Approach to using trend arrows in the FreeStyle Libre flash glucose monitoring systems in adults

Yogish C. Kudva, Andrew J. Ahmann, Richard M. Bergenstal, James R. Gavin, Davida F. Kruger, L. Kurt Midyett, Eden Miller, Dennis R. Harris

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


The use of personal continuous glucose monitoring (CGM) has expanded dramatically among individuals with diabetes. 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. 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. 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. Specifically, the FreeStyle Libre systems do not have automatic alarms, which impact how the system and trend arrow data are used. 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. We based our approach on previous work and expanded upon engagement and scanning recommendations, and we incorporated pre-exercise planning specific to these systems. Our approach provides insulin dose adjustments as discrete insulin units based on an individual's insulin sensitivity and directionality of the trend arrow. 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 recommendations are intended to provide a safe, practical approach to using trend arrows in the FreeStyle Libre systems.

Original languageEnglish (US)
Pages (from-to)1320-1337
Number of pages18
JournalJournal of the Endocrine Society
Issue number12
StatePublished - Dec 2018


  • Continuous glucose monitoring
  • Diabetes
  • Diabetes technology
  • Flash glucose monitoring
  • Scanning
  • Trend arrows

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Approach to using trend arrows in the FreeStyle Libre flash glucose monitoring systems in adults'. Together they form a unique fingerprint.

Cite this