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Use of Continuous Glucose Monitoring (CGM) in Ambulatory Patients: Sustainment and Improvement
Mary Paschal RN, MS, CDE
Joslin Diabetes Center, BID-Needham
Introduction/Problem
Self monitoring of blood glucose (SMBG) is an essential task to assess the blood sugar trends and patterns for
the person with Diabetes Mellitus (DM)Type1.
Because many persons with Type 1 DM are only monitoring blood sugars 1 – 2 times/day rather than pre-meals
and bed time, they are unaware of blood sugar trends and insulin requirements.
To identify the frequency of blood glucose monitoring, blood glucose monitors were downloaded at each
educational visit..
• Because of limited monitoring of blood sugars, many patients were not adequately correcting high blood
sugars and therefore experienced sub-optimal control of blood sugars and A1-C..
Best practice evidence demonstrates significant benefits and improved, stabilized glucose control from use of
self-monitor clinical diagnostic sensor for CGM.
This process improvement project has been implemented for outpatients of the Joslin Clinic associated with Beth
Israel Deaconess Needham .
This project presents the opportunity to improve the effectiveness, efficiency and patient-centered care by
providing increased patient education and engagement in their self-care management. By stabilizing blood
sugars through improved monitoring, this intervention also provides improved efficiency and effectiveness of selfcare management.
Aim/Goal
The Interventions
Educate patients with DM type 1 about the benefits of continuous glucose monitoring (CGM)
Provide use of clinic diagnostic sensor with interpretation of blood glucose trends
Facilitate acquisition of CGM
Review CGM uploads at visits to identify glycemic control and incidence of acute complications
Results/Progress to Date
Increase use of CGM and Improved Glycemic Control in
Ambulatory Patients using CGM
90%
80%
70%
The primary goal of this project is increased awareness and utilization of continuous glucose monitoring
systems. Additional objectives include:
• Increase use of continuous sensors in patients with Type 1 DM .
• Increased time in target blood sugar range with less hypoglycemia in people using CGMS
The Team
Mary Paschal RN, MS, CDE
60%
50%
40%
30%
20%
10%
0%
2015 pts using CGM
2017 Patients acquired and using CGM
Reduction in hypoglycemia in pts using
CGM
• Since the inception of this project in 2015, the use of CGM has increased dramatically
• From <10% in 2015, over 60% of type 1 patients now use CGM, and the incidence of hypoglycemic
episodes has been drastically reduced.; 80% reduction in episodes of hypoglycemia.
• This improvement project has demonstrated that the effort can be sustained overtime with increasing
numbers of patients adopting the monitoring system and enjoying significantly improved outcomes
For more information, contact:
Mary Paschal RN, MS CDE Joslin Diabetes Center BID-N mpaschal@bidneedham.org
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Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mary Paschal (<a href="mailto:mpaschal@bidneedham.org">mpaschal@bidneedham.org</a>)
Project Team
Mary Paschal
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Needham
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Use of Continuous Glucose Monitoring (CGM) in Ambulatory Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness