'A Better Picture': First AACE Guidelines on Diabetes Techno
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The use of advanced diabetes technology is strongly recommended with proper education and decision support for people with diabetes, according to a new guideline from the American Association of Clinical Endocrinology.

The guideline, “The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus,” is the first AACE guideline to outline available advanced diabetes technology — defined as continuous glucose monitoring, insulin delivery systems, and “smart” connected devices and apps — and to provide recommendations for their use in diabetes management. The guideline was presented during the AACE annual meeting and simultaneously published in Endocrine Practice.

A task force of clinicians conducted a literature search and evaluated 2,478 studies assessing advanced diabetes technology, ultimately including 357 graded references published from 2012 through February 2021. The authors acknowledged the challenge of designating a specific time frame for such a rapidly evolving field.

“We believed that roughly choosing the past decade would strike the appropriate balance between the currently used technologies and the foundational studies on which they were built,” the authors wrote.

An AACE methodologist and staff assigned evidence levels and study types according to established AACE evidence ratings. When the task force determined guidance was necessary despite a lack of available supporting literature, a recommendation was developed based on expert opinion and consensus of task force authors’ collective experience, knowledge and judgment.

The guideline outlines several key recommendations for use of advanced diabetes technology:

-- Structured CGM is recommended for all people with diabetes treated with intensive insulin therapy, defined as three or more injections per day or use of an insulin pump. Real-time CGM should be recommended over intermittently scanned CGM for people with diabetes with problematic hypoglycemia, defined as frequent/severe or nocturnal hypoglycemia. The guideline also includes metrics to explain how to best interpret CGM data and what is considered time in range stratified by diabetes type and conditions, such as pregnancy.

-- Clinically validated smartphone apps should be recommended for people with diabetes to teach and reinforce diabetes self-management skills and encourage engagement.

-- Telemedicine is strongly recommended to treat people with diabetes, provide education, and monitor glucose and insulin data to indicate a need for therapy adjustments.

-- All people with diabetes using insulin delivery technology should receive comprehensive training on its proper use and care. Use of clinically validated smartphone bolus calculators, in the absence of pump therapy, is strongly recommended to decrease hypoglycemia or severe postprandial hyperglycemia.

-- Clinicians should caution people with diabetes who are using do-it-yourself automated insulin delivery systems that such devices have not undergone rigorous review by the FDA for safety and efficacy.

“It took more than 18 months to put this together, and of course the pandemic did not help,” researchers told. “This is such a rapidly evolving field. There are always new trials being presented. We know what is in press, but we are not allowed to include those things because it violates the principles of the guideline. Everything must be graded and analyzed.

Source: https://pro.aace.com/disease-state-resources/diabetes/clinical-practice-guidelines-treatment-algorithms/new-2021
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