New Clinical Practice Guideline Published on Diabetes Technologies

On September 26, the Endocrine Society issued a Clinical Practice Guideline recommending continuous glucose monitors (CGMs) as the gold standard of care for adults with Type 1 diabetes.

The guideline, titled “Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the November 2016 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM).

“Studies have found that people with type 1 diabetes who use CGMs are able to maintain better control of their blood sugar without increasing episodes of hypoglycemia when blood sugar drops to dangerous levels, compared to those who self-monitor blood glucose with periodic fingersticks,” says Anne L. Peters, MD, of the University of Southern California’s Keck School of Medicine in Los Angeles, Calif., and chair of the task force that authored the guideline. “Scientific evidence supports the use of CGM technology in individuals with type 1 diabetes whose blood sugar is above the targeted level as well as those whose blood glucose is well managed.”

The guideline task force gave its strongest recommendation in support of using CGM technology in individuals with type 1 diabetes who are able and willing to use the monitors. The task force also suggested that CGMs can be used on a short-term, intermittent basis for individuals with type 2 diabetes whose blood glucose is above targeted levels.

The guideline task force also recommended the use of insulin pumps over multiple daily insulin injections in type 1 diabetes patients who have not met their A1C goals and are willing and able to use the device. In addition, pumps are recommended for people with frequent hypoglycemia or glucose variability, and those who require increased insulin delivery flexibility or improved satisfaction with their diabetes care. Insulin pump use was suggested for people with type 2 diabetes who were not meeting their glycemic goals.

Regardless of what treatment technologies are used, the guideline recommends that all patients and healthcare providers be properly educated and trained to use the devices. “A device’s success is directly linked to an individual’s willingness to use and understand the technology,” Peters said. “It is crucial to ensure patients are comfortable with any devices they decide to incorporate into their treatment plans.”

“Scientific evidence supports the use of CGM technology in individuals with type 1 diabetes whose blood sugar is above the targeted level as well as those whose blood glucose is well managed.”

Other members of the Endocrine Society task force that developed this CPG include: Andrew J. Ahmann, MD, MS, Oregon Health and Science University in Portland, Ore.; Tadej Battelino, MD, PhD, of the University of Ljubljana and University Children’s Hospital in Ljubljana, Slovenia; Alison Evert, MS, RD, CDE, and Irl B. Hirsch, MD, of the University of Washington Medical Center in Seattle; M. Hassan Murad, MD, of the Mayo Clinic Evidence-based Practice Center in Rochester, Minn.; William E. Winter, MD, of the University of Florida in Gainesville, Fla.; and Howard Wolpert, MD, of the Joslin Diabetes Center and Harvard Medical School in Boston.

The guideline was co-sponsored by the American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology.

The guideline will be published online ahead of print.

Look for an in-depth feature on the guideline in the November issue of Endocrine News.

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