Differences in Use of Glucose Rate of Change (ROC) Arrows to Adjust Insulin Therapy Among Individuals With Type 1 and Type 2 Diabetes Who Use Continuous Glucose Monitoring (CGM)

Abstract

In 2013, we surveyed 300 individuals with T1D and insulin-treated T2D to assess how they are using real-time CGM and responding to their glucose information in real-world settings. Our subsequent report presented findings regarding CGM data utilization behaviors among the 222 T1D individuals who used real-time CGM and responded to the survey. 11 In a subsequent analysis, we reported differences in use of ROC arrows, comparing T1D respondents treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily insulin injection (MDI) Methods:We surveyed 300 individuals who regularly used real-time CGM, using 70 questions to obtain information about general CGM use and response to glucose rate of change (ROC) arrows. Results:The survey was completed by 222 T1D and 78 T2D respondents treated with intensive insulin therapy. T1D respondents included CSII (n = 166) and MDI (n = 56) users. T2D respondents were more balanced: 34 (44%) versus 44 (56%), respectively. A larger percentage of T1D then T2D respondents reported a constant use of CGM (85% vs 61%, P < .001). T1D and T2D respondents reported similar substantial increases in correction dosages in response to rapidly increasing glucose (>3 mg/dL/min; 2 arrows up): +140% versus +136%, P = .4534. However, T1D respondents reported making smaller correction dosage reductions than T2D respondents in response to rapidly decreasing glucose (-42% vs -80%, P < .001). Differences between T1D and T2D respondents were also observed in mealtime dosage adjustments in response to rapidly increasing glucose compared to when glucose is stable (flat arrow) at 110 mg/dl: +81% versus +108%, respectively (P = .003). Although these adjustments are statistically different, both are large.Conclusions: CGM users often rely on ROC information when determining insulin doses and tend to be more aggressive in their insulin adjustments despite differences in type of diabetes.

The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: A consensus view of Italian diabetes experts using the Delphi method

“…Recent surveys indicate that people with diabetes using rtCGM rely on trend arrows to calculate mealtime insulin boluses and also to make corrective insulin dose adjustments between meals [31]. Importantly, in response to RoC trend arrows, respondents using rtCGM made significantly larger dose adjustments than would be recommended by published algorithms for using RoC trend arrows for insulin dose management [32,33].…”

A Simplified Approach Using Rate of Change Arrows to Adjust Insulin With Real-Time Continuous Glucose Monitoring

“…17,18 However, a recent survey of 300 individuals with type 1 and type 2 diabetes using RT-CGM found that those initial recommendations of 10-20% adjustments in doses are viewed as too conservative (Table 2 and Table 3). [19][20][21] From that survey it is clear that for extreme trends people with diabetes are inclined to take more drastic action than were initially recommended, and that individuals using multiple daily injections of insulin make even larger changes (correction and mealtime) compared to pump users. An adjustment in the timing of mealtime insulin relative to the meal based on the ROC was reported by most (58%) of the type 1 respondents including MDI-treated (61%) and CSIItreated (58%) and most of the type 2 respondents (67%).…”

Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations

“…No systematic evaluations have been reported on the information most often used in daily life to guide insulin adjustment decisions, i.e., whether individuals with diabetes mostly rely for decisions on insulin dose adjustment on the current glucose value, the glucose profile over the previous few hours, or the "trend arrow" (which indicates when the blood glucose is rapidly falling or rising but differs in format between devices) (44,45) [3e].…”