This article pertains to: INFORM (V2)
The Validic Inform API suports Dexcom CGM data as intraday, or high-frequency data. But you already knew that.
What you may not know is that the implementation of the Dexcom intraday data includes some things that are worth calling out to ensure that you are properly capturing all possible data for your patients.
Regional Servers
The API credentials needed are different for the two servers so you’ll want to evaluate your user base to determine whether you need API keys setup for Dexcom US, Dexcom EU, or both.
Dexcom must approve clients to use either regional server. It’s up to Dexcom’s discretion on which server(s) a client has access to.
The Inform Dexcom integration works with the Dexcom US server (for those Dexcom users located in the United States) and the Dexcom EU server (for those Dexcom users that are located in much of the rest of the world, except for Singapore and Japan).
The Inform Dexcom integration defaults to using the Dexcom US server since the majority of our clients and users are US-based. Any user without a country in their Validic user profile will be assumed to be a US user.
A non-US user will receive a marketplace error if they attempt to authorize data sharing when a country code has not been specified in their Validic user profile.
To use the Dexcom EU server, a country must be specified in each user’s Validic user profile.
Specifying a non-US country in the user profile will direct the user to the Dexcom EU server for authorization and data syncing.
Therefore, if you intend to use the Dexcom EU server, you must have Dexcom EU API credentials from Dexcom AND you must specify a non-US country code when provisioning users in Inform. Any non-US users that are already provisioned in Inform must be updated to include the correct non-US country code.
Historical Data
Validic captures a maximum of 7 days of Dexcom historical data. This would be the 7 days prior to the Dexcom user first syncing to Validic. While Dexcom may be able to have more than 7 days of historical data, Validic chose to only pull in 7 days due to the sheer volume of intraday data that would have to be captured, stored, and then made available in the Inform API.
Getting ongoing data from Dexcom
As noted on this page,https://helpdocs.validic.com/docs/high-frequency-data , Validic is getting the CGM data from Dexcom in 5 minute intervals via hourly data pulls. Each new hourly pull of data from Dexcom looks at the timestamp of the last record received and then adds 5 seconds to that time to look for new data. Because of the 1 hour delay that Dexcom has on the CGM data, this means that each payload would include the readings from the previous hour. For example, the 10am payload would include the records from 8am to 9am.
Duplicate Data
If a patient fully disconnects Dexcom from their Validic user and then reconnects that same user within 7 days, it is highly likely that the data pulled in upon reconnection will contact duplicate data that you have already received. Normally you would use the Validic "id" and "checksum" to check for data you may have already consumed. This will not work for the Dexcom CGM data. You would want to check the "time" and "value" pairs of the records to check for possible duplicates.
Timezones
Validic does not get timezone information from Dexcom. Therefore, the user is asked to provide their home timezone when connecting to Dexcom via the Validic Marketplace. If they had previously provided this timezone information, they will not be prompted for it again. The offset_origin for Dexcom will be "user_defined".
As a result, if a user is traveling across timezones, their Dexcom data will still show their timezone (utc_offset) as their base or home timezone. If this same user has other devices in use, like Fitbit or Apple Health, that do provide updated timezone information from the user's phone, you may see different utc_offsets depending on the data source.
Scenarios that Dexcom data wouldn’t be available in their cloud
If the data isn’t available in the Dexcom API the Validic system wouldn’t be able to capture with our scheduled jobs
Sensor can be flaky due to nearing time to change
The sensor is dead and needs to be changed
The Dexcom G6 and G7 sensors can be worn for up to 10 days, with the G7 also having a 12-hour grace period at the end.
Bad sensor placement
Placed in a part of the body that doesn’t have enough fat - easily possible on an underweight patient. More common on younger and older patients.
Adhesive failure. People who are active, get sweaty, swim, etc. may have problems with the adhesive on the sensor breaking down sooner than the expected timeframe (the sensor is good for 10 days so the adhesive needs to last that long). When the sensor doesn’t have solid contact there is a potential to get flakey results, no data, bad readings, etc…