Assess CGM site selection and care
STEP 1 — Gather Information
Collect data on current CGM site(s), duration of use, skin condition (redness, itching, infection, induration), adhesion quality, rotation pattern, patient hygiene practices, understanding of site selection, any adhesive allergies, and use of skin prep or barrier products.
STEP 2 — Rule In / Rule Out
Determine if there are signs of site‑related complications (persistent erythema, induration, purulent discharge, lipohypertrophy, or frequent sensor loss due to poor adhesion). If present, rule in a site issue; if absent, rule out.
STEP 3 — Classify or Stratify
Classify site adequacy as: Adequate (no complications, proper rotation, good adhesion), Marginal (mild irritation, occasional adhesion failure, suboptimal rotation), or Inadequate (significant skin breakdown, infection, repeated sensor failures attributable to the site).
STEP 4 — Decide
- Adequate: Reinforce current practice and schedule routine reassessment at next visit or per Table 2 annual review.
- Marginal: Provide targeted education on skin preparation (clean with mild soap/water, dry fully), proper rotation (≥2 weeks between uses), and adhesive use; consider a skin‑tac barrier or hypoallergenic tape.
- Inadequate: Discontinue CGM use at the affected site, allow skin to heal, educate on alternative sites and proper care, and re‑initiate CGM only after resolution and with a revised site‑selection plan.
Clinical Guardrails / Mimics / Pitfalls
Do not ignore mild erythema as it can progress to infection; avoid alcohol wipes immediately before insertion if they cause dryness; do not reuse a site without adequate healing time (≥2 weeks); avoid placing sensors over lipohypertrophy, scar tissue, or bony prominences; do not rely solely on patient self‑report without visual inspection of the site.
Concrete Clinical Example
A 58‑year‑old with type 1 diabetes reports frequent sensor detachment and mild itching at the abdomen site used for the past 6 weeks. Assessment shows localized erythema without drainage and adhesion failure after 3 days. Classified as Marginal. Intervention: educated on cleaning with mild soap/water, drying fully, applying a thin barrier wipe, rotating to the upper buttock, and using a skin‑tac adhesive patch. Sensor re‑inserted at the new site with no detachment or irritation at 1‑week follow‑up.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2534