Predictive Glucose Trends From Continuous Glucose Monitoring: Friend or Foe in Clinical Decision Making?

Fantasia, Kathryn L.; Modzelewski, Katherine L.; Steenkamp, Devin

doi:10.1177/1932296818823538

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…This study also revealed that participants who wear CGM reported using less CHO to treat hypoglycemia, possibly due to earlier detection. Although there are mixed reviews of predictive trends using CGM arrows, 23 DCESs can work with PWD and their care partners to determine the amount of CHO they need based on sensor glucose, arrows, and alarms while considering the delay and personal variables. These findings support the need for better coverage and access to CGM in all PWD at risk for hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Understanding Hypoglycemia in the Real World

Ziemer

Litchman

2022

The Science of Diabetes Self-Management and Care

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Purpose: The purpose of this study was to gain a better understanding of real-world hypoglycemia experiences from people living with diabetes. Methods: An exploratory cross-sectional study of a convenience sample of 374 English-speaking adults affected by diabetes using an online survey was conducted. Results: Participant mean age was 37 years with an average diabetes duration of 21 years. On average, participants reported feeling hypoglycemia at 64 mg/dL (3.6 mmol/L), worrying about hypoglycemia at 63 mg/dL (3.5 mmol/L), and treating hypoglycemia at 72 mg/dL (4 mmol/L). Terminology used by study participants did not match the current classifications of hypoglycemia used in clinical research. Participants who have been told they have hypoglycemia unawareness treat at a significantly lower level compared to those without hypoglycemia unawareness. Only 58% always carry hypoglycemia treatment; there was a relationship with increasing age and always carrying hypoglycemia treatment. Thirty-eight percent of participants treat hypoglycemia with the recommended 15 g of carbohydrate (CHO). Survey respondents who wore continuous glucose monitors reported using significantly less CHO to treat hypoglycemia. Conclusions: In the real world, experiences related to feeling, worrying about, and treating hypoglycemia trend higher than what is noted in the standardized hypoglycemia classifications. Study findings have implications for teaching and supporting people with diabetes who experience hypoglycemia. Consuming less CHO to treat hypoglycemia could lead to fewer episodes of rebound hyperglycemia and less weight gain. Increased support for continuous glucose monitoring is warranted.

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Section: Discussionmentioning

confidence: 99%

Understanding Hypoglycemia in the Real World

Ziemer

Litchman

2022

The Science of Diabetes Self-Management and Care

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“…57 While this is a significant advancement in diabetes technology, the approach to using trend arrows from flash CGM to make clinical decisions is not without concerns. 58,59 Therefore, some important caveats are necessary for the patient and pharmacist to understand prior to using, or recommending that treatment decisions be based on trend arrows. First, incorporation of trend arrow data to make treatment decisions from flash CGM has not been well studied in a controlled clinical trial.…”

Section: Methodsmentioning

confidence: 99%

“…First, incorporation of trend arrow data to make treatment decisions from flash CGM has not been well studied in a controlled clinical trial. 58 In a study conducted by Freckmann and colleagues which included a small number of subjects using a flash CGM device, trend indicators did a poor job of matching future glucose change, notably within the first few hours of carbohydrate intake and insulin administration. 60 The majority of ROC indicators were shown to overestimate glucose change, which could lead to hypoglycemia.…”

Section: Methodsmentioning

confidence: 99%

Flash Continuous Glucose Monitoring: A Practical Guide and Call to Action for Pharmacists

Cowart

Zgibor

2021

Journal of Pharmacy Practice

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Despite advances in diabetes technology, the proportion of patients with type 2 diabetes achieving recommended glycemic goals remains suboptimal. There is a growing interest in flash continuous glucose monitoring (CGM) among patients, pharmacists and providers. Pharmacists are well positioned to collaborate with patients and providers in ambulatory care or community-based settings to allow a greater number of patients with diabetes to harness the benefits of flash CGM. The purpose of this narrative review is to provide pharmacists with a background on flash CGM technology, review the data supporting pharmacist-driven flash CGM services, and address common questions that arise in pharmacy practice surrounding flash CGM.

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“…Change in bolus insulin dose according to trend arrows has been suggested for both patients with multiple daily injections and insulin pumps [ 2 ]. For users of insulin pump with the predictive low-glucose suspend (PLGS) feature, only the arrows for management of hyperglycemia (upward arrows) should be used for insulin adjustments, as the insulin pump algorithm has incorporated the downward arrows for hypoglycemia prevention [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement

Rodacki

Calliari

Ramalho

et al. 2021

Diabetol Metab Syndr

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This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.

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Predictive Glucose Trends From Continuous Glucose Monitoring: Friend or Foe in Clinical Decision Making?

Cited by 4 publications

References 32 publications

Understanding Hypoglycemia in the Real World

Understanding Hypoglycemia in the Real World

Flash Continuous Glucose Monitoring: A Practical Guide and Call to Action for Pharmacists

Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement

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