Rationale of the Week | Ambulatory Glucose Profile Confusion
For last week’s practice question, we quizzed test takers on ambulatory glucose profile confusion. Only 62% of respondents chose the best answer, which indicates that there was some uncertainty. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question:
LS is 72 years old with type 2 diabetes and injects insulin 4 times a day. They were started on a CGM device last month and you are looking at the Ambulatory Glucose Profile (AGP) together. You notice their time in range is 60%, their time above range is 38%, in low range is 2% and their coefficient of variation is less than 36%.
What is the best response?
Answer Choices:
- We still need to improve your coefficient of variation.
- Based on these results, let’s decrease your insulin by 20%.
- Time in range should be 70% or greater for your age group.
- This information is going to help with problem solving.
Getting to the Best Answer
Answer 1 is incorrect. 11.89% chose this answer, “We still need to improve your coefficient of variation.” This is a juicy answer, but not the best one. If you refer to the Ambulatory Glucose Profile (AGP) below, you will see that the goal for Coefficient of Variation is less than 36%. In this question, LS has coefficient of variation is less than 36%, so they are meeting the target. This measure of glucose variability is important since it informs us of the intensity and duration of glucose levels fluctuations.
Answer 2 is incorrect. 5.26% of you chose this answer, “Based on these results, let’s decrease your insulin by 20%.” This is not the best answer either. Since their time in range of 60% is a little below target and 38% of the time they are above target, LS might actually need some more insulin. Of course, safety is always first, but their low blood sugar range is only 2%, well below the 5% target.
Answer 3 is incorrect. 20.91% of respondents chose this answer, “Time in range should be 70% or greater for your age group.” Another juicy answer, but just like A1C goals, time in range targets are based on the individual and other factors. For a 72 year old on multiple daily injections, 70% time in range may be too aggressive and put them at risk for hypoglycemia. The target time in range is not a “one size fits all” and needs to be customized to the individual. In addition, this statement uses the “should” word, which can evoke feelings of embarrassment or shame. Instead we might say, “Great job tracking your blood sugars. How are you feeling about your progress?
Finally, Answer 4 is correct. 61.94% chose this answer, “This information is going to help with problem solving.” YES, GREAT JOB, this is the best answer. It is person centered, acknowledges their effort and engages LS in participating in problem solving. This comment will definitely increase their feelings of mastery and empowerment.
Want to learn more about this topic?
Dr. Diana Isaacs is providing a fantastic technology update.
Coach Beverly will highlight diabetes language that is empowering.
Virtual DiabetesEd Training Conference | 30+ CEs
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Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
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If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
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Ambitious Action Plan to Help Americans Eat Healthier | Free White House Conference
The Standard American Diet (SAD) is not known for optimizing health and improving longevity. Almost half of U.S. deaths from heart disease are linked to unhealthy food choices. People who have lower incomes have even worse health-related outcomes. “It is clear that the challenges of food insecurity, diet-related diseases, and health inequities intersect with and exacerbate each other, and that radical systemic changes across multiple sectors are needed to adequately address them.” (Task Force)
“We’re really in a nutrition crisis in this country.”
says Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University.
Nutrition Task Force Recommendations
The good news is that there is growing momentum to address this problem. A newly convened Task Force on Hunger has put together a comprehensive plan to improve the nutrition of Americans.
The Task Force members have an unwavering belief in the “importance of taking decisive action to achieve transformative change to end food insecurity and hunger, improve nutrition, and reduce diet-related diseases.”
White House Conference Sept 28th
The Biden administration will hold the White House Conference on Hunger, Nutrition, and Health on September 28th with the agenda driven by the Task Force Recommendations.
Afterward, they will announce a new national strategy to improve access to healthier foods based on these tenets.
Seven Big Ideas Recommended by Task Force on Hunger, Nutrition and Health
1. Treat Food as Medicine
There is growing momentum to integrate food and nutrition into regular health care through innovative strategies. Providing prescriptions for healthy groceries coupled with nutrition education is an idea that is being piloted around the country. In this model, health care systems or insurers pay for groceries to help people make significant changes to their eating habits.
2. Focus on the Quality of Calories, not just the Quantity
Historically, federal food assistance programs have helped to address hunger. Policies and programs have historically focused on improving access to sufficient quantities of food. Now there is momentum to modernize this approach and focus on the quality of food and make sure people have adequate access to enough nutritious food.
3. Expand Access to Dietary and Lifestyle Counseling
The task force recommends more preventive behavioral lifestyle coaching by providers as a part of usual care. They also recommend that Congress expand Medicare and Medicaid coverage for medical nutrition therapy for people with hypertension, prediabetes, celiac disease, HIV/AIDS, cancer and other diet-related conditions. There is also a call for expanded coverage of cooking classes and nutrition assistance, as well as coverage of the Diabetes Prevention Programs delivered by telehealth.
4. Support Food Entrepreneurs
By supporting individuals who start food businesses, they can help nourish communities and create jobs. The task force calls on the federal government to pass policies that boost new healthy food enterprises, including providing new loans and grants to food and nutrition-related companies centered on health, equity, and sustainability. The idea is to focus especially on businesses owned by people of color and other marginalized groups.
5. Increase the number of new farmers growing healthy foods using regenerative farming techniques
The U.S. has invested heavily in monoculture with a focus on producing corn and soybeans on most cropland. Now, there’s growing recognition of the need for more specialty crops – including fruits, vegetables, and nuts. To promote crop diversity, the task force proposed providing new farmers with paid internships and apprenticeships to learn about sustainable farming and funding to cover a living wage and housing. Read more here Beginning Farmers and Ranchers Development Program.
6. Make school meals free for all students
Many families who are eligible for free or reduced-priced meals may not receive them, sometimes due to the paperwork, bureaucracy or stigma of participating or enrolling. Amid the pandemic, school meals have been offered for free to all students. Now, the task force says this should be a permanent change.
7. Establish a Federal Agency and National Director of Food and Nutrition.
To initiate and formulate these bold and common sense changes, the task force recommends the creation of a new role in the federal government; a National Director of Food and Nutrition. This department could evaluate the success of programs, make adjustments and expand and fund programs that work.
Click here to access the Full report and dive into the details
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
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