Kudva Yogish C, Ahmann Andrew J, Bergenstal Richard M, Gavin James R, Kruger Davida F, Midyett L Kurt, Miller Eden, Harris Dennis R
Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon.
J Endocr Soc. 2018 Nov 14;2(12):1320-1337. doi: 10.1210/js.2018-00294. eCollection 2018 Dec 1.
The use of personal continuous glucose monitoring (CGM) has expanded dramatically among individuals with diabetes. CGM systems provide retrospective data, as well as the current glucose value and trend arrow data, which indicate the direction and velocity of changing glucose. In 2017, Aleppo and colleagues developed a simplified approach for adults with diabetes to safely adjust rapid-acting insulin doses using trend arrow information in the Dexcom G5 CGM system. Since then, the FreeStyle Libre and FreeStyle Libre 14-day CGM systems have become available in the United States; however, guidance on using trend arrow data that take the unique features of these systems into consideration is lacking. Specifically, the FreeStyle Libre systems do not have automatic alarms, which impact how the system and trend arrow data are used. The Endocrine Society convened an expert panel to address this gap and develop an approach to adjusting rapid-acting insulin doses for adults using trend arrows in the FreeStyle Libre systems. We based our approach on previous work and expanded upon engagement and scanning recommendations, and we incorporated pre-exercise planning specific to these systems. Our approach provides insulin dose adjustments as discrete insulin units based on an individual's insulin sensitivity and directionality of the trend arrow. We focus on the needs of patients treated with multiple daily injections because these individuals currently make up a greater proportion of individuals on intensive insulin therapy. Our recommendations are intended to provide a safe, practical approach to using trend arrows in the FreeStyle Libre systems.
个人连续血糖监测（CGM）在糖尿病患者中的应用已大幅扩展。CGM系统可提供回顾性数据，以及当前血糖值和趋势箭头数据，后者能指示血糖变化的方向和速度。2017年，阿勒颇及其同事为成年糖尿病患者开发了一种简化方法，可利用德康G5 CGM系统中的趋势箭头信息安全调整速效胰岛素剂量。自那时起，FreeStyle Libre和FreeStyle Libre 14天CGM系统在美国上市；然而，缺乏考虑到这些系统独特特征的关于使用趋势箭头数据的指导。具体而言，FreeStyle Libre系统没有自动警报功能，这影响了该系统及趋势箭头数据的使用方式。内分泌学会召集了一个专家小组来填补这一空白，并制定一种利用FreeStyle Libre系统中的趋势箭头为成年患者调整速效胰岛素剂量的方法。我们的方法基于之前的工作，并在参与和扫描建议的基础上进行了扩展，还纳入了针对这些系统的运动前规划。我们的方法根据个体的胰岛素敏感性和趋势箭头的方向性，以离散的胰岛素单位提供胰岛素剂量调整。我们关注每日多次注射治疗患者的需求，因为目前这些个体在强化胰岛素治疗的患者中占比更大。我们的建议旨在为在FreeStyle Libre系统中使用趋势箭头提供一种安全、实用的方法。
