Practical Approach to Using Trend Arrows on Real-Time Continuous Glucose Monitoring System in Type 1 Diabetes Adolescents Living Camp Setting Treated With Multiple Daily Injection or Continuous Subcutaneous Insulin Infusion Insulin Therapy

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2020 Jun 20

PMID 32552001

Citations 5

Authors

Marta Bassi

Nicola Minuto

Graziella Fichera

Clara Rebora

Alice Parodi

Valentina Natoli

Lidia Pontillo

Marco Buccianti

Giuseppe DAnnunzio

Mohamad Maghnie

Affiliations

Soon will be listed here.

Abstract

Background: The aim of the study was to determine the effect of an educational intervention on the use of trend arrows of a real-time continuous glucose monitoring (rt-CGM) to manage daily therapy decisions in a group of adolescents with type 1 diabetes attending a camp. The secondary aim was to evaluate the variations in total daily dose (TDD) of insulin requirement.

Methods: Twenty patients (15-17 years) on multiple insulin injections ( = 8) or continuous subcutaneous insulin infusion ( = 12) attended a training session at the beginning of the camp to learn our algorithm for the management of therapy depending on trend arrows. TDD, time in range (TIR), time above range (TAR), and time below range (TBR) (in the 24 hours and in the three hours after breakfast) before the training session (run-in) and at the end of the camp (T1) were analyzed.

Results: Data showed a reduction of TAR (run-in 42.6%, T1 32.05%, = .036) and an increase in TIR (run-in 52.9%, T1 62.4%, = .013). Reduction of TBR (run-in 42.5%, T1 37.5%, = .05) and improvement in TIR (run-in 49.0%, T1 57.0%, = .02) were also observed in the post-breakfast period. Data showed a significant reduction in the TDD (run-in 52.02 ± 17.44 U/die, T1 46.49 ± 12.39 U/die, = .024).

Conclusions: Statistically significant improvement of glycemic control and reduction of TTD were observed in all patients regardless of therapy type. The improvement between run-in and T1 demonstrates the importance of patients' education on the correct use of rt-CGM with simple algorithms for the management of therapy.

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References

Slover 2nd R . Continuous glucose monitoring in children and adolescents. Curr Diab Rep. 2012; 12(5):510-6. DOI: 10.1007/s11892-012-0303-6. View

Pettus J, Edelman S . Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes. J Diabetes Sci Technol. 2016; 11(1):138-147. PMC: 5375074. DOI: 10.1177/1932296816663747. View

Szypowska A, Ramotowska A, Dzygalo K, Golicki D . Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials. Eur J Endocrinol. 2011; 166(4):567-74. DOI: 10.1530/EJE-11-0642. View

Cherubini V, Bonfanti R, Casertano A, de Nitto E, Iannilli A, Lombardo F . Time In Range in Children with Type 1 Diabetes Using Treatment Strategies Based on Nonautomated Insulin Delivery Systems in the Real World. Diabetes Technol Ther. 2020; 22(7):509-515. DOI: 10.1089/dia.2020.0031. View

. JDRF randomized clinical trial to assess the efficacy of real-time continuous glucose monitoring in the management of type 1 diabetes: research design and methods. Diabetes Technol Ther. 2008; 10(4):310-21. DOI: 10.1089/dia.2007.0302. View

Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R . Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia. 2010; 53(12):2487-95. DOI: 10.1007/s00125-010-1878-6. View

Laffel L, Aleppo G, Buckingham B, Forlenza G, Rasbach L, Tsalikian E . A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System to Manage Children and Adolescents With Diabetes. J Endocr Soc. 2018; 1(12):1461-1476. PMC: 5760209. DOI: 10.1210/js.2017-00389. View

Lind M, Polonsky W, Hirsch I, Heise T, Bolinder J, Dahlqvist S . Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial. JAMA. 2017; 317(4):379-387. DOI: 10.1001/jama.2016.19976. View

Ziegler R, von Sengbusch S, Kroger J, Schubert O, Werkmeister P, Deiss D . Therapy Adjustments Based on Trend Arrows Using Continuous Glucose Monitoring Systems. J Diabetes Sci Technol. 2019; 13(4):763-773. PMC: 6610609. DOI: 10.1177/1932296818822539. View

10.

Buckingham B, Xing D, Weinzimer S, Fiallo-Scharer R, Kollman C, Mauras N . Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator). Pediatr Diabetes. 2008; 9(2):142-7. PMC: 2390770. DOI: 10.1111/j.1399-5448.2007.00301.x. View

11.

Battelino T, Conget I, Olsen B, Schutz-Fuhrmann I, Hommel E, Hoogma R . The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012; 55(12):3155-62. PMC: 3483098. DOI: 10.1007/s00125-012-2708-9. View

12.

Klonoff D, Kerr D . A Simplified Approach Using Rate of Change Arrows to Adjust Insulin With Real-Time Continuous Glucose Monitoring. J Diabetes Sci Technol. 2017; 11(6):1063-1069. PMC: 5951054. DOI: 10.1177/1932296817723260. View

13.

Heinemann L, Freckmann G, Ehrmann D, Faber-Heinemann G, Guerra S, Waldenmaier D . Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet. 2018; 391(10128):1367-1377. DOI: 10.1016/S0140-6736(18)30297-6. View

14.

Beck R, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S . Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA. 2017; 317(4):371-378. DOI: 10.1001/jama.2016.19975. View

15.

Bergenstal R, Tamborlane W, Ahmann A, Buse J, Dailey G, Davis S . Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010; 363(4):311-20. DOI: 10.1056/NEJMoa1002853. View

16.

Hirsch I, Abelseth J, Bode B, Fischer J, Kaufman F, Mastrototaro J . Sensor-augmented insulin pump therapy: results of the first randomized treat-to-target study. Diabetes Technol Ther. 2008; 10(5):377-83. DOI: 10.1089/dia.2008.0068. View