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
{"title":"Expert Clinical Interpretation of Continuous Glucose Monitor Reports From Individuals Without Diabetes.","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","doi":"10.1177/19322968251315171","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>We sent a survey out to expert clinicians (<i>n</i> = 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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968251315171"},"PeriodicalIF":4.1000,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822776/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Diabetes Science and Technology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19322968251315171","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
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.
期刊介绍：
The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
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