“The future depends on what we do in the present.” – Mahatma Gandhi
In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing continuous glucose monitoring or CGM. If you’ve been reading our blog, you know we’ve written about CGM before in our posts about Exceptions and Possibilities and also in our series on “Flipping the Paradigm” when applying a solution focused approach to Monitoring.
Focus on “exceptions” rather than “problems”
When we think about applying a solution-focused approach to CGM, Bright Spots and Landmines by Adam Brown comes to mind. It’s a framework for evaluating diabetes habits and decisions. (You can read our 2019 interview with him here.) As we were identifying our technology themed blog posts, Deb happened to watch a North Carolina JDRF Chapter presentation by Adam (see slides here) that really highlighted the approach we encourage diabetes care and education specialists (DCES) to take when discussing CGM data.
When evaluating CGM data similar to that below, the typical first response may be to focus on the glucose spike and try to identify what went wrong.
However, when taking a solution-focused approach, we want to turn focus to all of the things that are working well (rather than what went “wrong”). Similar to Adam’s “Bright Spots”, we call them “Exceptions” or times when the problem did NOT occur and when things were going well. Below you can see where Adam focuses on his Exceptions, instead of his “landmines” and identifies all of his successes during the day. If we only focus on times that are not working well, we miss identifying successes.
CGM creates a great opportunity for discovery learning!
When CGM was first incorporated as a management tool, the focus was typically on hypoglycemia, and preventing serious events from happening. As CGM has evolved and more individuals with type 2 diabetes are incorporating it into their diabetes care, the focus has broadened and now includes focus on making healthy behavior changes. CGM creates a great opportunity for discovery learning, where people can try different foods or activities and personally experiment to learn what works well for them. While Adam identifies 42 factors that can impact blood glucose, he stated that there are more likely more than 60-100 factors if you include mental health and other daily issues. There’s so much to learn!
As DCES use CGM in practice with clients with type 2 diabetes, applying a solution-focused approach to CGM data can be motivating and help reinforce habits and choices that result in increased time in range (TIR) and overall quality of life. (The recommended goal for TIR is > 70% of glucose values between 70 and 180 mg/dL) Focusing on their “best day” pattern (the day with the greatest TIR) and working towards increasing TIR is a positive goal to strive for because they can “do more of what’s working” instead of giving up or stopping something they enjoy. Our “fresh view” photo today was taken by Deb on an easy hike near her home. Physical activity is one of many factors that can help one see more TIR. Applying a solution-focused mindset with CGM can help your clients want to learn to use their own data to learn about their diabetes and create a plan that works for them, where they can be successful.
Do you use CGM in your practice and with your clients? If you do, try focusing on times when they are in their goal range and inquire about their actions and activities during that time. Help them identify what’s working well and what choices will move them towards more TIR.
- One mnemonic to facilitate conversation is MGLR, which stands for “more green, less red” when looking at the TIR bar. The goal is to see more green (time between 70-180 mg/dL) and less red (< 70 mg/dL). Talking about TIR can be a great way to have a solution-focused discussion and to help clients identify opportunities to succeed instead of focusing on past failures.
- A second mnemonic is FNIR, or “flat, narrow and in-range”, which is a goal for the trend graph. When viewing the trend graph the goal is to have the majority of the data fall within the target range, again typically 70-180 mg/dL without extreme variability swinging from below range to above range. CGM creates an opportunity to move towards a clients goals while providing constant, non-judgemental feedback on their progress.
We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!
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Deb is employed by Dexcom but her words and opinions in this blog are her own.