Dexcom Clarity 14-day report guides post-holiday efforts

[Terry4]

I just returned from a 20-day holiday in NewZealand. I enjoyed my vacation and did not unduly deprive myself when it came to enjoying food. Now that I’m back, I’m ready to resume my former BG control.

As you can see from the Clarity 14-day data report, I can see where I need to concentrate my efforts.

I need to restart my post-meal walks, after both of my daily meals, to knock down post meal BGs and narrow the 15th-75th percentile glucose range. This narrowing should cut off most of the yellow or high BGs shown on the graph. I also need to watch out for some low activity between 2:00-2:30 a.m. In addition I will concentrate on reducing and limiting evening snacking.

I love this tool because it definitely shows where the statistically valid areas of concern are in my standard day. Fourteen days is enough data to draw a valid conclusion and not too long so that it obscures or averages out where I need to focus my efforts.

With the Thanksgiving holiday in the U.S. and all the attendant eating looming large, I suggest to those that have access to a CGM and this report to experiment with it and see if it might help you, too.

I’ll post updates over the next few weeks and hopefully show some significant improvement in this graph.

One week later

Last week’s 14-day Clarity report showed some lows around 2:30 a.m. It also showed moderate hyperglycemia while sleeping, post breakfast, and post dinner. To address the early morning lows, I reduced my 11:00 p.m. to 1:00 a.m. basal rates. This mild hypo problem moved to after 3:00 a.m. and I’m now playing with the midnight to 2:00 a.m. basal rates.

I’ve been trying to limit the evening snacking to reduce the width of the overnight BGs as well as bring the average down. I’m getting more consistent exercise and that’s having a good overall effect, too. My after meal walking continues to bring down post-meal BGs. I’m using Afrezza more to correct during this last week. I’ll continue to use it as needed but I expect Afrezza corrections to return to less frequent use, like I did before my travel.

I’m moving in the right direction as I’m eyeing my next endo appointment in two weeks. I’ve been able to move the entire average line to within my target range. I’ll post again next week.

Six weeks later

Well, things did not turn around as quickly as I would have liked. I finally was able to reduce my basal rates closer to what they were. Before my travel in November, my total daily dose was around 30 units. It ramped up to about 38. I’m now down to about 32. This experience reminds me that sometimes changes take longer. Persistence and patience will eventually pay off. Here’s my latest Dexcom Clarity 14-day report:

Things are back where I’d like them to be. I still have to work on bringing my overnight averages down. I also have a minor low problem in the 3:15-3:45 p.m. time period. There’s always room for improvement and this job is never over. But I am at a spot that’s good enough for me. The important thing is to pay attention, act when needed, and don’t give up!

[Siri]

First of all, thank you for having helped me on how to use all the data I get from my CGM. It has helped a ton and I feel a lot more self reliant in my daily diabetes life. Maybe my question is a bit off topic this time, but I wonder if Dexcom Clarity is a bit like the new Ambulatory Glucose Profile (AGP) from Diasend.

I can´t find a way to uplod an example picture to compare to yours, but this link includes a picture. AGP explained here.

I don´t have access to Dexcom Clarity because I use an Animas Vibe with integrated Dexcom G4 and you always have such easy-to-understand explanations,- hence my question.

[jjm335]

I use Diasend and am not familiar with Clarity. However, looking at Terry4’s profile, it looks like more or less the same information as AGP, with only a slightly different graphic format.

[Thas]

I am curious about the way Clarity reports. Here is the 30-day trend data graph for me:

I can clearly see that after dinner is my biggest challenge; however, I also know that I periodically have spikes after lunch. Those spikes do not appear in the overall 30-day picture, though they do show up when I do the 14-day graph. IS this because they are just “statistically insignificant” relative to a 30-day period? Though it looks nice, I find this data confusing.

[Jen]

I find the Clarity presentation a lot more clear than Dexcom’s AGP presentation.

