![]() Smaller observational and prospective studies have also shown improvements in both A1c and a reduction in hypoglycemic events. Studies also showed high device utilization, suggesting that the FreeStyle Libre system may enhance patient engagement. These benefits were seen in well-controlled type 1 diabetes (T1D) as well as suboptimally controlled type 2 diabetes (T2D) treated with intensive insulin therapy. Large randomized controlled trials demonstrated that use of the FreeStyle Libre system resulted in significant reductions in hypoglycemia, increased time in target range, reduced glycemic variability, and greater patient satisfaction compared with fingerstick monitoring. The nonadjunctive indication allows patients to calculate insulin doses based on current sensor value using individual insulin dosing parameters, target glucose concentration, and trend arrow information. The FreeStyle Libre 14-day flash glucose monitoring system (FreeStyle Libre 14-day system Abbott Diabetes Care) was more recently approved by the US Food and Drug Administration with the same indications but with a longer wear time and shorter warm-up period that is comparable to systems available in Europe ( Table 1). The system received US Food and Drug Administration clearance in September 2017 for nonadjunctive use in adults (age 18 years and older) with diabetes. One of the newest CGM systems available in the United States is the FreeStyle Libre flash glucose monitoring system (FreeStyle Libre system Abbott Diabetes Care, Alameda, CA), often referred to as flash CGM or intermittently scanned CGM. Retrospective review of CGM data in combination with standardized data management tools such as the ambulatory glucose profile help clinicians and patients fine-tune management strategies. Real-time information allows patients to react immediately to mitigate or prevent acute glycemic events. Unlike fingerstick monitoring, which measures glucose at a single point in time, CGM displays the immediate glucose value within the context of both prior glucose data and, importantly, the direction and velocity of changing glucose using trend arrows. ĬGM provides information that can be critical for safe and effective diabetes management. Use of personal continuous glucose monitoring (CGM) has expanded dramatically over the past decade and is recommended as the gold standard of care for individuals with diabetes treated with intensive insulin therapy. Our recommendations are intended to provide a safe, practical approach to using trend arrows in the FreeStyle Libre systems.Ĭontinuous glucose monitoring, flash glucose monitoring, trend arrows, scanning, diabetes, diabetes technology 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 approach provides insulin dose adjustments as discrete insulin units based on an individual’s insulin sensitivity and directionality of the trend arrow. We based our approach on previous work and expanded upon engagement and scanning recommendations, and we incorporated pre-exercise planning specific to these systems. 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. Specifically, the FreeStyle Libre systems do not have automatic alarms, which impact how the system and trend arrow data are used. 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. 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. 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. The use of personal continuous glucose monitoring (CGM) has expanded dramatically among individuals with diabetes.
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