MCQ Quiz-Continuous Glucose Monitoring

MCQ Quiz: Continuous Glucose Monitoring

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Continuous Glucose Monitoring (CGM) has revolutionized diabetes management, offering real-time data that empowers both patients and healthcare providers to make informed decisions. For PharmD students, a thorough understanding of CGM technology, data interpretation, and its application in patient care is crucial. This technology allows for personalized therapeutic adjustments, improves glycemic control, and enhances patient quality of life, making it an essential topic in modern ambulatory care and pharmacotherapy.

1. What does a Continuous Glucose Monitor (CGM primarily measure ?

  • Hemoglobin A1c
  • Interstitial fluid glucose
  • Capillary blood glucose
  • Venous blood glucose Answer: Interstitial fluid glucose

2. Which of the following is a key advantage of CGM over traditional self-monitoring of blood glucose (SMBG)?

  • It eliminates the need for fingerstick calibrations entirely.
  • It provides real-time glucose readings and trend data.
  • It is less expensive than SMBG strips.
  • It directly measures blood glucose levels. Answer: It provides real-time glucose readings and trend data.

3. What information does a CGM trend arrow provide?

  • The exact blood glucose value.
  • The time of the last meal.
  • The direction and speed of glucose change.
  • The remaining battery life of the sensor. Answer: The direction and speed of glucose change.

4. The “time in range” (TIR) metric on a CGM report typically refers to the percentage of time a patient’s glucose is within what range?

  • 50-150 mg/dL
  • 70-180 mg/dL
  • 100-200 mg/dL
  • 80-120 mg/dL Answer: 70-180 mg/dL

5. A lag time of 5-15 minutes is expected between CGM readings and blood glucose meter readings because:

  • The CGM sensor is less accurate.
  • Glucose needs to diffuse from the capillaries to the interstitial fluid.
  • The blood glucose meter requires a larger sample.
  • The CGM data is encrypted. Answer: Glucose needs to diffuse from the capillaries to the interstitial fluid.

6. Which component of a CGM system is inserted just under the skin to measure glucose?

  • The transmitter
  • The receiver
  • The sensor filament
  • The adhesive patch Answer: The sensor filament

7. In the context of the PHA5060 Ambulatory Care course, a virtual pill box assembly activity for the empathy project is designed to help students understand:

  • The pharmacokinetics of oral medications.
  • The challenges patients face with medication adherence.
  • The cost of different medications.
  • The process of drug manufacturing. Answer: The challenges patients face with medication adherence.

8. For most real-time CGM systems, how often is a new glucose reading typically provided?

  • Every 30 minutes
  • Every 15 minutes
  • Every 5 minutes
  • Every 60 seconds Answer: Every 5 minutes

9. What is a “compression low” in the context of CGM?

  • A true hypoglycemic event caused by stress.
  • A false low glucose reading due to pressure on the sensor site.
  • Low glucose caused by insufficient carbohydrate intake.
  • A low reading that occurs after a high-carbohydrate meal. Answer: A false low glucose reading due to pressure on the sensor site.

10. Intermittently scanned CGM (isCGM), also known as “flash” monitoring, differs from real-time CGM (rtCGM) in that:

  • isCGM requires the user to scan the sensor to get a reading.
  • isCGM provides automatic alerts for high and low glucose.
  • isCGM sensors last longer than rtCGM sensors.
  • isCGM does not show trend data. Answer: isCGM requires the user to scan the sensor to get a reading.

11. The component of a CGM that sends glucose information wirelessly to a display device is the:

  • Sensor
  • Applicator
  • Transmitter
  • Receiver Answer: Transmitter

12. A patient’s CGM shows a glucose level of 120 mg/dL with a trend arrow pointing straight down. What is the most appropriate immediate action?

  • Administer a correction dose of insulin.
  • Confirm the reading with a fingerstick blood glucose test.
  • Consume a fast-acting carbohydrate.
  • Go for a brisk walk to lower the glucose. Answer: Confirm the reading with a fingerstick blood glucose test.