[Terry4]

@Siri - Thank-you for bringing the new Diasend AGP report to my attention! I read about the Ambulatory Glucose Profile in the Diabetes Technology and Therapeutics meeting report, Volume 15, Number 3, 2013. The logic presented in that report impressed me. Here’s the description that caught my eye:

For instance, without dependence on numbers, formulas, or derived indices, clinicians and patients can quickly become skilled at identifying the risk of hypoglycemia. For example, if the 10th percentile curve crosses 70 mg/dL or lower, there is moderate risk of hypoglycemia at that time because consistently 10% of the values fall in this range. However, if the 25th percentile curve crosses into hypoglycemia, this implies a marked risk because more than 25% of the glucose values fall in the hypoglycemic range, and consequently this should be addressed before additional therapy is instituted to treat accompanying hyperglycemia as is often seen with significant GV [glucose variability]. [emphasis added]

At the time I was looking for authoritative scientific documentation that I could show my endocrinologist that I was not in danger of “too many lows.” I was tired of all the hypo-phobia talk that the doctors had presented to me over the years. I had already changed to a low-carb way of eating at this point and my danger from hypoglycemia was now very low, in my opinion. I just had to convince my doctor about this. Once she looked at the report and my CGM numbers she accepted that I was indeed not at significant risk for hypoglycemia. This was over two years ago, in 2013.

The AGP next came up on my radar when the Abbott Freestyle Libre flash glucose monitor was released in Europe. In its analysis software it included the AGP report as its main tool and referenced the very same study that caught my eye.

I am convinced that the 14-day standard day as implemented by the Ambulatory Glucose Profile is the best and simplest tool for both the clinician and patient to use. It communicates quickly and clearly, with enough statistical heft, what time of day needs work. The 30-day report can obscure more recent trends.

I’ve been traveling recently and missed Diasend’s software update that includes the AGP. So, I finally arrive at the end of my long-winded answer to your question! The Dexcom Clarity is a close approximation of the AGP report in the Diasend software. The only difference is that Clarity uses the 15th and 75th percentiles as the thresholds to define low and high blood glucose (BG). I prefer the the more conservative 10th and 90th percentiles that Diasend uses to signal low and high BGs. Diasend has adopted the protocol in the original report that I read, the same as did Abbot’s Libre.

I will now switch to the Diasend AGP report as my main analysis tool.

@jjm335, I agree that the Dexcom Clarity 14-day standard day report is similar to the Diasend AGP. I think the Diasend report is superior due to its conservative use of the 10th percentile as a marker for low BGs.

@Thas, your numbers are excellent! Clarity 30-day report does reveal quite well your need to address your after dinner highs. For reasons stated above, I think the 14-day report is better at catching significant recent trends more quickly than the 30-day report. I think 14 days of data is the sweet spot between over-reacting to today’s data and having it obscured in a longer period’s report. I think the 14-day report would work better for you. It will raise the alarm for any negative trends in a more timely manner.

[Terry4]

@Jen

I find the Clarity presentation a lot more clear than Dexcom’s AGP presentation.

Jen, did you mean the Diasend AGP report? The two tools are very close in nature. I think you’re referring to the graphics appearance for the Clarity report is more appealing to your eye. I can understand that. In any case, each tool is valuable, in my opinion.

@Jen, the more I look at the Diasend AGP report, I see your point. While I like the addition of the 10th and 90th percentile curves, I don’t like the fact that the target range, in my case 65-140 mg/dl), is shaded grey and gets lost in the overlying graphics. Here’s the Diasend AGP report that’s comparable to the Clarity report posted above:

In the above graphic I would shoot to keep the bottom edge of the light blue shade (10th percentile) above the bottom edge (65 mg/dl) of the grey target range. The 1:30 a.m. to 2:30 a.m. needs work. The rest of the day is good.

Then I would try to keep the top edge of the dark blue shade (75th percentile) below the top edge of the grey target range (140 mg/dl).

If I could customize, I would choose the Clarity layout with the 15th percentile replaced by the 10th percentile. So it would show the 10th percentile, the median, and the 75th percentile. Seems like it would be easy for Dexcom to allow some minimal customization.

