J Korean Diabetes.  2020 Dec;21(4):191-196. 10.4093/jkd.2020.21.4.191.

Adjustment of Insulin Therapy: New Insights from Continuous Glucose Monitoring

• Oh TJ

• KMID: 2511884
• DOI: http://doi.org/10.4093/jkd.2020.21.4.191

Abstract

Diabetes management technology has advanced dramatically in recent decades, particularly real time continuous glucose monitoring (rtCGM) systems. A recent meta-analysis showed that rtCGM can reduce HbA1c by around 0.3% compared to standard care, and prevent hypoglycemia. In the CGM era, new treatment targets such as time in range should be considered in conjunction with HbA1c. One study using rtCGM demonstrated an increase of time in range compared to conventional treatment. rtCGM presents current glucose concentration data, as well as the direction and rate of change in glucose level every 1 to 5 minutes. This information enables development of new insulin dosing algorithms. This fine-tuning of insulin therapy should be based on healthy eating behavior. Furthermore, as the patient is the center of diabetes management patient education is needed regarding how this new technology can improve glucose management. This manuscript summarizes the utility of rtCGM for insulin adjustment.

Keyword

Ambulatory glucose profile; Continuous glucose monitoring system; Education; Insulin therapy

Figure

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  Fig. 1. Cases requiring adjustment of premeal insulin therapy. (A) Delayed injection of premeal insulin, or consuming high glycemic index diet. (B) Insufficient dose of premeal insulin, or high protein/high fat diet. (C) Too early injection of premeal insulin, or gastric paralysis. (D) Excess dose of premeal insulin, or low protein/low fat diet. Adopted from the article of Ajjan et al. (Diab Vasc Dis Res 2019;16:3–12) [9] with original copyright holder's permission.

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