13. Which of the following is a potential site for CGM sensor insertion?

  • The palm of the hand
  • The sole of the foot
  • The abdomen or the back of the upper arm
  • The neck Answer: The abdomen or the back of the upper arm

14. What does the term “sensor warm-up” refer to?

  • The time it takes for the user to get used to the device.
  • The initial period after sensor insertion before it starts providing glucose readings.
  • Heating the sensor before application to improve accuracy.
  • The time it takes for the transmitter battery to charge. Answer: The initial period after sensor insertion before it starts providing glucose readings.

15. What is the primary purpose of CGM alerts and alarms?

  • To remind the user to charge the device.
  • To notify the user of impending or actual high or low glucose events.
  • To track daily physical activity.
  • To log carbohydrate intake automatically. Answer: To notify the user of impending or actual high or low glucose events.

16. The data output from a CGM is often presented in an Ambulatory Glucose Profile (AGP). What does an AGP report summarize?

  • Only the patient’s A1c values over time.
  • A single day of glucose readings.
  • Glucose data from multiple days to show patterns and trends.
  • The patient’s insurance and billing information. Answer: Glucose data from multiple days to show patterns and trends.

17. For a patient with Type 1 diabetes, what is a primary benefit of using a CGM?

  • It completely replaces the need for insulin injections.
  • It can help reduce the frequency and severity of hypoglycemia.
  • It cures the underlying autoimmune condition.
  • It measures ketone levels in the blood. Answer: It can help reduce the frequency and severity of hypoglycemia.

18. Some CGM systems can be integrated with an insulin pump to create a:

  • Closed-loop or hybrid closed-loop system.
  • Manual glucose infusion system.
  • Blood pressure monitoring system.
  • Ketone monitoring system. Answer: Closed-loop or hybrid closed-loop system.

19. When counseling a patient on starting a CGM, what is a key piece of advice regarding skin preparation?

  • Use a moisturizing lotion on the site before insertion.
  • Ensure the skin is clean and completely dry before applying the sensor.
  • Apply the sensor over a recent injection site.
  • Shave the area with a razor immediately before application. Answer: Ensure the skin is clean and completely dry before applying the sensor.

20. What potential interference can cause inaccurate CGM readings?

  • High doses of acetaminophen.
  • Drinking large amounts of water.
  • Eating foods high in fiber.
  • Normal daily exercise. Answer: High doses of acetaminophen.

21. What is meant by “time above range” (TAR)?

  • The percentage of time glucose levels are above 250 mg/dL.
  • The total time the user has worn the sensor.
  • The percentage of time glucose levels are above 180 mg/dL.
  • The time elapsed since the last high glucose alert. Answer: The percentage of time glucose levels are above 180 mg/dL.

22. What is meant by “time below range” (TBR)?

  • The percentage of time glucose levels are below 54 mg/dL.
  • The time the sensor has been inactive.
  • The percentage of time glucose levels are below 70 mg/dL.
  • The time until the next calibration is due. Answer: The percentage of time glucose levels are below 70 mg/dL.

23. The MARD (Mean Absolute Relative Difference) is a measure of:

  • The battery life of the CGM transmitter.
  • The accuracy of the CGM compared to a reference glucose value.
  • The cost-effectiveness of the CGM system.
  • The strength of the wireless connection. Answer: The accuracy of the CGM compared to a reference glucose value.

24. A lower MARD value indicates:

  • Lower CGM accuracy.
  • Longer sensor life.
  • Higher CGM accuracy.
  • Faster warm-up time. Answer: Higher CGM accuracy.

25. Which patient population might benefit most from professional CGM, where the patient wears a blinded sensor for a period and reviews the data later with their provider?

