The use of continuous glucose monitoring (CGM) devices should be ‘gold standard’ in the management of blood glucose levels in adults with Type 1 diabetes, the Endocrine Society says in new guidelines.
The Chair of the task force set up to develop the new clinical practice guidelines, Dr Anne L Peters, said scientific evidence supported the use of CGM devices in both those with type 1 diabetes whose blood sugar was well controlled, as well as those whose blood sugar levels ran above their therapeutic targets.
“Studies have found that people with type 1 diabetes who used CGMs were able to maintain better control of their blood sugar without increasing episodes of hypoglycemia, compared with those who self-monitored blood glucose with periodic fingersticks,” said Dr Peters who is based at the the University of Southern California’s Keck School of Medicine.
The task force also recommended that insulin pump therapy is used with devices that provide continuous subcutaneous insulin infusion (CSII) for patients with type 1 diabetes who had not achieved their HbA1c targets, or those who had achieved their targets but were experiencing severe hypoglycaemia or high glucose variability.
Insulin pump therapy is also recommended for patients with type 2 diabetes with poor glycaemic control despite intensive therapy.
They also recommend the short term use of CGM devices for adults with type 2 diabetes not on prandial insulin who have an HbA1c of 7% or higher, although the task force concede that this particular recommendation is based on limited data.
The guideline authors noted that the success of these devices and technologies is directly linked to the level to which people are educated, capable, and willing to use them.
They also stressed that they had undertaken a rigorous conflict of-interest review process, with all Task Force members required to declare any potential conflicts of interest.
“The CGS reviews all conflicts of interest before the Society’s Council approves the members to participate on the Task Force and periodically during the development of the guideline,” they said.
Summary of Recommendations
1. Insulin pump therapy without sensor augmentation
1.1 We recommend continuous subcutaneous insulin infusion (CSII) over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device.
1.2 We recommend CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device.
1.3 We suggest CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device.
2. Insulin pump therapy in type 2 diabetes mellitus
2.1 We suggest CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications.
3. Insulin pump use in the hospital
3.1 We suggest that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures.
4. Selection of candidates for insulin pump therapy
4.1 We recommend that before prescribing CSII, clinicians perform a structured assessment of a patient’s mental and psychological status, prior adherence with diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits.
5. Use of bolus calculators in insulin pump therapy
5.1 We suggest encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations.
6. Real-time continuous glucose monitors in adult outpatients
6.1 We recommend real-time continuous glucose monitoring (RT-CGM) devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis.
6.2 We recommend RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis.
Use of continuous glucose monitoring in adults with type 2 diabetes mellitus
6.3 We suggest short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels 7% and are willing and able to use the device.
A full copy of the guidelines can be accessed here.