Each year the American Diabetes Association (ADA) publishes their evidence-based Standards of Medical Care in Diabetes, better known as clinical recommendations—this year being no exception.1 This comprehensive reference is the mainstay for many practicing healthcare professionals. While individual providers are not obligated to follow these recommendations (other professional organizations have their own), what the ADA has to say is held in high regard by many practitioners.
Section 7 of the clinical recommendations addresses technology in diabetes care.2 There are 29 recommendations in this section which include subheadings: General Device Principles, Blood Glucose Monitoring, Continuous Glucose Monitoring (CGM) Devices, Insulin Delivery (syringes and pens), Insulin Pumps (otherwise known as continuous subcutaneous insulin infusion—CSII), Automated Insulin Delivery (AID) Systems, Do-It-Yourself Closed-Loop Systems, Digital Health Technology, and Inpatient Care (and technology use). While some of this year’s updates are changes in semantics (for example “blood glucose monitoring” instead of “self-management of blood glucose” and “connected insulin pen” instead of “smart insulin pen”) there are other updates, summarized below, also worth mentioning.
For instance, the recommendation for individualized care is not new, however the inclusion of the caregiver’s skills and desires for technology is now at the forefront. Early in the technology section is the advice that people with diabetes and their caregivers should be provided initial device training, regular evaluation, and ongoing education.
Early initiation of CGM, CSII and/or AID can be helpful to the person’s diabetes management; in fact, the ADA says CGM should be considered at the onset of a diagnosis that requires insulin use.
There remains a place in diabetes care for blood glucose monitoring (BGM). It is clearly stated that people using CGM must have access to BGM at all times. BGM technology still has interfering factors (i.e. vitamin C use, hypoxemia) that can alter the accuracy of readings so practitioners should remain aware of this.
CGM recommendations for adults and youth have now been separated. The reason for separating the age groups appears to be related to different strengths of evidence. In general, both age groups, whether on basal-only insulin, multiple daily injections (MDI) or CSII, should be offered CGM.
Connected insulin pens (CIPs) are called out for what they can offer, such as the capability to record dose data, calculate insulin doses (based on insulin-to-carb ratio, insulin sensitivity factor and active insulin time), give dose reminders and be synced with CGM data. The ADA advises patients who want to use an insulin dose calculator to use one approved by the US Food and Drug Administration (FDA).
Recommendations for AID, sensor-augmented low glucose suspend pumps (pump + CGM) and insulin pumps without CGM have all been combined into one section. AID are offered to youth and adults with type 1 and other insulin-deficient types of diabetes. This inclusion of “other insulin-deficient types of diabetes” for the AID was not in the 2021 recommendations. If these individuals “are not able to use or are not interested” in AID, then insulin pumps with or without CGM sensor-augmented low glucose suspend may be offered. Finally, type 2 diabetes can be managed in youth and adults with insulin pump therapy (a recommendation that’s presented based on the highest strength of evidence).
Supporting a patient’s treatment journey warrants a team approach. At Medtronic, our goal is to meet patients where they are with innovative technology that is focused on reducing the burden of living with diabetes. We offer a family of solutions and support to help meet patients’ needs. To learn more about our therapies, reach out to your local Medtronic representative or visit our healthcare professional website.
† Smart insulin pens connect to a mobile app to provide dosing calculations, reminders and CGM system integration.
American Diabetes Association. Standards of Medical Care in Diabetes—2022. Diabetes Care, volume 45 (Suppl 1) S1-S264. https://professional.diabetes.org/content-page/practice-guidelines-resources
American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022;45(Suppl 1):S97–S112. https://diabetesjournals.org/care/article/45/Supplement_1/S97/138911/7-Diabetes-Technology-Standards-of-Medical-Care-in
American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S85-S99. https://diabetesjournals.org/care/article/44/Supplement_1/S85/30679/7-Diabetes-Technology-Standards-of-Medical-Care-in