  • Patients who want constant real-time feedback.
  • Patients with Type 2 diabetes who are not on insulin and want to see the effect of lifestyle on glucose.
  • Patients with an insulin pump and an integrated system.
  • Athletes who need real-time data during competition. Answer: Patients with Type 2 diabetes who are not on insulin and want to see the effect of lifestyle on glucose.

26. According to the syllabus for PHA5060, the Empathy Project includes a CGM activity to help students understand the patient experience. What is one goal of this project?

  • To learn how to bill for CGM services.
  • To appreciate the psychosocial aspects of living with and managing diabetes.
  • To develop a new type of CGM sensor.
  • To practice surgical insertion of the sensor. Answer: To appreciate the psychosocial aspects of living with and managing diabetes.

27. Why is it important to rotate CGM sensor sites?

  • To prevent skin irritation and lipohypertrophy.
  • To improve the wireless signal strength.
  • To make the sensor less visible.
  • To reset the transmitter’s memory. Answer: To prevent skin irritation and lipohypertrophy.

28. What is a “calibration” in the context of CGM?

  • Charging the receiver.
  • Entering a fingerstick blood glucose value into the system to ensure accuracy.
  • Setting the high and low glucose alert levels.
  • Updating the CGM’s software. Answer: Entering a fingerstick blood glucose value into the system to ensure accuracy.

29. Many newer CGM systems are labeled as “non-adjunctive.” What does this mean?

  • They do not require a prescription.
  • They can be used for making treatment decisions without a confirmatory fingerstick.
  • They are only for adjunctive use with SMBG.
  • They do not have alarms. Answer: They can be used for making treatment decisions without a confirmatory fingerstick.

30. What is a potential barrier to CGM use for some patients?

  • Lack of any improvement in A1c.
  • The requirement to manually write down every reading.
  • Cost and insurance coverage.
  • Inability to use during sleep. Answer: Cost and insurance coverage.

31. What feature allows a CGM user to share their glucose data in real-time with family members or caregivers?

  • Bluetooth pairing.
  • Data logging via USB.
  • Remote monitoring or “follower” apps.
  • Encrypted email reports. Answer: Remote monitoring or “follower” apps.

32. What is the typical wear time for most CGM sensors?

  • 1-3 days
  • 3-5 days
  • 7-14 days
  • 30-60 days Answer: 7-14 days

33. What does “glycemic variability” refer to?

  • The difference between fasting and post-meal glucose.
  • The frequency and amplitude of glucose fluctuations (swings) throughout the day.
  • The change in A1c from one visit to the next.
  • The normal variation in glucose levels in people without diabetes. Answer: The frequency and amplitude of glucose fluctuations (swings) throughout the day.

34. How can CGM data help a pharmacist optimize a patient’s medication regimen?

  • By identifying the patient’s insurance provider.
  • By revealing patterns of post-meal hyperglycemia or overnight hypoglycemia.
  • By measuring the patient’s blood pressure.
  • By automatically adjusting the insulin pump settings. Answer: By revealing patterns of post-meal hyperglycemia or overnight hypoglycemia.

35. A patient complains that their new CGM sensor is giving readings that are very different from their fingerstick meter. What is the first thing a pharmacist should ask?

  • “Have you tried restarting your phone?”
  • “Are you in the sensor’s warm-up period?”
  • “Did you apply a discount coupon?”
  • “Have you considered switching brands?” Answer: “Are you in the sensor’s warm-up period?”

36. A hybrid closed-loop system using CGM data will automatically adjust which type of insulin delivery?

  • Bolus insulin doses for meals.
  • Correction bolus doses.
  • Basal insulin delivery rate.
  • Pre-mixed insulin injections. Answer: Basal insulin delivery rate.

