2. Insulin pump therapy in type 2 diabetes
The task force suggests CSII for patients with type 2 diabetes who have poor glycemic control despite all reasonable efforts with insulin or other injectable therapy, oral agents, and lifestyle modifications.
3. Insulin pump use in the hospital
The guideline authors suggest continuation of CSII in patients with type 1 diabetes or type 2 diabetes who are admitted to the hospital, as long as the hospital has established protocols for evaluating and monitoring the use of CSII in such patients. This approach is supported by both the American Diabetes Association and the American Association of Clinical Endocrinologists.
4. Selection of candidates for insulin pump therapy
Before prescribing CSII, the authors recommend that clinicians conduct a comprehensive assessment of the patient’s mental and psychological status, history of adherence to other self-care measures pertaining to the disease (such as carbohydrate counting and sick-day rules), availability for necessary follow-up visits, and willingness to use the device.
5. Use of bolus calculators in insulin pump therapy
The task force suggests that clinicians encourage “patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations.”
They do not recommend the use of non-CSII insulin calculators, such as those available via smartphone apps, which are not FDA-approved.
6. Real-time continuous glucose monitors in adult outpatients
The authors recommend real-time CGM devices for patients with type 1 diabetes and above-target HbA1c levels, as well as those with well-controlled type 1 diabetes, who are capable of using such devices almost daily.
They suggest short-term, intermittent real-time CGM use in adults with type 2 diabetes who are not on prandial insulin and have HbA1c levels ≥7%.
They suggest that both patients with type 1 diabetes and type 2 diabetes using CSII and CGM receive appropriate education, training, and support to achieve and maintain their glycemic goals. They note that data showing improved long-term glycemic control using GCM underscores the importance of the patient’s skill in using the new technology.
“The authors of this guideline did an excellent job reviewing the recommendations based on the current available data,” said Dr Freeby. “As stated in the guideline, there are plenty of data to support the benefits of pump therapy and continuous glucose monitoring in type 1 diabetes, and anecdotally, these therapies really work in day-to-day practice.”
Dr Peters hopes clinicians will be excited about data analysis and how the new devices can help patients. “I don’t think they should be oversold—type 1 diabetes is still a challenge, but these are all steps on the way to more fully automated systems,” she said.
- Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology—Continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Sep 2. doi:10.1210/jc.2016-2534 [Epub ahead of print].