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:

  1. We still need to improve your coefficient of variation.
  2. Based on these results, let’s decrease your insulin by 20%.
  3. Time in range should be 70% or greater for your age group.
  4. 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.

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