I know I am in a minority of people here but I find these images valuable in framing my efforts. I think the human brain responds better to pictures and graphs than it does to the more abstract numbers.

[Thas]

Ok… Here’s my last 2 weeks, Diasend-style:

[Terry4]

Those are good numbers anyway it’s displayed. The Diasend display gives lots of info when hovering the pointer, something not available to view when their graphic when posted online.

I can see than the 10th percentile line penetrates the bottom edge of your target range (is it 60?) around 1:30 a.m. to 3:00 a.m. That could give rise to some higher rebound numbers later in the morning. Stopping that low trend could settle down your aggregate curve even more. Great numbers nonetheless.

You can clearly see the after lunch and after dinner numbers trending higher. Is your earlier post of the Clarity graph the same time period as this graph? Clarity didn’t show an after-lunch hyperglycemia trend but this graph does. I know you’re are already aware of the after-dinner higher-BG trend. What could you do to tamp down these relatively mild to medium-sized spikes?

@Thas

Though it looks nice, I find this data confusing.

What confuses you? I think both of these graphs give clear actionable data for you.

[Thas]

The Clarity graph was a 30-day period. The 14-day graph does show fairly mild spikes after lunch. The 3am (or so) lows were after the highest dinner spikes. Regardless, I already dropped my midnight basal rate a little, so I will have to watch and see what happens.

With Thanksgiving, this will be an idea time to do that watching!

[Terry4]

I added an update edit to the main post. Bump.

[Dragan1]

@Thas

IS this because they are just “statistically insignificant” relative to a 30-day period?

Sort of. Each point on the clarity report is based on the data associated with that particular time point. On the other hand, I am pretty sure your meals do not happen always at the same time - sometimes you may have your lunch at 11:55pm, sometimes at 12:25pm, or 12:48pm, etc. As a result, even if you had exactly the same spike after lunch every single day, those spikes would get flattened, i.e. averaged out in the clarity report, simply because they do not always happen at the same time, and you would not be able to ‘see’ the need to make any adjustments. The more days you include in the report, the flatter the report curve will look like. As a side note, you may use this to your advantage to impress your doctor . I agree with @Terry4 that the 14-day report is probably the best compromise to guide any strategic adjustments - not too short to be affected by one-time events, and not too long to just average out all relevant multi-day trends and variations.

[Terry4]

I added my latest 14-day Clarity report to the main post.

I’ve said it before and I’ll say it again. The 14-day Standard Day report is an excellent tool to identify trends to target for action.

[Thas]

Here’s my latest 14-day Clarity report. Near the beginning of the period, I had some lows that required a small adjustment to my basal profile. Still having some dinner-time issues – mostly on weekends. Not sure if I’ll ever be able to manage those larger meals the way I’d like.

[Terry4]

@Thas, you do a great job with your BGs. You have a lot of skinny 15-minute periods. I love the way that you can quickly see from your report the two places that you need to target efforts. Did you adjust the basal rate starting at 1:00 a.m.?

[Thas]

Yes, that is where I made the adjustment for the 3-4am lows. I actually had a shorter extra (slightly higher) segment from midnight to 1am that I eliminated at the same time. The initial change resulted almost immediately in much higher waking BGs, so I pushed the 4:30am increase back to 4am, and that seems to have compensated for the lower middle of the night basal.

[Terry4]

This is where the pump flexibility shines. I can’t imagine making these changes with MDI.

[Dragan1]

Very good @Thas! This reminded me that I should look at my 14-day Clarity report

Hmm, not much to change this time, but I am pretty sure I’ll find something next time

[Terry4]

@Dragan1, if perfect was possible, this is what it would look like. Nice graph!

[Helmut]

@Terry4

I’ve said it before and I’ll say it again. The 14-day Standard Day report is an excellent tool to identify trends to target for action.

Thanks for promoting the 14-day Standard Day report. My assumption was that I could not learn anything from it since I look at my dex every 5 minutes. I was wrong. My BG was consistently too high at around 11 am. It was easy to fix once it had my attention.