Use of Glucose Rate of Change Arrows to Adjust Insulin Therapy Among Individuals with Type 1 Diabetes Who Use Continuous Glucose Monitoring

Pettus, Jeremy; Edelman, Steven V.

doi:10.1089/dia.2015.0369

Cited by 35 publications

(33 citation statements)

References 19 publications

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“…The majority of CGM users in this study also reported using ROC arrows frequently to guide changes in their insulin dosage, with these changes more aggressive than the recommended 10%-20% adjustments commonly advised. 6 …”

Section: Accuracymentioning

confidence: 99%

Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Slattery

Choudhary

2017

Diabetes Technology & Therapeutics

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With the emphasis on intensive management of type 1 diabetes, data from studies support frequent monitoring of glucose levels to improve glycemic control and reduce glucose variability, which can be related to an increase in macro and microvascular complications. However, few perform capillary blood glucose that frequently. There are currently two available alternatives that this review will discuss, continuous glucose monitoring (CGM) and flash glucose monitoring. CGM has become an important diagnostic and therapeutic option in optimizing diabetes management. CGM systems are now more accurate, smaller, and easier to use compared to original models. Randomized controlled trials (RCTs) have demonstrated that CGM can improve Hemoglobin A1c (HbA1C) and reduce glucose variability in both continuous subcutaneous insulin infusion and multiple daily injection users. When used in an automated ''insulin-suspend'' system, reduced frequency of hypoglycemia and shorter time spent in hypoglycemic range have been demonstrated. Despite the potential benefits CGM has to offer in clinical practice, concerns exist on the accuracy of these devices and patient compliance with therapy, which may prevent the true clinical benefit of CGM being achieved, as observed in RCTs. Flash glucose monitoring systems FreeStyle Ò LibreÔ (Abbott Diabetes Care, Alameda, CA) are as accurate as many CGM systems available and have the added benefit of being factory calibrated. Studies have shown that flash glucose monitoring systems are very well tolerated by patients and effectively reduce glucose variability, increasing time in range.

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Section: Accuracymentioning

confidence: 99%

Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Slattery

Choudhary

2017

Diabetes Technology & Therapeutics

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“…Therefore, there is a clear need to provide a framework to patients and clinicians on how to make these adjustments. 37 …”

Section: Evidence For Efficacy Of Rtcgm Usementioning

confidence: 99%

Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes

Pettus

Edelman

2016

J Diabetes Sci Technol

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101

104

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The clinical benefits of real time continuous glucose monitoring (rtCGM) use have been well demonstrated in both CSII- and MDI-treated individuals in large clinical trials. However, recommendations for patient use of rtCGM in everyday life situations are lacking. This article provides guidance to clinicians and patients with type 1 diabetes (T1D) in effective use of rtCGM data, including glucose rate of change (ROC) arrows, for insulin dosing adjustments and other treatment decisions. The recommendations presented here are based on our own clinical experiences as endocrinologists, our personal experiences living with T1D using rtCGM, and findings from a recent survey of T1D patients who have successfully used rtCGM in their self-management. It is important that both clinicians and people with diabetes understand the utility and limitations of rtCGM. Maintaining a collaborative clinician-user relationship remains an important factor in safe, successful rtCGM use.

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“…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].…”

Section: Data Handling and Reportingmentioning

confidence: 99%

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

et al. 2017

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The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre-and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

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Use of Glucose Rate of Change Arrows to Adjust Insulin Therapy Among Individuals with Type 1 Diabetes Who Use Continuous Glucose Monitoring

Cited by 35 publications

References 19 publications

Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes

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

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