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Practical Approach To Using Trend Arrows On The Dexcom G5 CGM System For The Management Of Adults With Diabetes | Journal Of The Endocrine Society | Oxford Academic

Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes | Journal of the Endocrine Society | Oxford Academic

Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes | Journal of the Endocrine Society | Oxford Academic


As the accuracy of continuous glucose monitoring (CGM) devices has improved and the benefits are better understood, their use has greatly increased. For patients with diabetes, CGM does more than provide additional data points; it uses trend arrow data to give context to current glucose values. With this level of insight, real-time CGM (rtCGM) has been demonstrated to improve glycemic control without increasing hypoglycemia in patients with type 1 diabetes [ 13 ] as well as in insulin-treated patients with type 2 diabetes [ 4 , 5 ].
In December 2016, the US Food and Drug Administration approved the Dexcom G5 Mobile CGM system (Dexcom G5, Dexcom, Inc., San Diego, CA) for nonadjunctive insulin dosing. Aside from the required twice daily calibrations, patients using the Dexcom G5 can now dose insulin without confirmatory fingerstick glucose monitoring in most situations, further improving usability. However, there is sparse guidance for how individuals should act on the trend arrow data.
Notably, there are four previously published methods for using trend arrow data to adjust insulin doses [ 69 ]. However, each method has various limitations in its complexity, utility, and applicability. Our approach focuses on the Dexcom G5 systemthe first Food and Drug Administration-approved system for nonadjunctive insulin dosing and the system that we have the most clinical experience using in this manner to date.
Our goal is to offer a safe, practical approach for using CGM trend arrow data to adjust insulin dosing. We based this approach on previous algorithms [ 6 , 10 , 11 ], our Continue reading

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How Does Coffee Affect Blood Sugar and Diabetes?

How Does Coffee Affect Blood Sugar and Diabetes?


How Does Coffee Affect Blood Sugar and Diabetes?
03 Jan, 2018 By Peter Maultsby 0 Comments
Type 2 diabetes is a massive health problem worldwide.
About 29 million people, or 9% of all US adults, had type 2 diabetes in the year 2012.
Interestingly, long-term studies have linked coffee drinking with a reduced risk of type 2 diabetes.
Yet, oddly enough, many short-term studies have shown that coffee and caffeine can raise blood sugar and insulin levels.
Why this happens is not fully known, but there are several theories.
This article examines the short-term and long-term effects of coffee on blood sugar and diabetes.
Coffee Drinkers Have a Lower Risk of Type 2 Diabetes
The health benefits of drinking coffee are well-documented.
In observational studies, coffee is linked to reduced blood sugar and insulin levels, which are major risk factors for type 2 diabetes.
Furthermore, consuming regular or decaf coffee on a regular basis is linked to a 2350% lower risk of developing type 2 diabetes.
Studies have also shown that each daily cup of coffee you consume may reduce this risk by 48%.
Additionally, people who drink 46 cups of coffee each day have a lower risk of type 2 diabetes than people who drink less than 2 cups each day.
BOTTOM LINE:Regular coffee drinking has been linked to a 2350% lower risk of type 2 diabetes. Each daily cup is linked to a 4-8% lower risk.
Coffee and Caffeine May Raise Blood Sugar
A major paradox exists between the long-term and short-term effects of coffee.
Short-term studies have linked caffeine and coffee consumption with increased bl Continue reading

Association between consumption of dairy products and incident type 2 diabetesinsights from the European Prospective Investigation into Cancer study

Association between consumption of dairy products and incident type 2 diabetesinsights from the European Prospective Investigation into Cancer study


Association between consumption of dairy products and incident type 2 diabetesinsights from the European Prospective Investigation into Cancer study
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Association between consumption of dairy products and incident type 2 diabetesinsights from the European Prospective Investigation into Cancer study
The public health burden of type 2 diabetes has risen unabated over the past decades, fueled by obesity and lifestyle influences, including diet quality. Epidemiological evidence is accumulating for an inverse association between dairy product intake and type 2 diabetes risk; this is somewhat counterintuitive to the saturated fat and cardiometabolic disease paradigm. The present report reviews the contribution that the findings of the European Prospective Investigation into Cancer (EPIC) study have made to this debate, noting that types of dairy products, particularly fermented dairy products including yogurt, may be more relevant than overall dairy intake for the prevention of type 2 diabetes. The EPIC study has contributed evidence through complementary approaches of a large prospective study across 8 European countries with heterogeneous di Continue reading

Standardized Diabetes Care Empowers Patients

Standardized Diabetes Care Empowers Patients


Diabetes is the most common life-threatening, chronic illness in children who live in developed countries.1 With effective management of diabetes, children with diabetes can live long, healthy, and active lives. Following evidence-based guidelines such as the routine screenings recommended by the American Diabetes Association (ADA) helps patients manage their diabetes and avoid further complications.
Texas Childrens Hospital, the nations largest pediatric hospital and ranked one of the top four Best Childrens Hospitals by U.S. News & World Report, believes that diabetes patients and their families are most successful in managing their disease if they receive standardized, family-centered, multidisciplinary care in both inpatient and outpatient settings. Like other leading childrens hospitals, Texas Childrens had the best intentions of adhering to the guidelines. However, team members were concerned that not all patients were receiving the ADA-recommended testsand baseline data confirmed they were falling short. While clinicians were aware of the evidence-based guidelines, they lacked the support of data and technology that would help them keep track of every patient and their status in relation to the guidelines. Clinicians were also concerned that variation in care and gaps in communication were negatively impacting patient satisfaction and empowerment.
To tackle this multi-faceted problem, Texas Childrens created a new Clinic Care Process Team (CPT). The team developed a comprehensive approach to standardizing diabetes care by automating best practice alerts that help Continue reading

Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial

Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial


Metformin is widely used to treat gestational diabetes (GDM), but many women remain hyperglycaemic and require additional therapy. We aimed to determine recruitment rate and participant throughput in a randomised trial of glibenclamide compared with standard therapy insulin (added to maximum tolerated metformin) for treatment of GDM.
We conducted an open label feasibility study in 5 UK antenatal clinics among pregnant women 16 to 36weeks gestation with metformin-treated GDM. Women failing to achieve adequate glycaemic control on metformin monotherapy were randomised to additional glibenclamide or insulin. The primary outcome was recruitment rate. We explored feasibility with uptake, retention, adherence, safety, glycaemic control, participant satisfaction and clinical outcomes.
Records of 197 women were screened and 23 women randomised to metformin and glibenclamide (n=13) or metformin and insulin (n=10). Mean (SD) recruitment rate was 0.39 (0.62) women/centre/month. 9/13 (69.2%, 95%CI 38.690.9%) women adhered to glibenclamide and all provided outcome data (100% retention). There were no episodes of severe hypoglycaemia, but metformin and insulin gave superior glycaemic control to metformin and glibenclamide, with fewer blood glucose readings <3.5mmol/l (median [IQR] difference/woman/week of treatment 0.58 [0.031.87]).
A large randomised controlled trial comparing glibenclamide or insulin in combination with metformin for women with GDM would be feasible but is unlikely to be worthwhile, given the poorer glycaemic control with glibenclamide and metformin in this pilot Continue reading

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