On October 13, the American Association of Clinical Endocrinologists (AACE) published two new consensus statements, one concerning continuous glucose monitoring (CGM) and the other on the topic of insulin pumps. The statements are intended to help health-care providers identify the best candidates for these types of therapy.
Continuous glucose monitoring systems provide real-time blood glucose estimations and can provide warnings to guard against highs and lows. (CGM devices use thin sensors inserted under the skin to measure glucose levels in interstitial fluid. The sensor sends this information to a receiver, which displays the current glucose concentration.) The AACE recommends that people with Type 1 diabetes who frequently have hypoglycemia (low blood glucose), have widely variable blood glucose levels, have an A1C (an indicator of blood glucose control over the previous 2–3 months) above their target level, or who need to lower their A1C without increasing their number of hypoglycemic events, as well as those who are pregnant or planning to become pregnant, are ideal candidates for using this technology. Children and adolescents who have achieved A1C levels below 7%, as well as children with Type 1 diabetes and A1C levels of 7% or higher who would be able to use a CGM device on a nearly daily basis are also included among the AACE’s list of ideal candidates.
Studies have indicated that the more consistently CGM is used, the more effective it is at helping maintain diabetes control. According to Irl B. Hirsch, MD, co-chair of the CGM task force, “Over the past few years, a number of randomized, controlled clinical trials have been undertaken to evaluate the impact of real-time CGM devices in the treatment of Type 1 diabetes. Several important observations have emerged. The most important is that the devices have to be used on a nearly daily basis to be effective in achieving and maintaining target A1C levels.”
The AACE suggests that longer-term studies be conducted with CGM to determine the effects of this type of monitoring over periods longer than 6 to 12 months.
Insulin pump therapy, which involves continuously infusing insulin into the body from a small reservoir of insulin, has been available since the late 1970’s. It provides an alternative to insulin injections. According to the AACE insulin pump task force, the best candidates for insulin pump therapy have either Type 1 diabetes or insulin-deficient Type 2 diabetes, perform four or more blood glucose checks and four or more insulin injections daily, are motivated to achieve tighter blood glucose control, and are “willing and intellectually and physically able to undergo the rigors of insulin pump therapy initiation and maintenance.”
The AACE press release on the insulin pump consensus statement notes that there is no official requirement for medical supervision of those using insulin pumps in the United States, and as a result, people often must rely solely on the manufacturer and their own efforts to learn how to manage their insulin pump treatment. It is therefore critical, the AACE release says, to select candidates who are well suited for this type of therapy.
To learn more, see the press releases on the continuous glucose monitoring consensus statement and the insulin pump management consensus statement on the Web site of the American Association of Clinical Endocrinologists. (Links to download the consensus statements are available in the press releases.) And be sure to check out our articles on continuous glucose monitoring and insulin pumps to learn more about these technologies.