A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes

Aleppo, Grazia; Laffel, Lori M.; Ahmann, Andrew J.; Hirsch, Irl B.; Kruger, Davida F.; Peters, Anne L.; Weinstock, Ruth S.; Harris, Dennis

doi:10.1210/js.2017-00388

Cited by 87 publications

(85 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previously, subjects in clinical trials using rtCGM have been provided with treatment algorithms for managing insulin dosing decisions in line with trend arrows data [10,34], and a range of real-world methods have been proposed for adjusting insulin doses using trend arrows. Methods proposed by Scheiner [35], Pettus/Edelman [36] and Aleppo (specific to Dexcom G5) [37] rely on using trend arrows to anticipate a future glucose value to recommend an adjustment in insulin dose. Users can then use their own predetermined insulin sensitivity factor to add or subtract insulin, based on insulin sensitivity.…”

Section: Trend Arrows and Insulin Dosing Decisionsmentioning

confidence: 99%

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

Bruttomesso

Laviola

Avogaro

et al. 2019

Nutrition, Metabolism and Cardiovascular Diseases

View full text Add to dashboard Cite

Until recently, in Italy, the use of continuous glucose monitoring (CGM) systems has been limited, but is now rapidly increasing, including the so-called real-time CGM (rtCGM) and the intermittently viewed CGM (iCGM), also called Flash Glucose Monitoring (FGM). These technologies overcome many of the limitations of self-monitoring of blood glucose (SMBG) by fingerprick and allow to go beyond HbA1c to check glucose control in diabetes. However, standardized protocols for applying and interpreting rtCGM and FGM data are lacking. In this paper, we delineate a consensus amongst Italian diabetes physicians on the attributes of rtCGM and FGM technologies, and introduce a consistent approach for their use by Italian healthcare professionals. Most experts consider rtCGM and FGM as two separate categories of interstitial subcutaneous fluid (ISF) sensing technologies, and see them as superior to SMBG. Furthermore, there is strong consensus that rtCGM and FGM reduce hypoglycemia risk, increase the amount of time in the target glucose range and augment treatment satisfaction. However, there is still no agreement on the indication of the FGM for subjects who suffer asymptomatic hypoglycemia. Consensus on the role of education in initiating and optimizing use of rtCGM/FGM and about the interpretation of glucose trends was near unanimous, whereas no consensus was reached on the statement that there are no disadvantages/risks of rtCGM/FGM. Some issues remain in rtCGM/FGM management: a) risk of excessive correction of high or low glucose; b) risk of alert fatigue leading to alert silencing or rtCGM termination; c) allergic reaction to the adhesive keeping rtCGM or FGM sensors in place. The panel almost unanimously agreed that sensor accuracy depends on multiple variables, that alarm setting should be individualized, and that global jo urnal homep age: www.el sevie r.co m/locate/nm cd glycemic profile represent an useful tool in interpreting glucose data. More clinical studies and a wider use of these devices will increase the efficacy and effectiveness of continuous glucose monitoring in Italy.

show abstract

Section: Trend Arrows and Insulin Dosing Decisionsmentioning

confidence: 99%

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

Bruttomesso

Laviola

Avogaro

et al. 2019

Nutrition, Metabolism and Cardiovascular Diseases

View full text Add to dashboard Cite

show abstract

“…Die Insulindosisanpassung kann durch Trendpfeile erfolgen. Der große Vorteil besteht in der Entdeckung von Hypoglykämien [28,29]. Die Dosisanpassung in den Zielbereich bei der BOT ist wichtig, um den Betazellstress zu verringern und einen optimalen Therapieerfolg zu gewährleisten.…”

Section: Herausforderungen Der Insulintherapieunclassified

Beginn der Insulintherapie bei Typ-2-Diabetes

Kreß

2019

Diabetes aktuell

View full text Add to dashboard Cite

ZUSAMMENFASSUNGDer erstmalige Beginn einer Insulintherapie beim Typ-2-Diabetes stellt für viele Patienten und Therapeuten eine Herausforderung dar. Die Notwendigkeit und der Beginn der Insulintherapie belasten den Patienten enorm und stellen oft einen schweren Einschnitt in seinem Leben dar. Dabei ist Typ-2-Diabetes nicht gleich Typ-2-Diabetes. Der Verlust der Betazellfunktion geschieht mit unterschiedlicher Geschwindigkeit. Und bereits zum Zeitpunkt der Diagnose kann die Betazellfunktion im Mittel um 50 % reduziert sein. Die Therapie sollte also vielmehr bedarfsgerecht auf mehrere Typen mit unterschiedlicher Betazellfunktion abgestimmt sein. Zahlreiche Studien demonstrieren, dass Patienten von einer frühen, sehr guten und stabilen Einstellung profitieren und vor einer Progression, d.h. dem weiteren Nachlassen der Betazellfunktion, geschützt werden. Darüber hinaus reduziert die frühe Therapieintensivierung nach Erstdiagnose eines Typ-2-Diabetes im Vergleich zum verzögerten Vorgehen das Risiko für kardiovaskuläre Erkrankungen bzw. Myokardinfarkte.

show abstract

“…Recent consensus reports provide clinical guidance for using trend arrow data with the Dexcom and FreeStyle Libre systems. 1,2 In addition, retrospective glucose trend data can be downloaded and reviewed, enabling patients and their health care team to identify glycemic patterns that may indicate the need for therapy adjustments and/or lifestyle and behavior changes.…”

Section: Introductionmentioning

confidence: 99%

Utilizing the Ambulatory Glucose Profile to Standardize and Implement Continuous Glucose Monitoring in Clinical Practice

Johnson

Martens

Criego

et al. 2019

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

Use of continuous glucose monitoring (CGM) is recognized as a valuable component of diabetes selfmanagement and is increasingly considered a standard of care for individuals with diabetes who are treated with intensive insulin therapy. As the clinical use of CGM technology expands, consistent and standardized glycemic metrics and glucose profile visualization have become increasingly important. A common set of CGM metrics has been proposed by an international expert panel in 2017, including standard definitions of time in ranges, glucose variability, and adequacy of data collection. We describe the core CGM metrics, as well as the standardized glucose profile format consolidating 2 weeks of CGM measurements, referred to as the ambulatory glucose profile (AGP), which was also recommended by the CGM expert panel. We present an updated AGP report featuring the core CGM metrics and a visualization of glucose patterns that need clinical attention. New tools for use by clinicians and patients to interpret AGP data are reviewed. Strategies based on the authors' experience in implementing CGM technology across the clinical care spectrum are highlighted.

show abstract

A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes

Abstract: After reviewing previously published methods, we developed a practical approach to adjusting insulin doses based on insulin sensitivity for adult patients with diabetes using rtCGM trend arrow data.

Cited by 87 publications

References 26 publications

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

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

Beginn der Insulintherapie bei Typ-2-Diabetes

Utilizing the Ambulatory Glucose Profile to Standardize and Implement Continuous Glucose Monitoring in Clinical Practice

Contact Info

Product

Resources

About