95249 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording

Name of the Procedure:

Ambulatory Continuous Glucose Monitoring of Interstitial Tissue Fluid via a Subcutaneous Sensor (CGM)

Summary

This is a method to continuously measure glucose levels in the tissue fluid under the skin. It involves placing a small sensor under the skin, which monitors glucose levels for at least 72 hours. The patient uses their own equipment to check, calibrate, and record the glucose readings.

Purpose

Continuous glucose monitoring is used to manage diabetes by providing ongoing information about glucose levels. This helps in identifying glucose patterns, guiding treatment decisions, and improving blood sugar control.

Indications

• Patients with Type 1 or Type 2 diabetes.
• Individuals experiencing frequent hypoglycemic episodes.
• Patients having difficulty reaching target glucose levels.
• Pregnant women with diabetes.

Preparation

• No specific fasting is required unless combined with another test.
• Ensure all personal CGM equipment is available and functional.
• Patients may need a preliminary blood glucose test.

Procedure Description

1. Sensor Placement: A healthcare professional will clean the skin and insert a tiny sensor under the skin, usually on the abdomen or arm.
2. Hook-Up: The sensor is connected to a transmitter that sends glucose data to a monitoring device or smartphone.
3. Calibration: The patient or healthcare provider will calibrate the monitor using blood glucose readings from a fingerstick test.
4. Patient Training: The patient is trained on how to use the device, recognize alert signals, and respond to glucose trends.
5. Printout of Recording: After the monitoring period, the device provides a printout of the glucose readings and trends.

Duration

The monitoring process takes a minimum of 72 hours.

Setting

• Outpatient clinic
• Patient's home

Personnel

• Endocrinologist or diabetic specialist
• Nurse or diabetes educator

Risks and Complications

• Mild skin irritation or discomfort at the sensor site.
• Rarely, sensor insertion may cause minor bleeding or infection.

Benefits

• Improved glucose control and management.
• Real-time data providing actionable insights.
• Reduced risk of hypoglycemia and hyperglycemia.
• Better understanding of glucose patterns.

Recovery

• Minimal recovery needed as this is a non-invasive procedure.
• Keep the sensor area clean and monitor for any skin issues.
• Follow-up appointments as needed to discuss results and modify treatment.

Alternatives

• Traditional blood glucose monitoring using fingerstick tests.
  • Pros: Cost-effective and widely available.
  • Cons: Provides less frequent glucose measurements and less comprehensive data.

Patient Experience

• Minimal discomfort during sensor insertion.
• Continuous monitoring requires the patient to wear the device for at least 72 hours.
• Possible alert signals or vibrations from the monitor requiring attention to glucose levels.
• Training provided to manage any discomfort and understand glucose data.

Pain management and comfort measures include using a topical numbing cream before sensor insertion if needed and ensuring proper placement to avoid discomfort.