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Reassesses annually the patient’s ability to use CGM trend information to adjust insulin doses. Triggered by yearly CGM skills check or annual review of trend-based dosing competence.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
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| name | endo-annual-reassess-cgm-trend-insulin-adjust |
| description | Reassesses annually the patient’s ability to use CGM trend information to adjust insulin doses. Triggered by yearly CGM skills check or annual review of trend-based dosing competence. |
Collect patient logs of trend-based insulin adjustments (e.g., basal/bolus changes in response to rising/falling arrows), SMBG calibration frequency, sensor site condition, and alarm settings; if any data missing, schedule focused education before proceeding.
Determine whether the patient correctly interprets CGM trend data (direction and rate of change) and makes appropriate insulin dose adjustments; if yes, rule in competence; if no, rule out.
Classify competence level: Competent (independent, accurate trend‑based adjustments), Needs Retraining (occasional errors or reliance on caregiver), or Unable (requires caregiver for all trend‑based decisions).
If Competent: continue current CGM‑based insulin regimen with annual reassessment; if Needs Retraining: provide targeted one‑on‑one training on trend interpretation and insulin adjustment; if Unable: involve caregiver in dose decisions or consider a simplified insulin regimen.
Do not rely solely on CGM trends without confirming with SMBG; avoid making insulin adjustments based on trend alone during rapid glucose changes; do not ignore alarm fatigue or sensor site irritation; never assume competence without direct observation of trend‑based decision making.
A 48‑year‑year‑old with T1D using RT‑CGM user with T1D reviews logs showing they reduce basal rate by 10% when a downward trend arrow exceeds 2 mg/dL/min and confirm with fingerstick; they calibrate twice daily, rotate sensor sites, and report no severe hypoglycemia; deemed Competent, current plan continued.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2534