Your browser does not support java script. Skip navigation
Loading, please wait  Loading, please wait...
CPE CONSULTANTS, LLC
 

Role of the Pharmacist and CGM Technology in Intensive Diabetes Treatment and Management


Self-monitoring of blood glucose (SMBG) is a core component of a diabetic patient's management but only provides a measurement of blood glucose levels at a specific point in time, often missing trends, hyperglycemic or hypoglycemic excursions. HbA1c is even more limited and reports an average reading over 90 days; therefore incapable of alerting the patient of fluctuations in blood glucose at any point in time.
As Real Time (RT) Continuous Glucose Monitoring (CGM) continues to improve, treatment guidelines by leading societies have incorporated this technology to reduce glycemic excursions, episodes of dangerous hypoglycemic events, and reduce HbA1c. In 2011, The Endocrine Society recommended CGM use starting at 8 years of age for anyone with Type 1 diabetes (T1D) able to use it on a near-daily basis. More recently, the American Diabetes Association (ADA) added CGM to the 2014 Standards of Care, noting its potential benefits to lower HbA1c in adults ≥25 and preventing hypoglycemic events in all age groups. Multiple studies, however, indicate that the benefits of RT-CGM are only realized if it is used more than 70% of the time (≥5 days per week).
Other experts have focused on the use of CGM in the notification and prevention of hypoglycemic events, particularly in children, those who require supervision, and those with hypoglycemia unawareness. Despite the urgency of treating hypoglycemia, CGM is not commonly used in T1D children at this juncture. Reports show that <30% of children with T1D have an HbA1c <8%, and children experience episodes of severe hypoglycemia more frequently than adults. The ASPIRE trial of 247 patients showed that sensor augmented insulin pump therapy with a low glucose suspend significantly reduced nocturnal hypoglycemia, without increasing A1C levels for those >16 years of age.
CGM may also offer benefits for the Type 2 diabetes (T2D) adult. In addition to the potential to lower HbA1c and warn of hypoglycemic events and other glycemic excursions, the information provided can serve as an educational and motivational tool for these T2D patients by influencing their eating and exercise options.
Selection of an appropriate CGM device is important because improvements in accuracy and reliability are ongoing. RT-CGM is one cornerstone of optimal glycemic control. Each varies; relying on different sensing technology and requiring the traditional finger-stick for confirmation of alerts. The Mean Absolute Relative Difference (MARD) between sensor readings and reference glucose levels can vary by as much as 20% with worrisome discrepancies in the hypoglycemic range. But new generation devices have significantly improved MARD measurements. These devices have shorter lag times and improvements in accuracy. Many physicians are lacking the appropriate level of knowledge to employ CGM as part of their practices.
Significant improvements in accuracy of Continuous Glucose Monitoring (CGM) sensors and device algorithms have made CGM-based decisions a near-term possibility. This program will evaluate the potential clinical application and use of CGM in diabetes management decisions and the importance of various aspects of CGM to guide optimal treatment.

Fee

$0.00

CE Hours

1.50

CE Units

0.150

Activity Type

  • Knowledge

Target Audience(s)

  • Pharmacists

Accreditation(s)

CPE Consultants, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education
Accreditation Council for Pharmacy Education
 

Requirements for CE Credit

  CPE Consultants LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE). The Universal Activity Number (UAN) for this activity is 0864-0000-16-080-H04-P. The activity is accredited for 1.5 contact hour (0.15 CEUs). The official release date for this activity is December 15, 2016 and the expiration date is December 15, 2017.
 
Statement of ACPE Credit will be provided upon completion of the requirements for this activity (completing the pretest, viewing the webcast and successfully passing the posttest) by the approved provider, CPE Consultants LLC.
 
Your continuing education credits will be electronically be uploaded to CPE Monitor within 48 hours. Please check your CPE Monitor account to make sure your credits were accurately reported. We encourage participants to keep a printed copy of all statements of continuing education credit.

