scholarly journals Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes

2021 ◽  
Vol 18 (6) ◽  
pp. 147916412110621
Author(s):  
Nancy Elbarbary ◽  
Othmar Moser ◽  
Saif Al yaarubi ◽  
Hussain Alsaffar ◽  
Adnan Al Shaikh ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Vascular Complications ◽  
Rate Of Change ◽  
Rapid Expansion ◽  
Nocturnal Hypoglycaemia ◽  
Glucose Levels

Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.

Advantages and Disadvantages of Realtime Continuous Glucose Monitoring in People with Type 2 Diabetes

2012 ◽  
Vol 08 (01) ◽  
pp. 22 ◽  
Author(s):  
M Susan Walker ◽  
Stephanie J Fonda ◽  
Sara Salkind ◽  
Robert A Vigersky ◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glucose Levels ◽  
Advantages And Disadvantages ◽  
Blood Glucose Levels

Previous research has shown that realtime continuous glucose monitoring (RT-CGM) is a useful clinical and lifestyle aid for people with type 1 diabetes. However, its usefulness and efficacy for people with type 2 diabetes is less known and potentially controversial, given the continuing controversy over the efficacy of self-monitoring of blood glucose (SMBG) in this cohort. This article reviews theextantliterature on RT-CGM for people with type 2 diabetes, and enumerates several of the advantages and disadvantages of this technology from the perspective of providers and patients. Even patients with type 2 diabetes who are not using insulin and/or are relatively well controlled on oral medications have been shown to spend a significant amount of time each day in hyperglycemia. Additional tools beyond SMBG are necessary to enable providers and patients to clearly grasp and manage the frequency and amplitude of glucose excursions in people with type 2 diabetes who are not on insulin. While SMBG is useful for measuring blood glucose levels, patients do not regularly check and SMBG does not enable many to adequately manage blood glucose levels or capture marked and sustained hyperglycemic excursions. RT-CGM systems, valuable diabetes management tools for people with type 1 diabetes or insulin-treated type 2 diabetes, have recently been used in type 2 diabetes patients. Theextantstudies, although few, have demonstrated that the use of RT-CGM has empowered people with type 2 diabetes to improve their glycemic control by making and sustaining healthy lifestyle choices.

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

2016 ◽  
Vol 11 (1) ◽  
pp. 138-147 ◽  
Author(s):  
Jeremy Pettus ◽  
Steven V. Edelman
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Rate Of Change ◽  
Clinical Experiences ◽  
Clinical Benefits ◽  
Effective Use ◽  
Patient Use

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.

Continuous Glucose Monitoring Data Sharing in Older Adults with Type 1 Diabetes: A feasibility study (Preprint)

2021 ◽  
Author(s):  
Nancy Allen ◽  
Michelle Litchman ◽  
James Chamberlain ◽  
Ernest Grigorian ◽  
Eli Iacob ◽  
...  
Keyword(s):  
Older Adults ◽  
Type 1 Diabetes ◽  
Data Sharing ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Action Planning ◽  
Glucose Levels ◽  
Related Quality ◽  
To Receive

BACKGROUND Family members or friends (care partners) of older adults with type 1 diabetes mellitus (T1DM) regularly become part of the diabetes care team yet often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Continuous glucose monitoring (CGM) allows a person with diabetes to see their glucose levels continuously and to receive predictive alerts. A smartphone data sharing application called the Follow app allows the person with diabetes (PWD) to share continuous glucose numbers with others and to receive predictive alerts of impending hypo- and hyperglycemia. However, there are barriers to sharing this continuous glucose level data with CPs. OBJECTIVE This study aimed to address the barriers to sharing CGM data. Our objective was to examine the feasibility of using CGM+Follow and a data-sharing intervention called SHARE plus in older adults with T1DM and their CPs. SHARE plus includes dyadic communication strategies, problem-solving strategies, and action planning to facilitate CGM data sharing. METHODS Older adults with T1DM (n=20) and their CPs (n=20) received the SHARE plus intervention at baseline. PWD wore the CGM for 12 weeks while sharing their glucose data with a CP using the Follow App. Feasibility data were analyzed using descriptive statistics. RESULTS The SHARE plus intervention was feasible, had high self-reported satisfaction for PWD and their CP, and high adherence (96±6.8%) with wearing the CGM. Broad improvements were shown in the diabetes-related quality of life using CGM in PWD and their CPs measure. Although the majority of PWD were willing to share hyperglycemia data (55%), several chose not to. The majority of PWD were willing to talk about glucose numbers with a CP (n=70%). CONCLUSIONS Older adults with T1DM diabetes and their CPs identified the positives of the SHARE plus intervention as having someone else aware of glucose levels and working together with a partner on diabetes self-management. Clinicians can use these results to provide data-sharing coaching in older adults and their CPs.

Methods for Insulin Bolus Adjustment Based on the Continuous Glucose Monitoring Trend Arrows in Type 1 Diabetes: Performance and Safety Assessment in an In Silico Clinical Trial

2021 ◽  
pp. 193229682110431
Author(s):  
Giulia Noaro ◽  
Giacomo Cappon ◽  
Giovanni Sparacino ◽  
Federico Boscari ◽  
Daniela Bruttomesso ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
In Silico ◽  
Safety Assessment ◽  
Glucose Monitoring ◽  
Postprandial Glucose ◽  
Rate Of Change ◽  
The Other ◽  
Single Meal

Background: Providing real-time magnitude and direction of glucose rate-of-change (ROC) via trend arrows represents one of the major strengths of continuous glucose monitoring (CGM) sensors in managing type 1 diabetes (T1D). Several literature methods were proposed to adjust the standard formula (SF) used for insulin bolus calculation by accounting for glucose ROC, but each of them provides different suggestions, making it difficult to understand which should be applied in practice. This work aims at performing an extensive in-silico assessment of their performance and safety. Methods: The methods of Buckingham (BU), Scheiner (SC), Pettus/Edelman (PE), Klonoff/Kerr (KL), Aleppo/Laffel (AL), Ziegler (ZI), and Bruttomesso (BR) were evaluated using the UVa/Padova T1D simulator, in single-meal scenarios, where ROC and glucose at mealtime varied between [-2,+2] mg/dL/min and [80,200] mg/dL, respectively. Efficacy of postprandial glucose control was quantitatively assessed by time in, above and below range (TIR, TAR, and TBR, respectively). Results: For negative ROCs, all methods proved to increase TIR and decrease TAR and TBR vs SF, with KL, PE, and BR being the most effective. For positive ROCs, a general worsening of the performances is present, only BR improved the glycemic control when mealtime glucose was close to hypoglycemia, while SC resulted the safest in the other conditions. Conclusions: Insulin bolus adjustment methods are effective for negative ROCs, but they generally appear to overdose for positive ROCs, calling for safer strategies in such a scenario. These results can be useful in outlining guidelines to identify which adjustment to apply based on the mealtime condition.

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