Original ArticlesHow Patients With Type 1 Diabetes Translate Continuous Glucose Monitoring Data into Diabetes Management Decisions
Section snippets
INTRODUCTION
As a result of studies showing improvements in glycemic control in children and adults who regularly use continuous glucose monitoring (CGM) (1-4), the use of real-time CGM is becoming accepted as part of the standard of care in the treatment of patients with type 1 diabetes (5,6). However, the mechanism of action for glycemic benefit from CGM use differs from pharmacologic interventions. The observed benefits are not a direct result of wearing the device but rather the result of behavioral and
METHODS
The survey comprised 6 sections: (1) patient characteristics; (2) general CGM use; (3) hypoglycemia prevention and management; (4) hyperglycemia prevention and management; (5) insulin dosing adjustments (both for incidental hyperglycemia not at meals and at mealtimes); and (6) real-time use versus retrospective analysis. In order to contextualize the information, many of the survey questions were framed as clinical scenarios that would be commonly experienced by patients either on multiple
Patient Characteristics
The respondents included 222 patients with type 1 diabetes from 22 states across the United States. The mean age of respondents was 46 ± 14 years, the duration of diabetes 22 ± 14 years, 52% were male, and the self-reported hemoglobin A1c (A1c) was 6.9 ± 0.8%. For their method of insulin delivery, 75% used an insulin pump and 25% used multiple daily injections. Education levels varied: 0.5% did not graduate high school, 9% were high school graduates or attended technical or trade school after
DISCUSSION
The survey was conducted to gain insight into what regular CGM users are doing in their daily lives to translate their CGM information into improvements in their diabetes management. Our findings revealed multiple areas in which patients alter their daily treatment decisions in real time. Notably, patients are frequently being alerted and awoken at night to hyperglycemia and hypoglycemia, perceive greater benefit from the real-time information provided compared to retrospective data analysis,
CONCLUSION
In summary, the current study is the first report describing how patients are using their CGM devices to modify their diabetes management. The extent and magnitude of these adjustments had not been previously quantified; the insulin dose modifications are far greater than commonly recommended. It is clear from this survey that patients place a tremendous amount of importance on ROC information when determining insulin doses and depend on CGM alerts for their safety. Research is needed to
DISCLOSURE
Dr. Edelman has served as a consultant and advisory board member for and has received research funding from Dexcom Inc. Dr. Pettus has served as a consultant for Dexcom Inc. Dr. Price is an employee of Dexcom Inc.
ACKNOWLEDGMENT
We thank the study participants and consultants with the SiGMa group for enrolling participants and reviewing the manuscript: Gregg Gerety, MD, Albany, NY; Damon Tanton, MD, Celebration, FL; Nicholas B. Argento, MD, Columbia, MD; Kimberly Bourne, MD, Orlando, FL; Laura Akright, MD, Schertz, TX; Joe Henske, MD, Glen Ellyn, IL; Rachel Malish, ACNS-BC, CDE, Austin, TX; Heather Lamar, RD, CDE, Las Vegas, NV; Michael Harris, MD, Beverly Hills, CA; Tomas Walker, PhD, DNP, APN, CDE, Henderson, NV;
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