Annually reassess ability to make insulin adjustment based on CGM trend information
STEP 1 — Gather Information
Collect patient logs of trend-based insulin adjustments (e.g., basal/bolus changes in response to rising/falling arrows), SMBG calibration frequency, sensor site condition, and alarm settings; if any data missing, schedule focused education before proceeding.
STEP 2 — Rule In / Rule Out
Determine whether the patient correctly interprets CGM trend data (direction and rate of change) and makes appropriate insulin dose adjustments; if yes, rule in competence; if no, rule out.
STEP 3 — Classify or Stratify
Classify competence level: Competent (independent, accurate trend‑based adjustments), Needs Retraining (occasional errors or reliance on caregiver), or Unable (requires caregiver for all trend‑based decisions).
STEP 4 — Decide
If Competent: continue current CGM‑based insulin regimen with annual reassessment; if Needs Retraining: provide targeted one‑on‑one training on trend interpretation and insulin adjustment; if Unable: involve caregiver in dose decisions or consider a simplified insulin regimen.
Clinical Guardrails / Mimics / Pitfalls
Do not rely solely on CGM trends without confirming with SMBG; avoid making insulin adjustments based on trend alone during rapid glucose changes; do not ignore alarm fatigue or sensor site irritation; never assume competence without direct observation of trend‑based decision making.
Concrete Clinical Example
A 48‑year‑year‑old with T1D using RT‑CGM user with T1D reviews logs showing they reduce basal rate by 10% when a downward trend arrow exceeds 2 mg/dL/min and confirm with fingerstick; they calibrate twice daily, rotate sensor sites, and report no severe hypoglycemia; deemed Competent, current plan continued.
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