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

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          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.

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          Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections

          Andrew Ahmann, Katrina Ruedy, Tonya Riddlesworth … (2017)
          Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin.
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            The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial

            T. Battelino, I Conget, BIRGITTE B. OLSEN … (2012)
            Aims/hypothesis The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Methods Children and adults (n = 153) on CSII with HbA1c 7.5–9.5% (58.5–80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months’ washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA1c levels between arms after 6 months. Results Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA1c was –0.43% (–4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI −0.32%, −0.55% [−3.50, −6.01 mmol/mol]; p < 0.001). Following cessation of glucose sensing, HbA1c reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p = 0.009). The mean number of daily boluses increased in the Sensor On arm (6.8 ± 2.5 vs 5.8 ± 1.9, p < 0.0001), together with the frequency of use of the temporary basal rate (0.75 ± 1.11 vs 0.26 ± 0.47, p < 0.0001) and manual insulin suspend (0.91 ± 1.25 vs 0.70 ± 0.75, p < 0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p = 0.40). Conclusions/interpretation Continuous glucose monitoring was associated with decreased HbA1c levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects. Trial registration ClinicalTrials.gov registration no. NCT00598663. Funding The study was funded by Medtronic International Trading Sarl Switzerland.
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              Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial.

              Katrina J. Ruedy, Christopher G Parkin, Tonya Riddlesworth … (2017)
              The objective was to determine the effectiveness of real-time continuous glucose monitoring (CGM) in adults ≥ 60 years of age with type 1 (T1D) or type 2 (T2D) diabetes using multiple daily insulin injections (MDI).
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Endocr Soc
                Journal ID (iso-abbrev): J Endocr Soc
                Journal ID (publisher-id): JS
                Journal ID (pmc): JS
                Title: Journal of the Endocrine Society
                Publisher: Endocrine Society (Washington, DC )
                ISSN (Electronic): 2472-1972
                Publication date Collection: 01 December 2017
                Publication date (Electronic): 20 November 2017
                Publication date PMC-release: 20 November 2017
                Volume: 1
                Issue: 12
                Pages: 1445-1460
                Affiliations
                [1 ]Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
                [2 ]Pediatric, Adolescent and Young Adult Programs, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
                [3 ]Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon 97239
                [4 ]Department of Medicine, University of Washington, Seattle, Washington 98195
                [5 ]Division of Endocrinology, Diabetes and Bone & Mineral, Henry Ford Health System, Detroit, Michigan 48202
                [6 ]Keck School of Medicine, University of Southern California, Los Angeles, California 90033
                [7 ]Department of Medicine, SUNY Upstate Medical University, Syracuse, New York 13210
                [8 ]Endocrine Society, Washington, District of Columbia 20036
                Author notes
                Correspondence:  Grazia Aleppo, MD, Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Suite 530, Chicago, Illinois 60611. E-mail: aleppo@ 123456northwestern.edu .
                Article
                Publisher ID: JS_201700388
                DOI: 10.1210/js.2017-00388
                PMC ID: 5760210
                SO-VID: 139741e0-4659-4a2e-a6c7-8a91780b691f
                Copyright © Copyright © 2017 Endocrine Society
                License:

                This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 02 October 2017
                Date accepted : 03 November 2017
                Page count
                Figures: 5, Tables: 4, Equations: 0, References: 28, Pages: 16
                Categories
                Subject: Perspectives

                Keywords: continuous glucose monitoring,diabetes,fine-tuning,insulin dose adjustment,insulin dosing,trend arrows
                Data availability:
                Keywords: continuous glucose monitoring, diabetes, fine-tuning, insulin dose adjustment, insulin dosing, trend arrows

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