ESPE Abstracts (2014) 82 P-D-3-2-716

Uptake of a Novel Tool to Adjust Insulin Boluses, Based on CGM Trend Arrows and Insulin Sensitivity (Trend Arrow Adjustment Tool); in Children with Type 1 Diabetes, Who are Using Insulin Pump Therapy and Continuous Glucose Monitoring

Emmeline Heffernan & Margaret Lawson


Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada


Background: Real-time CGM data includes ‘trend arrows’ which indicate when the blood glucose is rapidly falling or rising thus enabling the pump user to make immediate adjustments in insulin delivery to prevent subsequent low or high blood sugars. However, effective strategies for adjusting insulin boluses based on CGM trend arrows are lacking. Previous studies recommended that boluses be adjusted based on trend arrows using a standard 10–20% increase/decrease of the bolus dose (10% for one arrow up or down and 20% for two arrows up or down), with the original bolus dose calculated by the pump calculator. However, the original recommended bolus dose is dependent on the amount of food to be consumed and the current blood glucose, and therefore increasing or decreasing the total recommended bolus by 10–20% could potentially overcompensate for the trend arrows and result in postprandial hypoglycemia. This formula also requires the pump user, or the caregiver, to perform mathematical calculations with each trend arrow. Attempts to use the 10/20% formula resulted in low acceptance and adherence by CGM users. Dissatisfaction with the 10/20% formula led to the development of an innovative tool for adjusting boluses for CGM trend arrows based on the patient’s insulin sensitivity factor.

Objective and hypotheses: We aimed to assess patient uptake of the Trend Arrow Adjustment Tool (TAAT) and whether its use is sustained.

Method: A retrospective audit of CGM data; examining the uptake of the TAAT, in 40 patients, over a 3-month period.

Results: Uptake of the TAAT was very good, with use being sustained over a 3-month period.

Conclusion: We plan a more detailed evaluation of TAAT, to assess effectiveness and patient satisfaction.

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