Continuous Glucose Monitoring Information Session [Text on screen: The Ohio State University Wexner Medical Center Continuous Glucose Monitoring. Diabetes Care & Education Team The Ohio State University Wexner Medical Center Division of Endocrinology Basics of CGM therapy FDA approved CGM options Next steps] Speaker: Welcome to the Continuous Glucose Monitor Information Session brought to you by the certified diabetes care and education specialists with the Ohio State University Wexner Medical Center Division of Endocrinology. A continuous glucose monitor will be referred to as a CGM throughout this video. We will be reviewing the basics of what a CGM is and how it works. We will then cover each of the FDA approved CGMs that are available. And lastly, we will discuss the next steps in obtaining the device. Please note that there is a link for a short survey at the end of the session for you to communicate your device preferences with the education team. [Text on screen: What is Continuous Glucose Monitoring? - Continuously monitors sensor glucose 24 hours / day - Displays sensor glucose readings every 1-5 minutes - Shows ongoing stream instead of single snapshot - Can be used alone or with an insulin pump - Speed and direction of blood sugar - Optional alert features - High or low sensor glucose - Rising or falling sensor glucose] A CGM is a device that tracks glucose levels in real time, 24 hours a day, and updates readings every one to five minutes. CGMs can be used alone or with an insulin pump and can be used for people with both type 1 and type 2 diabetes. A blood glucose meter provides a single snapshot of where your glucose level is, while a CGM is like a video that provides a continuous stream of information on glucose levels, trends, and overnight data. Not only does it provide a sensor glucose value, but it will also show you the speed and direction that your glucose is headed. Another helpful tool is the optional alert feature. Most sensors have high and low alerts that can be individualized for the user. You may also choose to have alerts when your glucose is rising or falling rapidly. [Text on screen: CGM Supplies - Sensor: placed under the skin and held in place with adhesive patch - Transmitter: sits on top of the sensor and sends glucose readings to receiver - Receiver (or compatible smart device): displays data There is natural lag time between glucose levels in the interstitial fluid and glucose levels in the blood.] There are three main parts to the CGM system. The sensor is the piece that is placed directly under the skin and held in place by an adhesive patch. The transmitter wirelessly sends the glucose reading to the receiver. Lastly, the receiver, which may also be your smartphone if you have compatibility with the mobile app, will display your sensor glucose data. The sensor is measuring the interstitial glucose level, which is the glucose that is found in the fluid between the cells. Due to this, the sensor data can be approximately five to 15 minutes behind the actual blood glucose level. [Text on screen: CGM Advantages: - Trend arrows - Detects asymptomatic hypoglycemia - Alerts when glucose is above/below target - Alerts for rapid rise/fall in glucose - Ability for user to share glucose alerts with a friend or family member CGM Disadvantages - Cost - Does not replace all monitoring - Skin sensitivities - Two insertion sites if user is also wearing an insulin pump - User may feel overwhelmed] There are many advantages of CGM therapy. It provides more than just the static number. It also provides the trend information in real time so you know where you are headed. With this glucose trend information, you are in a better position to make an informed choice on what to do about your current glucose level. By having personalized alerts, it can help you detect low blood sugar that you may not feel coming. It can also help you catch the highs that you may have otherwise missed. Some of the CGMs allow for the user to share glucose information, including alerts, with friends and family members. CGM data gives the user a visual representation of their patterns on a daily basis. This helps to assess the effectiveness of your current insulin doses as well as the effects of food and exercise on glucose levels. As previously mentioned, CGMs can be combined with certain insulin pumps, but can also be an extremely effective tool to use on its own. Despite the many benefits, all technology can have some drawbacks. There is an upfront cost for the CGM system as well as the ongoing cost of supplies. It does not entirely replace finger sticks, although it can significantly reduce the frequency of them. Some CGMs do require calibration. Calibration is the process of entering a blood glucose reading from your meter to calculate the sensor glucose values. Finger sticks are recommended anytime your symptoms do not match your sensor glucose reading. Due to this, you will want to make sure you still have your glucose meter and test strips. Some people experience skin sensitivities from the adhesive tape, however, there are many products out there that you can use on your skin to prevent or alleviate this. A sensor is something that is worn on the body. If you are wearing both a pump and a CGM, this is two insertion sites to get used to and two site changes to keep up with. Finally, CGMs provide a lot of data so it is possible to feel overwhelmed. Sometimes it may feel like there are too many numbers to know what to do with. A training with a diabetes care and education specialist is essential in helping you better understand how to use your system, interpret the data, and make appropriate treatment decisions. [Text on screen: CGM Options - Dexcom - Freestyle Libre - Eversense - Medtronic Guardian Connect] There are four CGMs available at this time. These are Dexcom, Freestyle Libre, Eversense, and Medtronic Guardian Connect. [Text on screen: Dexcom Two Systems: Dexcom G6 & G7 Dexcom G6: 2-hour warmup, sensor & transmitter are separate. Dexcom G7: 30 min warmup, sensor & transmitter all in one. - Sensor life: 10 days - No calibrations required - Updates every 5 minutes - Customizable alerts - Can share data with followers - Generate & share reports using Dexcom Clarity - Compatible with insulin pumps] Dexcom has two products. The Dexcom G6 and the Dexcom G7. A one-touch applicator is used to easily insert the sensor just beneath the skin. The sensor is changed once every 10 days. The G6 transmitter is changed once every three months while the G7 sensor and transmitter is combined into one device and changed out together every 10 days. The G6 is approved to be worn on the abdomen, and the G7 is approved for the back of the arm. The G6 warm-up time is two hours, while the G7 warms up in 30 minutes. There are no calibrations required from the user. The sensor glucose values are updated every five minutes. Optional high, low and predictive low glucose alerts are available to be customized by the user. You can