Assess patient understanding that CGM does not replace SMBG
STEP 1 — Gather Information
Ask the patient about their beliefs regarding CGM and SMBG: whether they think CGM eliminates the need for fingerstick glucose checks, and explore prior education on CGM use, calibration requirements, and situations requiring SMBG (e.g., symptom verification, hypoglycemia unawareness).
STEP 2 — Rule In / Rule Out
Determine if the patient correctly understands that CGM does NOT replace SMBG (i.e., they acknowledge ongoing need for fingersticks for calibration, confirmation of symptoms, or when CGM readings are questionable) versus the misconception that CGM alone suffices.
STEP 3 — Classify or Stratify
Classify understanding as adequate (patient affirms need for SMBG alongside CGM) or inadequate (patient believes CGM replaces SMBG or is unsure).
STEP 4 — Decide
If understanding is adequate, reinforce and continue routine CGM support; if inadequate, provide targeted education on CGM’s complementary role, calibration with SMBG, and clinical scenarios requiring fingerstick verification.
Clinical Guardrails / Mimics / Pitfalls
Do not assume patient understanding based on device ownership; avoid letting patients rely solely on CGM alarms for hypoglycemia detection; do not skip SMBG education during CGM initiation; beware of overreliance on trend data without confirmatory fingersticks in acute situations.
Concrete Clinical Example
A 22‑year‑old with T1DM starts real‑time CGM and tells the clinician they no longer need fingersticks. Assessment reveals the misconception; the clinician explains that CGM requires twice‑daily SMBG calibration and that fingersticks are needed to verify symptoms or discrepant readings, then documents improved understanding.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI: 10.1210/jc.2016-2534