7. Diabetes Technology: Standards of Medical Care in Diabetes—2020

Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes .org/SOC.Diabetes technology is the term used to describe the hardware, devices, and software that people with diabetes use to help manage their condition, from lifestyle to blood glucose levels. Historically, diabetes technology has been divided into two main categories: insulin administered by syringe, pen, or pump, and blood glucose monitoring as assessed by meter or continuous glucose monitor. More recently, diabetes technology has expanded to include hybrid devices that both monitor glucose and deliver insulin, some automatically, as well as software that serves as a medical device, providing diabetes self-management support. Diabetes technology, when coupled with education and follow-up, can improve the lives and health of people with diabetes; however, the complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation. OVERALL STATEMENT Recommendation 7.1 Use of technology should be individualized based on a patient's needs, desires, skill level, and availability of devices. Nonprofit websites can offer advice for providers and patients to determine the suitability of various options. ETechnology is rapidly changing, but there is no "one-size-fits-all" approach to technology use in people with diabetes. Insurance coverage can lag behind device availability, patient interest in devices and willingness to change can vary, and providers may have trouble keeping up with newly released technology. Not-for-profit websites such as DiabetesWise.org (1) and others can help providers and patients make decisions as to the initial choice of devices. Other sources, including health care providers and device manufacturers, can help people troubleshoot when difficulties arise. SELF-MONITORING OF BLOOD GLUCOSERecommendations 7.2 Most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should be encouraged to assess glucose levels using

Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

“…6 Indeed, in an untrained patient with stable glycemia, there is no difference between obtaining the current glucose levels by using FGM or SMBG. 3 Relevant to this concept, a reference to the interpretation of FGM data was reported only in three studies, 17 19 20 while the majority of the other papers described a training merely on scanning and sensor change or no training for interpretation of glucose sensor data. 7 8 14-16 21 23 One study specifically focused on the role of training in patients on FGM.…”

“…35 36 On the other hand, in FGM, the patients are informed about current glycemic level only following scanning and, if this is performed more than 8 hours after the last scan, some data can be lost. [3][4][5] Moreover, a negative bias at low glucose concentrations has been reported with FGM, possibly resulting in the patient inadvertently adapting to higher 'true' glucose concentrations and thus higher HbA1c. 37 38 Thus, while both FGM and RT-CGM can be regarded as effective options for CGM, some patient's characteristics (eg, hypoglycemia unawareness) and the glycemic goals may lead to consider one over the other device.…”

“…40 43-45 Concerning the inclusion of patients with different types of diabetes, according to current guidelines, FGM can be considered in patients with type 1 diabetes or type 2 diabetes to lower HbA1c levels and/or reduce hypoglycemia. 3 In general, the pooling of results from patients with different types of diabetes can lead to biased results. However, the included studies were all conducted in patients taking insulin, for which there is an indication to consider the use of FGM.…”

“…Although novel devices harbor improved characteristics, the widespread diffusion of previous versions has been often limited by the need of frequent calibration and the short wear time. [3][4][5] FGM is a factory-calibrated sensor-based technology characterized by a small-sized patch lasting up to 14 days and a short warm-up period. On-demand sensor scanning provides patients with comprehensive glucose data, including current glucose levels, which are updated every minute, historical glucose readings from the last 8 hours, and trend arrows.…”

Artificial Pancreas Control Strategies Used for Type 1 Diabetes Control and Treatment: A Comprehensive Analysis

“…Moreover, it is very difficult to manufacture one proper device with all related functionalities because metabolic conditions vary from patient to patient. Hence, despite the latest developments in tools and technologies, there is no single device and technology which can completely handle the task of self-care in T1DM patients [203].…”