Continuous Glucose Monitors

Small subcutaneous sensors can measure interstitial glucose levels, which correlate well with plasma glucose 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. When CGM is used, intensive diabetes education and support are required.

Based on several studies that have shown significant reductions in HbA1c and hypoglycemic events, the committee recommends a combination of real-time CGM with an intensive insulin regimen to improve glycemic control in adults with uncontrolled type 1 diabetes. 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.

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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.

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Automated Insulin Delivery

Automated insulin delivery systems include an insulin pump, a continuous glucose sensor, and an algorithm that determines insulin delivery. As 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 (aged >7 years) and adults with type 1 diabetes.

Disclosure: Several review authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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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