 

 

 

Self-monitoring of blood glucose (SMBG) is a core component of a diabetic patient's management but only provides a measurement of blood glucose levels at a specific point in time, often missing trends, hyperglycemic or hypoglycemic excursions. HbA1c is even more limited and reports an average reading over 90 days; therefore incapable of alerting the patient of fluctuations in blood glucose at any point in time.
As Real Time (RT) Continuous Glucose Monitoring (CGM) continues to improve, treatment guidelines by leading societies have incorporated this technology to reduce glycemic excursions, episodes of dangerous hypoglycemic events, and reduce HbA1c. In 2011, The Endocrine Society recommended CGM use starting at 8 years of age for anyone with Type 1 diabetes (T1D) able to use it on a near-daily basis. More recently, the American Diabetes Association (ADA) added CGM to the 2014 Standards of Care, noting its potential benefits to lower HbA1c in adults ≥25 and preventing hypoglycemic events in all age groups. Multiple studies, however, indicate that the benefits of RT-CGM are only realized if it is used more than 70% of the time (≥5 days per week).
Other experts have focused on the use of CGM in the notification and prevention of hypoglycemic events, particularly in children, those who require supervision, and those with hypoglycemia unawareness. Despite the urgency of treating hypoglycemia, CGM is not commonly used in T1D children at this juncture. Reports show that <30% of children with T1D have an HbA1c <8%, and children experience episodes of severe hypoglycemia more frequently than adults. The ASPIRE trial of 247 patients showed that sensor augmented insulin pump therapy with a low glucose suspend significantly reduced nocturnal hypoglycemia, without increasing A1C levels for those >16 years of age.
CGM may also offer benefits for the Type 2 diabetes (T2D) adult. In addition to the potential to lower HbA1c and warn of hypoglycemic events and other glycemic excursions, the information provided can serve as an educational and motivational tool for these T2D patients by influencing their eating and exercise options.
Selection of an appropriate CGM device is important because improvements in accuracy and reliability are ongoing. RT-CGM is one cornerstone of optimal glycemic control. Each varies; relying on different sensing technology and requiring the traditional finger-stick for confirmation of alerts. The Mean Absolute Relative Difference (MARD) between sensor readings and reference glucose levels can vary by as much as 20% with worrisome discrepancies in the hypoglycemic range. But new generation devices have significantly improved MARD measurements. These devices have shorter lag times and improvements in accuracy. Many physicians are lacking the appropriate level of knowledge to employ CGM as part of their practices.
Significant improvements in accuracy of Continuous Glucose Monitoring (CGM) sensors and device algorithms have made CGM-based decisions a near-term possibility. This program will evaluate the potential clinical application and use of CGM in diabetes management decisions and the importance of various aspects of CGM to guide optimal treatment.

Objectives

  • Describe the role of the pharmacist in utilizing CGM
  • Interpret CGM downloads from patient cases to evaluate medication adjustments needed
  • Recognize impact of patient medication taking behavior versus medication adjustments
  • Describe best practices for CGM billing
  • Discuss patient educational goals and troubleshooting recommendations

Speaker(s)/Author(s)

Stephanie Smith picture

Stephanie Smith, PharmD, CDE
Pharmacist, Ridgeview Clinics


Brief Bio : Dr. Stephanie Smith is a pharmacist currently practicing comprehensive medication management at Ridgeview Medical Center clinics, a practice that she implemented in 2012. She spends most of her time meeting with patients in the endocrinology and primary care clinic, with a focus on diabetes medications as well as emerging diabetes products and technology including insulin pumps and continuous glucose monitors. Providers send her the most complex and difficult patients because of her ability to motivate and empower them, as well as her expert drug knowledge in the field.

Activity Number

0864-0000-16-080-H04-P

Release Date: Dec 15, 2016
Credit Expiration Date: Dec 15, 2017