Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Interpreting the Ambulatory Glucose Profile

Video Transcription

Video Summary

Dr. Richard Bergenstahl explains how to interpret continuous glucose monitoring (CGM) data using the Ambulatory Glucose Profile (AGP), a standardized one-page report created to replace unwieldy multi-page CGM printouts and the limited insight of fingerstick logs. He argues diabetes care has been dominated by A1C for decades, but outcomes remain suboptimal and A1C often fails to reflect hypoglycemia risk, glucose variability, or inaccuracies caused by factors like CKD, anemia, erythropoietin, iron changes, and individual red blood cell lifespan. He illustrates that patients can have the same A1C yet radically different glucose patterns and hypoglycemia rates, and shows cases where lab A1C is far from CGM-derived GMI.<br /><br />He breaks AGP into three panels: key metrics (including time in range, time below range, mean glucose, GMI, and coefficient of variation), a 14-day “modal day” curve, and daily traces. Practical interpretation focuses on “more green, less red,” treating hypoglycemia first, and aiming for “flat, narrow, in range.” He proposes a simple decision framework based on time-in-range and time-below-range “buckets,” suggesting actions such as reducing basal insulin, stopping sulfonylureas, adding GLP-1 therapy, or “redoing” regimens needing major reset and team support. He notes patient self-learning from CGM is rapid, AI-driven decision support is emerging, and dual glucose-ketone sensors may improve safety for therapies like SGLT2 inhibitors.

Asset Subtitle

Richard Bergenstal

Meta Tag

Module DKD

Speaker Richard Bergenstal

Keywords

continuous glucose monitoring (CGM)

Ambulatory Glucose Profile (AGP) report

time in range (TIR)

time below range (hypoglycemia)

A1C limitations and discordance (GMI vs lab A1C)

glucose variability (coefficient of variation)

diabetes therapy adjustment (basal insulin, sulfonylureas, GLP-1, SGLT2)