菜单
This skill advises against using a single 24-hour CGM target <140 mg/dL when managing glucose in pregnancy for patients with preexisting diabetes. Trigger when a clinician is determining CGM-based glucose targets for pregnant individuals with type 1 or type 2 diabetes.
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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).
基于 SOC 职业分类
正在显示 SKILL.md
| name | pdm-cgm-targets |
| description | This skill advises against using a single 24-hour CGM target <140 mg/dL when managing glucose in pregnancy for patients with preexisting diabetes. Trigger when a clinician is determining CGM-based glucose targets for pregnant individuals with type 1 or type 2 diabetes. |
Collect: pregnancy confirmation, diabetes type (T1DM/T2DM), gestational age, current CGM metrics, proposed glucose target (e.g., single 24‑hour CGM target <140 mg/dL), maternal hypoglycemia history. Action: If data incomplete, obtain missing information before proceeding.
Is the clinician considering replacing standard pregnancy glucose targets with a single 24‑hour CGM target <140 mg/dL?
Assess for safety of standard targets: check for history of severe hypoglycemia, hypoglycemia unawareness, or tight control that may increase risk.
Recommend using the standard pregnancy glucose targets (fasting <95 mg/dL, 1‑hour postprandial <140 mg/dL, 2‑hour postprandial <120 mg/dL) for CGM‑guided management instead of a single 24‑hour target <140 mg/dL. Document the decision and educate the patient on target‑based insulin adjustments.
Do not use a single 24‑hour CGM target <140 mg/dL as a substitute for fasting and postprandial targets; avoid over‑reliance on time‑in‑range alone; be aware that hybrid closed‑loop algorithms may not achieve all three targets simultaneously; monitor for hypoglycemia when applying tight targets; consider individualized adjustments if maternal hypoglycemia occurs.
A 32‑year‑old with type 1 diabetes at 18 weeks gestation plans to use CGM. The clinician initially considers a simple target of “keep glucose <140 mg/dL all day.” After gathering information (no hypoglycemia history, gestational age 18w), the rule‑out step triggers, classification finds no contraindications, and the decision is to advise fasting <95, 1‑hour <140, 2‑hour <120 mg/dL targets, with insulin adjustments based on pre‑meal and post‑meal readings.
Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society and European Society of Endocrinology, 2025, DOI: 10.1210/clinem/dgaf288
TODO: consider adding scripts/calc.py for the pdm-cgm-targets calculator