Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What action should be taken first when a patient with diabetes presents an increased A1C after starting continuous glucose monitor therapy?

1. Recommend an increase in glargine dose

2. Adjust the insulin-to-carbohydrate ratio

3. Upload data from the CGM device

4. Review carbohydrate counting techniques

The correct answer is: Upload data from the CGM device

The most appropriate first action when a patient with diabetes presents an increased A1C after starting continuous glucose monitor (CGM) therapy is to upload data from the CGM device. This step is critical because the data provides real-time insight into the patient’s glucose patterns, trends, and specific areas of concern, such as periods of hyperglycemia or hypoglycemia. Understanding the data from the CGM allows for informed decision-making regarding any necessary adjustments in management strategies. For instance, practitioners can identify times when glucose levels were consistently high and correlate this information with the patient’s food intake, activity levels, and medication adherence. This comprehensive view is essential for tailoring education and interventions to improve the patient's overall glucose control and ultimately lower the A1C. Other options, while relevant in the context of diabetes management, should follow after the CGM data has been reviewed. Increasing the glargine dose or adjusting the insulin-to-carbohydrate ratio can be effective strategies for managing an increased A1C, but they require a clear understanding of the patient's glucose patterns gleaned from the CGM data. Similarly, reviewing carbohydrate counting techniques is beneficial, but it follows the initial analysis of the CGM data to identify if poor understanding or execution of these techniques is