37. Which of these is NOT a component of a typical CGM system?

  • Sensor
  • Transmitter
  • Lancet
  • Receiver/Display Device Answer: Lancet

38. The FDA classifies CGM devices as which class of medical device?

  • Class I
  • Class II or Class III
  • Class IV
  • They are not classified as medical devices. Answer: Class II or Class III

39. For a patient experiencing frequent, unpredictable hypoglycemia, what CGM feature is most beneficial?

  • The water-resistant sensor.
  • The color display screen.
  • The predictive low glucose suspend feature (in some pumps).
  • The data-sharing capability with a physician. Answer: The predictive low glucose suspend feature (in some pumps).

40. When interpreting an AGP report, what does the median (50th percentile) line represent?

  • The patient’s average glucose level.
  • The typical glucose pattern across the days measured.
  • The highest glucose value recorded.
  • The target glucose range. Answer: The typical glucose pattern across the days measured.

41. What is a key counseling point for a patient traveling with a CGM?

  • Remove the sensor before going through airport security scanners.
  • Inform security screeners about the medical device; it can usually go through scanners.
  • Turn off the receiver to save battery.
  • Sensors do not need to be hand-checked by security. Answer: Inform security screeners about the medical device; it can usually go through scanners.

42. Which is a recognized international consensus goal for Time in Range (TIR) for most adults with Type 1 or Type 2 diabetes?

  • 50%
  • 60%
  • 70%
  • 90% Answer: >70%

43. A patient’s CGM data shows a sharp spike in glucose every day around 10 AM. This information could prompt a discussion about:

  • Their dinner choices.
  • Their mid-morning snack or breakfast.
  • Their bedtime routine.
  • Their exercise schedule in the evening. Answer: Their mid-morning snack or breakfast.

44. What is the primary reason for confirming a CGM reading with a fingerstick before treating a low glucose event, especially if symptoms don’t match?

  • To double-check the A1c level.
  • To account for the physiological lag time and rule out sensor error.
  • To ensure the glucose meter is working correctly.
  • To satisfy insurance requirements. Answer: To account for the physiological lag time and rule out sensor error.

45. What is the role of the transmitter in a CGM system?

  • It analyzes the glucose in the interstitial fluid.
  • It receives the glucose data and displays it on a screen.
  • It takes the signal from the sensor and sends it to the receiver.
  • It pierces the skin to allow the sensor to be inserted. Answer: It takes the signal from the sensor and sends it to the receiver.

46. How does dehydration potentially affect CGM readings?

  • It can cause falsely high readings.
  • It can cause falsely low readings or sensor errors.
  • It has no effect on CGM readings.
  • It improves sensor accuracy. Answer: It can cause falsely low readings or sensor errors.

47. In the context of ambulatory care, CGM is a tool that facilitates:

  • Acute care in an emergency room setting.
  • Long-term, outpatient management of chronic conditions like diabetes.
  • Surgical procedures.
  • Inpatient chemotherapy administration. Answer: Long-term, outpatient management of chronic conditions like diabetes.

48. Why would a pharmacist recommend a CGM for a patient with “hypoglycemia unawareness”?

  • The device can alert the patient to a drop in glucose before they would feel symptoms.
  • The device can administer glucagon automatically.
  • The device measures blood ketones.
  • The device encourages more frequent fingersticks. Answer: The device can alert the patient to a drop in glucose before they would feel symptoms.

49. For a patient using a CGM integrated with an insulin pump, what is a “bolus calculator”?

  • A feature that calculates the basal rate.
  • A feature that helps determine the insulin dose for meals and corrections based on CGM data and user input.
  • A tool to calculate the total daily dose of insulin.
  • A device that measures the amount of insulin in the vial. Answer: A feature that helps determine the insulin dose for meals and corrections based on CGM data and user input.

50. The ultimate goal of using CGM technology in diabetes care is to:

  • Increase the sales of medical devices.
  • Reduce the number of necessary patient-provider interactions.
  • Improve glycemic control, increase Time in Range, and reduce the risk of long-term complications.
  • Eliminate the need for patients to manage their diet. Answer: Improve glycemic control, increase Time in Range, and reduce the risk of long-term complications.

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