we work in real life. There are different types of “looking” that patients do, including age-related monitoring, which is acceptable.

One example comes from a symposium I attended, Flash Continuous Glucose Monitoring, Clinical Real World and Patient Perspectives. Dr. Irl Hirsch, MD, Professor of Medicine at the University of Washington Medical Center, Seattle, Washington talked about adult patients. Some didn’t monitor their data enough to have enough to work with. Some looked too often, like the “engineer” type who may want to fix it every time he looks, which can be often, but then may overreact and cause more variability. Dr. Hirsch said that maybe checking 10 times a day would be an acceptable number of times to look.

On the other hand, according to the second speaker, Dr. Kurt Midyett, MD, Clinical Endocrinologist, St. Luke’s Hospital, Overland Park, Kansas, who works with adolescents, some of these patients hardly check their fingersticks. However, some of those who use CGMs will monitor more closely and he’s happy to see these people looking 3 or 4 times a day. More is great, but he likes to at least see them engage.

So once again, an important takeaway is the need for individualized patient care, which includes shared decision making.

Lessons Learned:

Be aware of how often a patient or loved one looks at their numbers. Discuss with patients what seems acceptable to them and, using your professional judgment, recommend a number of times to check daily, explaining that there may be times when more or less checking is needed.
I think in time we will have more formal recommendations for how often patients should look at the numbers.

Joy Pape, FNP, CDE
Medical Editor, Diabetes In Control

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Joy Pape, FNP-C, CDE
Medical Editor
Diabetes In Control

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