Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

Patient Guideline Summary

Publication Date: May 1, 2021

Objective

Objective

This patient summary means to discuss key recommendations from the American Association of Clinical Endocrinology (AACE) for the use of advanced technology in the management of persons with Diabetes Mellitus. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Advances in glucose monitoring and insulin delivery technologies enable persons with diabetes to enhance their daily self-management and improve the quality of their lives.
  • We will use multiple abbreviations throughout this summary. We will use “glucose” or “blood glucose” to refer to blood sugar.
  • This patient summary focuses on continuous glucose monitoring (CGM) and its multiple variations to improve glucose control.

Management

Management

  • The goal of diabetes management is to keep blood glucose levels as close to normal as possible, erring on the high side if necessary to avoid hypoglycemia (low blood glucose), which is much more immediately dangerous than high blood glucose.
    • Standards for quality data include 14 consecutive days of records that contain at least 70% of readings.
    • A one-page daily printout known as an ambulatory glucose profile (AGP) is available from CGM devices.
      • Critical measurements from an AGP include:
        • Time in range (TIR) – above 70%; above 50% for elderly and high-risk patients
        • Time below range (TBR) – below 1%
        • Time above range (TAR) – below 25%; below 10% for elderly and high-risk patients
  • Self-monitoring of blood glucose (SMBG) (with fingersticks or the newer no fingerstick gadgets) and insulin injections or insulin pens, the standard method of using insulin prior to the new technologies, is now recommended only for:
    • Patients who cannot or will not use CGM.
    • Patients who do not have access to their CGM readings.
    • Patients who are successfully using SMBG and wish to continue.
    • Backup of CGM when it is at risk of failure, such as when using telecommunicated values and instructions.
  • CGM is recommended for both Type 1 (T1D) and Type 2 (T2D) diabetes.
  • CGM can be combined with automated insulin dosing (AID) from a sensor-augmented pump (SAP).
  • CGM can be either intermittent or continuous, depending on the difficulty of controlling glucose levels, particularly hypoglycemia.
  • CGM can be programmed to warn of and respond to impending hypoglycemia by reducing programmed insulin injections but does not raise blood glucose.
  • CGM can be combined with telemedicine and smartphones to facilitate more rapid and intense diabetes management.
  • The optimal functioning of these technologies depends upon satisfactory education and frequent review of the skills of those using them.
  • Warning: Attention must be paid to possible system failures so that backup is available at an interval determined by the patient’s risk factors.

Abbreviations

  • AACE: American Association Of Clinical Endocrinology
  • AGP: Ambulatory Glucose Profile
  • AID: Automated Insulin Dosing
  • CGM: Continuous Glucose Monitoring
  • CSII: Continuous Subcutaneous Insulin Infusion
  • GMI: Glucose Management Indicator
  • LGS: Low-glucose Suspend
  • MDI: Multiple Daily Injections
  • PLGS: Predictive Low-glucose Suspend
  • SAP: Sensor-augmented Pump
  • SMBG: Self-monitoring Blood Glucose
  • T1D: Type 1 Diabetes
  • T2D: Type 2 Diabetes
  • TAR: Time Above Range
  • TBR: Time Below Range
  • TIR: Time In Range
  • isCGM: Intermittently Scanned CGM
  • rtCGM: Real-time CGM

Source Citation

Grunberger G, Sherr J, Allende M, Blevins T, Bode B, Handelsman Y, Hellman R, Lajara R, Roberts VL, Rodbard D, Stec C, Unger J. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract. 2021 Jun;27(6):505-537. doi: 10.1016/j.eprac.2021.04.008. PMID: 34116789.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.