title: Differences in Use of Glucose Rate of Change (ROC) Arrows to Adjust Insulin Therapy Among Individuals With Type 1 and Type 2 Diabetes Who Use Continuous Glucose Monitoring (CGM).
abstract: To understand differences between individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) in utilization of continuous glucose monitoring (CGM) data to adjust insulin therapy, either continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI).
  
  
  
  We surveyed 300 individuals who regularly used real-time CGM, using 70 questions to obtain information about general CGM use and response to glucose rate of change (ROC) arrows.
  
  
  
  The survey was completed by 222 T1D and 78 T2D respondents treated with intensive insulin therapy. T1D respondents included CSII (n = 166) and MDI (n = 56) users. T2D respondents were more balanced: 34 (44%) versus 44 (56%), respectively. A larger percentage of T1D then T2D respondents reported a constant use of CGM (85% vs 61%, P < .001). T1D and T2D respondents reported similar substantial increases in correction dosages in response to rapidly increasing glucose (>3 mg/dL/min; 2 arrows up): +140% versus +136%, P = .4534. However, T1D respondents reported making smaller correction dosage reductions than T2D respondents in response to rapidly decreasing glucose (-42% vs -80%, P < .001). Differences between T1D and T2D respondents were also observed in mealtime dosage adjustments in response to rapidly increasing glucose compared to when glucose is stable (flat arrow) at 110 mg/dl: +81% versus +108%, respectively (P = .003). Although these adjustments are statistically different, both are large.
  
  
  
  CGM users often rely on ROC information when determining insulin doses and tend to be more aggressive in their insulin adjustments despite differences in type of diabetes.
authors.affiliation: University of California, San Diego, San Diego, CA, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Pettus
authors.affiliation: University of California, San Diego, San Diego, CA, USA Veterans Affairs Medical Center, San Diego, CA, USA svedelman@vapop.ucsd.edu.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Edelman
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: continuous glucose monitoring; insulin pump; multiple daily insulin injections; rate of change; type 1 diabetes; type 2 diabetes