The American Diabetes Association (ADA) updates its Standards of Medical Care in Diabetes every year to give doctors, clinicians, and patients key recommendations for the diagnosis and management of patients with diabetes.
The recommendations are based on the evaluation of high-quality studies, and feedback from the larger clinical community.
This year, the updates included a new section on diabetes technology. According to the guidelines, diabetes technology encompasses the devices, hardware, and software that are used to assist in the management of blood glucose levels.
The following is a rundown of the updated recommendations, specifically relating to diabetes technology.
Self-Monitoring of Blood Glucose
Self-monitoring of blood glucose is an important daily regimen for patients who use insulin. Continuous glucose monitoring (CGM) is another method to get continuous glucose readings and can be used to inform patients of the effects of medications, meals, and exercise on the blood glucose level.
The updated guidelines recommend that most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should assess glucose levels using SMBG or CGM before meals and snacks, at bedtime, occasionally postprandially, before exercise, when low blood glucose is suspected, after treating hypoglycemia until achieving normoglycemia, and before critical tasks, such as driving.
As for patients using less frequent insulin injections, SMBG may help guide treatment decisions. The guidelines recommend the evaluation of the monitoring technique initially and at regular intervals.
Continuous Glucose Monitors
Small subcutaneous sensors can measure glucose levels and provide continuous glucose monitoring. There are real-time devices, which report glucose readings continuously, along with alerts for extremely abnormal glucose levels, as well as intermittently scanned CGM devices.
Systems for CGM can provide important data that may be used to adjust treatment for diabetes.
According to the guidelines, sensor-augmented pump therapy can be considered for children, adolescents, and adults to improve glycemic control. However, when CGM is used, intensive diabetes education and support are required.
For adults with Type 1 diabetes, the committee recommends a combination of real-time CGM with an intensive insulin regimen to improve glycemic control.
They also recommend considering this option for patients with frequent hypoglycemic events or hypoglycemia unawareness.
The use of real-time CGM as close to daily as possible is recommended because consistent CGM use is an important factor in improving glycemic control. In adult patients with Type 1 diabetes at high risk for hypoglycemia, sensor-augmented pump therapy with automatic low-glucose suspend can be considered.
In adults with diabetes requiring frequent glucose testing, it is possible to consider the use of intermittently scanned CGM (also called flash CGM) instead of SMBG, which measures glucose levels every minute, records a reading every 15 minutes, and can display up to 8 hours of data on the receiver, but does not provide blood glucose alerts.
Automated Insulin Delivery
Automated insulin delivery systems, which are also known as “artificial pancreas,” systems include an insulin pump, a continuous glucose sensor, and an algorithm that determines insulin delivery.
These systems can change or hold insulin delivery based on glucose levels. This option is suggested as a possible tool to improve glycemic control in children, ages 7 years and older, and adults with Type 1 diabetes.
You can access the complete 2019 Standards of Medical Care in Diabetes here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
- Chamberlain JJ, Doyle-Delgado K, Peterson L, Skolnik N. Diabetes technology: Review of the 2019 American Diabetes Association Standards of Medical Care in Diabetes [published online August 12, 2019]. Ann Intern Med. doi:10.7326/M19-1638