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

2016 ◽  
Vol 18 (S2) ◽  
pp. S2-34-S2-42 ◽  
Author(s):  
Jeremy Pettus ◽  
Steven V. Edelman
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Rate Of Change

scholarly journals Professional Continuous Glucose Monitoring for the Identification of Type 1 Diabetes Mellitus Among Subjects With Insulin Therapy

Medicine ◽  
2015 ◽  
Vol 94 (3) ◽  
pp. e421 ◽  
Author(s):  
Yin-Chun Chen ◽  
Yu-Yao Huang ◽  
Hung-Yuan Li ◽  
Shih-Wei Liu ◽  
Sheng-Hwu Hsieh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring

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.

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.

scholarly journals Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes

2011 ◽  
Vol 9 (1) ◽  
pp. 13 ◽  
Author(s):  
R Brett McQueen ◽  
Samuel L Ellis ◽  
Jonathan D Campbell ◽  
Kavita V Nair ◽  
Patrick W Sullivan
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Insulin Therapy ◽  
Continuous Glucose Monitoring ◽  
Intensive Insulin Therapy ◽  
Glucose Monitoring

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.

scholarly journals Metabolic control and hypoglycaemia in people with type 1 diabetes: insulin pump therapy vs. intensified insulin therapy in an unselected cohort in routine care

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Guido Kramer ◽  
Christof Kloos ◽  
Ulrich A. Müller ◽  
Gunter Wolf ◽  
Nadine Kuniss
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Metabolic Control ◽  
Continuous Glucose Monitoring ◽  
Treatment Satisfaction ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Routine Care ◽  
Insulin Dosage

Abstract Aims The aim of this study was to compare individuals with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and intensified insulin therapy (ICT) in routine care regarding metabolic control and treatment satisfaction. Methods Individuals with type 1 diabetes (CSII n = 74; ICT n = 163) were analysed regarding metabolic control, frequency of hypoglycaemia and treatment satisfaction (DTSQs range 0–36). Results Individuals with CSII (duration of CSII: 14.1 ± 7.2 years) were younger (51.1 ± 15.8 vs. 56.2 ± 16.2 years, p = 0.023), had longer diabetes duration (28.7 ± 12.4 vs. 24.6 ± 14.3 years, p = 0.033), lower insulin dosage (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004), used more frequently short-acting analogue insulin (90.5% vs. 48.5%, p < 0.001) and flash/continuous glucose monitoring (50.0% vs. 31.9%, p = 0.009) than people with ICT. HbA1c was similar between CSII and ICT (7.1 ± 0.8%/54.4 ± 9.1 mmol/mol vs. 7.2 ± 1.0%/55.7 ± 10.9 mmol/mol, p = 0.353). Individuals with CSII had higher frequency of non-severe hypoglycaemia per week (in people with blood glucose monitoring: 1.9 ± 1.7 vs. 1.2 ± 1.6, p = 0.014; in people with flash/continuous glucose monitoring: 3.3 ± 2.2 vs. 2.1 ± 2.0, p = 0.006). Prevalence of polyneuropathy (18.9% vs. 38.0%, p = 0.004) and systolic blood pressure (138.0 ± 16.4 vs. 143.9 ± 17.1 mmHg, p = 0.014) was lower in CSII. Satisfaction with diabetes treatment (26.7 ± 7.3 vs. 26.0 ± 6.8, p = 0.600) did not differ between CSII and ICT. Conclusions CSII and ICT yielded comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage.

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