本文へ移動
cccskills
無料GitHub で公開

endo-rtcgm-vs-no-cgm-t2d-insulin-su

Suggests real-time CGM over no CGM for outpatients with type 2 diabetes who use insulin and/or sulfonylureas and are at high risk for hypoglycemia to detect and prevent low glucose events. Consider when initiating CGM in T2D patients on insulin/SU with a history of severe hypoglycemia or impaired awareness of hypoglycemia (IAH).

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md3.1 KB

SKILL.md（原文）

インストールする前に、エージェントに与えられる指示の中身を確認できます。

Real-Time Continuous Glucose Monitoring vs No CGM for Outpatients with Type 2 Diabetes on Insulin/Sulfonylurea at High Hypoglycemia Risk

STEP 1 — Gather Information

Confirm outpatient status, type 2 diabetes diagnosis, current use of insulin and/or sulfonylurea (SU), and assess hypoglycemia risk: history of severe hypoglycemia requiring assistance, impaired awareness of hypoglycemia (IAH), renal or hepatic dysfunction, age ≥65 years, or other predisposing conditions. Collect medication list, recent hypoglycemia episodes, comorbidities, and patient awareness of low glucose symptoms.

STEP 2 — Rule In / Rule Out

Is the patient at high risk for hypoglycemia (e.g., severe hypoglycemia needing help, IAH, renal/hepatic insufficiency)?

  • Yes → Proceed to Step 3.
  • No → Do not initiate CGM based on this recommendation; consider other indications or routine SMBG.

STEP 3 — Classify or Stratify

Is the patient currently prescribed insulin and/or sulfonylurea (SU)?

  • Yes → Proceed to Step 4.
  • No → This recommendation does not apply; reassess hypoglycemia management strategies.

STEP 4 — Decide

For outpatients with T2D on insulin and/or SU who are at high hypoglycemia risk, suggest initiating real-time CGM rather than no CGM. Provide device education, set hypoglycemia alerts, and instruct periodic point-of-care blood glucose (POC-BG) checks to validate CGM readings, especially during sensor warm-up or symptomatic discrepancies.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on CGM alone for treatment decisions without confirmatory fingerstick validation when symptoms do not match sensor readings, during warm‑up, or in extremes of glycemia. Avoid CGM in patients with skin infection, hypoperfusion, vasoconstriction, or those unable to perform periodic SMBG. Recognize alarm fatigue and ensure patient education on device troubleshooting; CGM does not replace SMBG for calibration or confirmation. Consider cost, insurance coverage, and access barriers before prescribing.

Concrete Clinical Example

A 68‑year‑old woman with T2D on basal insulin and glimepiride (SU) reports two episodes of severe hypoglycemia requiring assistance in the past month and has impaired awareness of hypoglycemia. She is otherwise healthy and an outpatient. Initiate real‑time CGM, provide training on sensor insertion and alert response, and advise twice‑daily fingerstick checks to validate CGM values, especially if she feels low but sensor reads normal.

Source: Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, https://doi.org/10.1210/clinem/dgac596

レビュー

まだレビューはありません。使ってみた感想をお寄せください。

ログインしてレビューを書く

同じリポジトリのスキル

概要と使いどころ

780g-pump-adjustment

無料

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a download.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-acth-stim-test-interpretation

無料

Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-adrenal-crisis-treatment

無料

Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-ai-education

無料

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-lt4-monitoring

無料

In central hypothyroidism patients receiving levothyroxine who initiate enzyme‑inducing antiepileptic drugs, the guideline recommends checking free T4 at least 6 weeks after AED start and increasing the levothyroxine dose if free T4 falls below the target range. Triggers include: central hypothyroidism patient on levothyroxine starting antiepileptic drug such as phenytoin, carbamazepine, or oxcarbazepine.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-cortisol-cutoff-ai-diagnosis

無料

Applies serum cortisol cutoffs (<3 μg/dL indicates central adrenal insufficiency; >15 μg/dL likely excludes it) when evaluating morning cortisol for suspected adrenal insufficiency. Triggers include morning cortisol measurement in suspected AI and use when interpreting morning cortisol levels for adrenal insufficiency workup.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

dromlakhani のスキルをすべて見る

このスキルの問題を報告する