InPen™ system data reports
How to follow-up patients on Smart MDI system by using Insights Reports
InPen™ smart* insulin pen system + Guardian™ 4 smart† CGM system = Smart MDI system
Introduction
A structured follow-up for patients using the Smart MDI system is recommended for best possible therapy outcome and system use. Ask user to send reports 1-2 weeks post-onboarding on InPen™ system and Guardian™ 4 system to assess initial engagement and before visits or as needed to determine possible therapy amendments and behaviour changes.
The Insights Report can be printed or emailed to your clinic via the app.
Therapy goals
| Metric | Time above1 13.9 mmol/L | Time above1 10.0 mmol/L | Time in Range1 3.9 – 10.0 mmol/L | Time below1 3.9 mmol/L | Time below1 3.0 mmol/L | HbA1c2 | Average glucose3 |
| Goals | <5% | <25% | >70% | <4% | <1% | <7%(<53 mmol/mol) | ≤8.6 mmol/L* |
Review the Statistics section on the Overview report to check, Time in Range, above and below Range and Average Glucose.
*Average Glucose should be ≤8.6 mmol/L to have an HbA1c of 7% (53 mmol/mol) or below.
Personalised patient goals may be different than what is in the table. Action may not be required if personalised goals are met.
3 – Step methodology – how to follow-up patients
Step 1 : Review
Review Glucose Data, Missed Doses & Insulin Data
Step 2 : Evaluate & fine-tune
Titrate long-acting insulin, evaluate calculator use, fine-tune meal doses, ICR, ISF and Active Insulin Time (AIT)
Step 3 : Check behaviour
Therapy basics & knowledge
Review
Overview report
- Review Glucose Stats & Modal Day
– Time in Range, below and above range
– Average Sensor Glucose (SG)
– It is also worth checking the glucose Standard Deviation (SD)
– Always address hypoglycaemia first - Check Missed Doses –
Clarify if meals skipped or bolus forgotten?
Identify and address barriers to taking insulin. Adjust mealtimes in InPen™ app and set-up dose reminders if needed. - Evaluate TDD, basal/bolus split, average number of boluses per day.
Evaluate & fine-tune
Overview & daily chart report
- Titrate long-acting (basal) insulin first. The goal is to maintain glycaemic stability in the fasting state with no more than 1.7 mmol/L change (Long-Acting Assessment)
- Dosing Behaviour – Evaluate calculator usage & following dosing recommendations (Calculator Usage)
- Based on glycaemic response to meal doses, assess adequacy of meal doses Insulin to Carbohydrate Ratio and fine-tune if needed (Meal Assessment)
- For more insights, review specific days (i.e., bolus timing, glucose response, bolus overrides). If needed, fine-tune Insulin Sensitivity Factor & Active Insulin Time settings (Modal Day & Daily Chart Report)
Check behaviour
| Don’t forget the basics and discuss if needed | • Carb counting skills • Injection technique • Guardian™ 4 sensor insertion technique and change frequency | • Site rotation • Insulin expiration and storage |
| Check if patient knows | • …how/when to check BG (adequate monitoring supplies) • …how to detect, prevent, treat hypoglycaemia • …how to adjust doses based on SG trend arrows | |
References
- Battelino T et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range. Diabetes Care 2019; 42: 1593-1603
- American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42(1): S61-S70.
- https://www.diabetes.org/a1c Last accessed June 2021
* Smart Insulin pen connects to a mobile app to provide dosing calculations, reminders and CGM system integration. Please refer to IFU.
† Smart CGM predicts future high and low sensor glucose events up to 1 hour in advance and provides access to additional algorithms and insights that can inform users of clinically relevant glucose patterns. Please refer to IFU. See the device manual for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions, and potential adverse events. For further information, contact your local Medtronic representative
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