American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

Abstract

automated insulin dosing continuous glucose monitoring continuous subcutaneous insulin infusion diabetes diabetes technology glucose sensors hybrid closed loop insulin pumps sensor-augmented pump low-glucose suspend predictive low-glucose suspend a b s t r a c t Objective: To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. Methods: The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. Main Outcome Measures: Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. Results: This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base.Recommendations: Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. Conclusions: Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of Disclaimer: The American Association of Clinical Endocrinology medical guidelines for clinical practice are systematically developed statements to assist health care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on clinical evidence. In areas of uncertainty, or when clarification is required, expert opinion and professional judgment were applied.This guideline is a working document that reflects the state of the field at the time of publication. Because rapid changes are expected in this area, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made considering local resources and individual patient circumstances.

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

“…Alongside this, the development of continuous subcutaneous insulin infusions (CSII) systems combined with sensoraugmented pump therapy (SAP) and potentially hybrid closed-loops (HCL) systems to respond to changes in HbA1c levels thereby further reducing episodes of hypoglycaemia (Garg et al, 2017;Karges et al, 2017;Steineck et al, 2017;Burckhardt et al, 2018;Gómez et al, 2018;Korkmaz et al, 2018;Stone et al, 2018;Grunberger et al, 2021;Moreno-Ferández et al, 2021;Roze et al, 2021). There can though be concerns with the extent of patient benefits with CSII systems over multiple daily injections; however, again this is not universal (Mueller-Godeffroy et al, 2018;Blair et al, 2019).…”

Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe

“…However, the ADA acknowledged that physicians’ opinions can vary when prescribing CSII, with some recommending pump therapy for motivated PwD with daily schedules unsuited to MDI, and others only endorsing prescription when treatment with MDI fails to achieve glycemic control [ 33 ]. A further consensus statement published in 2021 by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) indicated that CSII should only be provided if the prescribing practice can offer a comprehensive pump management program for PwD [ 34 ]. Moreover, the AACE/ACE emphasized appropriate patient selection with a thorough assessment of the individual’s knowledge of diabetes management principles [ 34 ].…”

“…A further consensus statement published in 2021 by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) indicated that CSII should only be provided if the prescribing practice can offer a comprehensive pump management program for PwD [ 34 ]. Moreover, the AACE/ACE emphasized appropriate patient selection with a thorough assessment of the individual’s knowledge of diabetes management principles [ 34 ]. Combination of these guidelines and position statements indicate the ideal CSII candidate as an individual with T1D currently performing four or more insulin injections and SMBG tests per day, who is motivated to achieve optimal glycemic control, and is willing and able to carry out the tasks associated with CSII safely and effectively, while maintaining frequent contact with their healthcare team [ 30 , 34 , 35 ].…”

“…Moreover, the AACE/ACE emphasized appropriate patient selection with a thorough assessment of the individual’s knowledge of diabetes management principles [ 34 ]. Combination of these guidelines and position statements indicate the ideal CSII candidate as an individual with T1D currently performing four or more insulin injections and SMBG tests per day, who is motivated to achieve optimal glycemic control, and is willing and able to carry out the tasks associated with CSII safely and effectively, while maintaining frequent contact with their healthcare team [ 30 , 34 , 35 ].…”

“…A 2021 consensus statement indicated that characteristics of individuals with diabetes can be used to predict successful utilization of CSII [ 34 ]. For example, a preferred candidate for CSII would be an individual with high engagement with their diabetes regimen (i.e., highly motivated to achieve optimal blood glucose control yet unable to do so on current therapy).…”