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Publications

Journal Article Ahead of print 1 citation

PubMed: 39936548 DOI: 10.1177/19322968251315171

Expert Clinical Interpretation of Continuous Glucose Monitor Reports From Individuals Without Diabetes.

J Diabetes Sci Technol

Authors: Nicole L Spartano, Brenton Prescott, Maura E Walker, Eleanor Shi, Guhan Venkatesan, David Fei, Honghuang Lin, Joanne M Murabito, David Ahn, Tadej Battelino, Steven V Edelman, G Alexander Fleming, Guido Freckmann, Rodolfo J Galindo, Michael Joubert, M Cecilia Lansang, Julia K Mader, Boris Mankovsky, Nestoras N Mathioudakis, Viswanathan Mohan, Anne L Peters, Viral N Shah, Elias K Spanakis, Kayo Waki, Eugene E Wright, Mihail Zilbermint, Howard A Wolpert, Devin W Steenkamp

Affiliations

  • Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA.
  • Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA.
  • Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
  • Department of Health Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA.
  • Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
  • Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA.
  • Mary & Dick Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA.
  • Faculty of Medicine, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
  • University of California San Diego, San Diego, CA, USA.
  • Kinexum, Harpers Ferry, WV, USA.
  • Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany.
  • University of Miami Miller School of Medicine, Miami, FL, USA.
  • Diabetes Care Unit, Caen University Hospital, University of Caen Normandie, Caen, France.
  • Department of Endocrinology, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
  • Division of Endocrinology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
  • Department of Diabetology, P. L. Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine.
  • Division of Endocrinology, Diabetes & Metabolism, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
  • Madras Diabetes Research Foundation (ICMR - Collaborating Centre of Excellence) & Dr. Mohan's Diabetes Specialties Centre (IDF Centre of Excellence in Diabetes Care), Chennai, India.
  • Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
  • Indiana University School of Medicine, Indianapolis, IN, USA.
  • Endocrinology, Diabetes and Nutrition Section, Veterans Affairs Maryland Health Care, Baltimore, MD, USA.
  • Department of Biomedical Informatics, The University of Tokyo, Tokyo, Japan.
  • South Piedmont Area Health Education Center, Charlotte, NC, USA.
  • Johns Hopkins Community Physicians, Baltimore, MD, USA.
  • Suburban Hospital, Bethesda, MD, USA.

Abstract

BACKGROUND

Clinical interpretation of continuous glucose monitoring (CGM) data for people without diabetes has not been well established. This study aimed to investigate concordance among CGM experts in recommending clinical follow-up for individuals without diabetes, based upon their independent review of CGM data.

METHODS

We sent a survey out to expert clinicians (n = 18) and asked them to evaluate 20 potentially challenging Dexcom G6 Pro CGM reports (and hemoglobin A1c [HbA1c] and fasting venous blood glucose levels) from individuals without diabetes. Clinicians reported whether they would recommend follow-up and the reasoning for their decision. We performed Fleiss Kappa interrater reliability to determine agreement among clinicians.

RESULTS

More than half of expert clinicians (56-100%, but no clear consensus) recommended follow-up to individuals who spent >2% time above range (>180 mg/dL), even if HbA1c <5.7% and fasting glucose <100 mg/dL. There were no observed trends for recommending follow-up based on mean glucose or glucose management indicator. Overall, we observed poor agreement in recommendations for who should receive follow-up based on their CGM report (Fleiss Kappa = 0.36).

CONCLUSIONS

High discordance among expert clinicians when interpreting potentially challenging CGM reports for people without diabetes highlights the need for more research in developing normative data for people without diabetes. Future work is required to develop CGM criteria for identifying potentially high-risk individuals who may progress to prediabetes or type 2 diabetes.

MeSH

Diabetes Mellitus, Fasting, Prediabetic State, Continuous Glucose Monitoring

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