Posted Oct 17 , 2019 04:29 AM
Diabetes Technology: Review of the 2019 American Diabetes Association Standards of Medical Care in Diabetes.
Annals of Internal Medicine 2019_Online August 13
Institute Summary (excerpted from the abstract):
The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. The ADA Professional Practice Committee comprises physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts. To develop the 2019 standards, the committee continuously searched MEDLINE through November 2018 to consider and review studies, particularly high-quality trials including persons with diabetes, for potential incorporation into recommendations. It also solicited feedback from the larger clinical community. This synopsis focuses on selected guidance relating to use of diabetes technology in adults with diabetes. The recommendations address self-monitoring of blood glucose, continuous glucose monitors, and automated insulin delivery systems.
SMBG and CGM: Use of SMBG or CGM is most important for insulin-treated patients because it enables them to adjust therapy to minimize hypoglycemia and manage hyperglycemia. An observational study of almost 27 000 children and adolescents with type 1 diabetes showed that increased daily frequency of SMBG was significantly associated with lower HbA1c levels (difference 0.2 percentage points per additional tests per day) and fewer acute complications. In patients with type 2 diabetes who are not using insulin, potential benefits of glucose monitoring include insight into the effects of diet, physical activity, and medication management. In addition, SMBG is useful in assessing hypoglycemia, glucose levels during intercurrent illness, and discrepancies between measured HbA1c and glucose level. Sensor-augmented pump therapy can be considered for children, adolescents, and adults to improve glycemic control without increasing overall or severe hypoglycemia. Benefits correlate with ongoing consistent use of the device. Persons who have been successfully using continuous glucose monitors should have continued access across third-party payers. Use of CGM reduced hypoglycemia in adults with type 1 diabetes using multiple daily injections or continuous subcutaneous insulin infusion. Use of an intermittently scanned continuous glucose monitor can be considered as a substitute for SMBG in adults with diabetes requiring frequent glucose testing.
Automated Insulin Delivery:
Automated insulin delivery systems can be considered in children (aged >7 years) and adults with type 1 diabetes to improve glycemic control. Automated insulin delivery systems consist of an insulin pump, a continuous glucose sensor, and an algorithm that determines insulin delivery. These systems suspend, increase, or decrease insulin delivery on the basis of sensor glucose values. Recent studies suggest that these systems may have psychosocial benefits and may reduce exercise-induced hypoglycemia
Why is this important?
Endorsement of new technologies by the American Diabetes Association is important to provide clinicians with guidelines that enhance the value of these technologies in people with diabetes. The ADA has recently moved to update its Standards more often than annually, and that will improve the dissemination of these valuable new tools!
Concluding Thought: Taking new technology and incorporating into how people work and live is not easy. - Oren Etzioni
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