share your data with up to 10 different followers. You can also review your own glucose reports and share your information directly with your diabetes care team using Dexcom Clarity. You may choose to receive your data using the handheld receiver, or if you have a compatible smart device, you can download the mobile app and have your information sent directly to your phone using Bluetooth without the need for a receiver. If you use the phone and have a smartwatch, that is an additional avenue to receive your glucose information. Both the G6 and the G7 are compatible with insulin pumps. [Text on screen: Freestyle Libre Two Systems: Libre 2 & Libre 3 Libre 2: Displays sensor glucose when scanned. Libre 3: Sensor glucose is viewed without scanning. - Sensor life: 14 days - 1 hour warmup - Can share data with followers - Generate & share reports using Libreview - No calibrations - Optional high & low glucose alerts] The Freestyle Libre has two products, the Libre 2 and Libre 3. The sensor is worn on the back of the upper arm and is changed every 14 days. Glucose data can be viewed using a handheld reader or a compatible smartphone with either product. There is mobile app compatibility with both Android and iPhone. When using the mobile app, you can share data with up to 20 followers. Using LibreView, you can see your own glucose reports and share your information directly with the diabetes care team. This system does not accept calibrations by the user. Both systems have optional high and low glucose alerts. The Libre 2 sensor glucose value is displayed with a one-second scan using either the reader or the phone. Libre 3 readings can be viewed continuously without the need to scan. Libre 3 is currently the smallest sensor available. [Text on screen: Eversense Sensor: - 6-month wear - Implanted under the skin by small incision in office - Updates every 5 minutes - 1 calibration required after first 3 weeks - 24-hour warmup - Can share data with followers Transmitter: - On-body alerts - Removable - no sensor wasted - Needs charged daily - 1 year warranty] The Eversense is a six-month sensor that is professionally placed under the skin by a healthcare provider. It is inserted into the upper arm. Real-time glucose data is received using the mobile app on a compatible Android or iOS device. The sensor provides on-body alerts from the transmitter even when your mobile device is not nearby. The transmitter can be removed temporarily without wasting the sensor. It does get removed once daily to charge, and it is reusable for up to one year. Sensor glucose values are updated every five minutes. Two calibrations are required daily for the first three weeks of using the sensor. After day 21, one finger stick is required for the rest of the sensor life. After the sensor is placed, it does take 24 hours to warm up before glucose data is received. Your healthcare provider will remove and replace your sensor for you in the clinic every six months. [Text on screen: Medtronic Guardian Connect Sensor: - 7-day wear - 2 calibrations required daily - Customizable alerts - Real-time shareable data - Sugar IQ app generates reports, patterns & trends - 2-hour warmup - Can share data with followers Transmitter: - Needs to be charged weekly - 1 year warranty - 2 pieces of tape used to secure device] The Medtronic Guardian Connect is the last standalone sensor. Current glucose levels and trends are seen using the app on your mobile device. There are optional alerts, including predictive alerts up to 60 minutes in advance of a high or a low-glucose event. The sensor is approved for use on the back of the upper arm or the abdomen. It comes with a one-press serter for insertion. The sensor is changed out every seven days. The transmitter is reusable for up to one year. The system requires a calibration from the user a minimum of once every 12 hours. Data can be shared with up to five people. The Sugar IQ diabetes assistant app works with the Guardian Connect and can help the user identify patterns and understand trends. The transmitter that is used for this Medtronic standalone CGM is different than the transmitter that is used for the CGM that connects with the Medtronic insulin pumps. [Text on screen: Next steps Decide on device: - Assess device options. - Choose device that best aligns with personal preference & needs. Complete survey: - Click the red box labeled "Take the survey" from the home screen. - Answer all questions and submit. Begin order process: - Patient Navigator will initiate the order and determine insurance coverage. - Contact will be made through OSU My Chart at each step of the process. Schedule training: - Schedule comprehensive training with a Certified Diabetes Care & Education Specialist.] A CGM device and supplies require a prescription. CGMs may be approved under a pharmacy plan or a medical plan depending on the specific insurance coverage. Guidelines may vary based on the type of diabetes and treatment regimen. The next step in the process is to decide which CGM best aligns with your needs. There is a red box on the home page labeled, Take the Survey, where you can submit your device preferences to our team. After receiving your CGM choice, the patient navigator will initiate the order and determine insurance coverage. The final step is to contact us when you receive your device to schedule a training with a diabetes care and education specialist. [Text on screen: The Ohio State University Wexner Medical Center Phone: 614-688-9147 E-mail: diabetes@osumc.edu Refer to the video "Diabetes Technology Information Session" for more information on diabetes technology and the connection between a CGM and insulin pump.] Please refer to the next two slides for our contact information, as well as some frequently asked questions. If you are interested in learning more about diabetes technology or the connection between a CGM and an insulin pump, this can be found in the video titled, "Diabetes Technology Information Session". We thank you for your time and look forward to working with you. [Music playing] [Text on screen: Frequently Asked Questions Can I shower while wearing a CGM? - Yes, you can shower without putting anything over your device. How long does a CGM last? - Sensors generally need replaced every 7–14 days depending on the device. The implanted Eversence sensor is the exception which is replaced every 3 months. Can I share my CGM data with others? - Data & alerts can be shared with friends, caregivers and loved ones using mobile apps. Do I still have to test my blood sugar when I am using a CGM? - It is recommended to test using a traditional blood glucose meter if your symptoms do not match your sensor glucose readings. Sensor readings are not perfect and may be delayed. Some CGMs do require calibrations twice/day. How can I keep my CGM from falling off? - Adhesive patches/tape or liquid adhesive agents can be used if the sensor is not staying securely attached to the skin for the duration of the sensor session.]