Elsevier

Endocrine Practice

Volume 21, Issue 6, June 2015, Pages 613-620
Endocrine Practice

Original Articles
How Patients With Type 1 Diabetes Translate Continuous Glucose Monitoring Data into Diabetes Management Decisions

https://doi.org/10.4158/EP14520.ORGet rights and content

ABSTRACT

Objective: To understand how patients use continuous glucose monitoring (CGM) data in their diabetes management.

Methods: We surveyed patients who regularly used CGM (>6 days per week), using 70 questions, many scenario-based. The survey had 6 sections: patient characteristics, general CGM use, hypoglycemia prevention and management, hyperglycemia prevention and management, insulin dosing adjustments (both for incidental hyperglycemia not at meals and at mealtimes), and real-time use versus retrospective analysis.

Results: The survey was completed by 222 patients with type 1 diabetes. In response to a glucose of 220 mg/dL, the average correction dose adjustment based on rate of change arrows varied dramatically. Specifically, when the CGM device showed 2 arrows up (glucose increasing >3 mg/dL/minute), respondents stated they would increase their correction bolus, on average, by 140% (range, 0 to 600%). Conversely, 2 arrows down (glucose decreasing >3 mg/dL/minute) caused respondents to reduce their dose by 42%, with 24% omitting their dose entirely. Furthermore, 59% of respondents stated they would delay a meal in response to rapidly rising glucose, whereas 60% would wait until after a meal to bolus in response to falling glucose levels. With a glucose value of 120 mg/dL and a falling glucose trend, 70% of respondents would prophylactically consume carbohydrates to avoid hypoglycemia.

Conclusion: CGM users utilize CGM data to alter multiple aspects of their diabetes care, including insulin dose timing, dose adjustments, and in hypoglycemia prevention. The insulin adjustments are much larger than common recommendations. Additional studies are needed to determine appropriate insulin adjustments based on glucose trend data.

Abbreviations: A1c = hemoglobin A1c CGM = continuous glucose monitoring ROC = rate of change SMBG = self-monitored blood glucose

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;

REFERENCES (12)

There are more references available in the full text version of this article.

Cited by (52)

  • 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

    2019, Nutrition, Metabolism and Cardiovascular Diseases
    Citation Excerpt :

    The utility of trend arrows for insulin dosing is a topic of intense discussion. Recent surveys indicate that people with diabetes using rtCGM rely on trend arrows to calculate mealtime insulin boluses and also to make corrective insulin dose adjustments between meals [31]. Importantly, in response to RoC trend arrows, respondents using rtCGM made significantly larger dose adjustments than would be recommended by published algorithms for using RoC trend arrows for insulin dose management [32,33].

  • Covid 19 and diabetes in children: advances and strategies

    2024, Diabetology and Metabolic Syndrome
View all citing articles on Scopus
View full text