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