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Review
. 2017 Jan;11(1):138-147.
doi: 10.1177/1932296816663747. Epub 2016 Aug 20.

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

Jeremy Pettus  1 , Steven V Edelman  1
Affiliations
Review

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

Jeremy Pettus et al. J Diabetes Sci Technol. 2017 Jan.

Abstract

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.

Keywords: CSII; MDI; continuous glucose monitoring; insulin pump; multiple daily insulin injections; rate of change; type 1 diabetes.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JP and SVE have served as a consultants and advisory board members for Dexcom, Inc, and received research funding from Dexcom, Inc.

Figures

Figure 1.
Figure 1.
Data components of rtCGM-based therapy adjustments. (A) Current glucose: The rtCGM displays the current sensor glucose as a numerical value. (B) Trend graph: The rtCGM systems display trend graphs that visualize glucose levels over the past 1-24 hours. This information provides information that can help users prevent recurrence of specific problems. (C) Rate of change (ROC) arrows: The ROC arrows indicate the direction and rate of change (increase/decrease) within a specified time period. Note that the current commercially available rtCGM systems use slightly different arrow configurations and time periods.
Figure 2.
Figure 2.
System differences in ROC arrows.
Figure 3.
Figure 3.
Flow sheet for prandial and correction dosages.
Figure 4.
Figure 4.
110 mg/dl with angle UP arrow (phone app display).
Figure 5.
Figure 5.
110 mg/dl with angle DOWN arrow (phone app display).
Figure 6.
Figure 6.
220 mg/dl with UP arrow (phone app display).
Figure 7.
Figure 7.
220 mg/dl with DOWN arrow (phone app display).
See this image and copyright information in PMC

Comment in

References

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