New AACE guideline outlines secure use of superior diabetes know-how

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Grunberger G. Guide to Clinical Practice – Using Advanced Technology in the Treatment of Individuals with Diabetes Mellitus. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; 26.-29. May 2021 (virtual meeting).

Disclosure:
Grunberger reports that he has received speaking fees from Abbott, Eli Lilly, and Novo Nordisk. In the guideline you will find all relevant financial information of all other authors.

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According to a new guideline from the American Association of Clinical Endocrinology, the use of advanced diabetes technology with adequate education and decision support is highly recommended for people with diabetes.

The “Using Advanced Technology in the Treatment of Individuals with Diabetes Mellitus” guideline is the first AACE guideline to describe the advanced diabetes technology available – defined as continuous glucose monitoring, insulin delivery systems and “smart” connected devices and apps. and make recommendations for their use in diabetes management. The guideline was presented during the AACE Annual Meeting and published simultaneously in Endocrine Practice.

Grunberger is that Chairman of the Grunberger Diabetes Institute in Bloomfield Hills, Michigan.

“AACE has previously issued opinions or consensus statements on blood glucose management, continuous glucose monitoring systems, insulin pump management, and the integration of CGM and pump therapy. However, this is the first time there is a guide to clinical practice. George Grunberger, MD, FACP, MACE, chairman of the Grunberger Diabetes Institute in Bloomfield Hills, Michigan, told Healio. “The AACE Scientific Diabetes Committee decided the time has come – there is now enough evidence, peer-reviewed literature, randomized trials – to deserve consideration for an evidence-based guideline.” Grunberger was co-chair of the Advanced Diabetes Technology Guideline task force Jennifer Sherr, MD, PhD, Pediatric Endocrinologist at the Diabetes Clinic at Yale New Haven Children’s Hospital and Associate Professor of Pediatric Endocrinology at the Yale School of Medicine.

Rapidly changing field

A task force of clinicians conducted a literature review and evaluated 2,478 studies evaluating advanced diabetes technology, including an eventual 357 tiered references published from 2012 to February 2021. The authors recognized the challenge of setting a specific time frame for a rapidly developing area.

“We felt that a rough sample of the past decade would strike the right balance between the technologies currently in use and the fundamental studies on which they were built,” the authors wrote.

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

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

  • Structured CGM is recommended for all people with diabetes who are being treated with intensive insulin therapy, defined as three or more injections per day or the use of an insulin pump. Real-time CGM should be recommended for people with diabetes with problematic hypoglycemia, defined as frequent / severe or nocturnal hypoglycemia versus intermittently scanned CGM. The guideline also includes metrics to explain how best to interpret CGM data and what time is considered in a range stratified by type and conditions of diabetes, such as pregnancy.
  • Clinically validated smartphone apps should be recommended to people with diabetes to teach and strengthen diabetes self-management skills and encourage engagement.
  • Telemedicine is highly recommended for treating people with diabetes, providing education, and monitoring glucose and insulin data to indicate that therapy adjustments are needed.
  • All people with diabetes who use insulin delivery technology should receive extensive training in its proper use and care. The use of clinically validated smartphone bolus calculators without pump therapy is strongly recommended to reduce hypoglycemia or severe postprandial hyperglycemia.
  • Doctors should advise people with diabetes who use automated do-it-yourself insulin delivery systems that such devices have not been rigorously tested for safety and effectiveness by the FDA.

“It took more than 18 months to put this together and of course the pandemic didn’t help,” Grunberger told Healio. “This is a rapidly evolving field. New studies are always presented. We know what is in the press, but we must not include these things as it goes against the principles of the directive. Everything has to be assessed and analyzed. Most importantly, this is a guideline, not an opinion, limited to the February 1st deadline [for accepted studies]. We strongly support advanced diabetes technology in qualified hands with training. “

Ensure universal access

Advanced diabetes technology promises to be beneficial for all people with diabetes. However, such technology remains inaccessible to many.

“With data showing that glycemic metrics have improved with advanced diabetes technology, the call to action now is to provide adequate coverage to payers, educate diabetics about available devices, and help integrate those tools in to ensure the care system. ” The authors wrote. “As with other technological advances, the field of diabetes technology is rapidly evolving. Clinicians and people with diabetes must strive to keep up with these developments. “

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