Abstract
This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.
Highlights
Continuous glucose monitoring (CGM) brought important advances to diabetes care
The use of trend arrows for bolus insulin adjustments was firstly suggested by the DirecNet Applied Treatment Algorithm (DATA) study with Freestyle NavigatorTM realtime continuous glucose monitor, which indicated an increase of bolus insulin dose by 10% or 20% for one or two arrows in the upward direction and a reduction in the same proportion for one and two downward arrows, respectively [4]
Tables with suggested bolus insulin dose adjustments based on trend arrows, insulin sensitivity and glucose levels were elaborated for use in clinical practice
Summary
Continuous glucose monitoring (CGM) brought important advances to diabetes care. One of the important advantages of CGM over self-monitoring blood glucose alone is the presence of trend arrows. Ziegler et al proposed bolus insulin dose adjustments based on trend arrows considering current glucose and sensitivity factor at all times without differentiating pre and postprandial adjustments for all sensors [10]. In most situations, this method uses approximately the doses proposed by Aleppo et al for level 1 hyperglycemia (180–250 mg/dL), milder changes for glucose levels within the target range (70–180 mg/ dL) and more significant changes for patients with level 2 hyperglycemia (> 250 mg/dL). Tables with suggested bolus insulin dose adjustments based on trend arrows, insulin sensitivity and glucose levels were elaborated for use in clinical practice. A major concern of SBD was that the use of trend arrows could
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