Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline

In September 2016, An Endocrine Society Clinical Practice Guideline issued guidelines on Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults. Following are its major recommendations :

1. Insulin pump therapy without sensor augmentation

1.1 Guidelines recommend continuous subcutaneous insulin infusion (CSII) over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1QQQE)

1.2 Guidelines recommend CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. (1QQEE)

1.3 Guidelines suggest CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2QQEE)

2. Insulin pump therapy in type 2 diabetes mellitus

2.1 Guidelines suggest CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2QQEE)

3. Insulin pump use in the hospital

3.1 Guidelines suggest that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures. (2QQEE)

4. Selection of candidates for insulin pump therapy

4.1 Guidelines recommend that before prescribing CSII, clinicians perform a structured assessment of a patient's mental and psychological status, prior adherence with diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits. (1QQEE)

5. Use of bolus calculators in insulin pump therapy

5.1 Guidelines suggest encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations. (2QQEE)

6. Real-time continuous glucose monitors in adult outpatients

6.1 Guidelines recommend real-time continuous glucose monitoring (RT-CGM) devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis. (1QQQQ)

6.2 Guidelines recommend RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis. (1QQQQ)

Use of continuous glucose monitoring in adults with type 2 diabetes mellitus

6.3 Guidelines suggest short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels 7% and are willing and able to use the device. (2QQEE)

Education and training on the use of continuous subcutaneous insulin infusion and continuous glucose monitoring

6.4 Guidelines suggest that adults with T1DM and T2DM who use CSII and continuous glucose monitoring (CGM) receive education, training, and ongoing support to help achieve and maintain individualized glycemic goals. (Ungraded Good Practice Statement)

You can read the full Guideline by clicking on the following link :

http://press.endocrine.org/doi/pdf/10.1210/jc.2016-2534