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demonstrate impaired counterregulatory\nresponses to hypoglycemia and/or expe-\nrience impaired hypoglycemia awareness,a measured glucose level <70 mg/dL\n(<3.9 mmol/L) is considered clinically im-\nportant, regardless of symptoms. Level 2\nhypoglycemia (de fined as a blood glucose\nconcentration <54 mg/dL [ <3.0 mmol/L... | [
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concentration <54 mg/dL [ <3.0 mmol/L])\nis the threshold at which neuroglycopenicsymptoms begin to occur and requires im-mediate action to resolve the hypoglyce-\nmic event. If an individual has level 2\nhypoglycemia without adrenergic or neu-roglycopenic symptoms, they likely haveimpaired hypoglycemia awareness (dis-... | [
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HYPOGLYCENMIA RISK ASSESSMENT ,\nbelow). This clinical scenario warrants inves-tigation and review of the treatment plan\n(72,73). Lastly, level 3 hypoglycemia is de-\nfined as a severe event characterized by al-\ntered mental and/or physical functioningthat requires assistance from another per-son for recovery, irrespe... | [
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Hypoglycemia has a broad range of\nnegative health consequences (74). Level 3\nhypoglycemia may be recognized or un- | [
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hypoglycemia may be recognized or un-\nrecognized and can progress to loss ofconsciousness, seizure, coma, or death.Level 3 hypoglycemia was associated withmortality in both the standard and the in-tensive glycemia arms of the ACCORD trial,but the relationships between hypoglyce-\nmia, achieved A1C, and treatment inten... | [
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mia, achieved A1C, and treatment inten-\nsity were not straightforward (75). Anassociation of level 3 hypoglycemia withmortality was also found in the ADVANCEtrial and in clinical practice (76,77). Hypo-glycemia can cause acute harm to the per-son with diabetes or others, especially if it\ncauses falls, motor vehicle a... | [
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causes falls, motor vehicle accidents, or\nother injury (78). Hypoglycemia may alsocause substantial anxiety that can reducethe quality of life of individuals with dia-betes and their caregivers and may con-tribute to problems with diabetes self-management and treatment (79 –81). | [
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Recurrent level 2 hypoglycemia and/orlevel 3 hypoglycemia is an urgent medi-cal issue and requires intervention withmedical treatment plan adjustment, be-havioral intervention, delivery of diabetes\nTable 6.4 —Classi fication of hypoglycemia\nGlycemic criteria/description\nLevel 1 Glucose <70 mg/dL ( <3.9 mmol/L) and $5... | [
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Level 1 Glucose <70 mg/dL ( <3.9 mmol/L) and $54 mg/dL ( $3.0 mmol/L)\nLevel 2 Glucose <54 mg/dL ( <3.0 mmol/L)\nLevel 3 A severe event characterized by altered mental and/or physical status requiring\nassistance for treatment of hypoglycemia, irrespective of glucose level | [
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Reprinted from Agiostratidou et al. (70).S118 Glycemic Goals and Hypoglycemia Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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self-management education and support,\nand use of technology to assist with hypo-\nglycemia prevention and identi fication\n(73,82 –85).\nStudies of rates of hypoglycemia pre-\ndominantly rely on claims data for hospi-\ntalizations and emergency department\nvisits (86 –89). These studies do not cap- | [
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visits (86 –89). These studies do not cap-\nture the level 1 and level 2 hypoglycemiathat represent the vast majority of hypo-\nglycemic events, and they also substan-\ntially underestimate level 3 hypoglycemia\n(86,90). Nevertheless, they reveal a sub-\nstantial burden of hypoglycemia-related\nhospital utilization in ... | [
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hospital utilization in the community (86 –89).\nLevel 1 and level 2 hypoglycemia can be as-certained from patient self-report (91) and\nare strong risk factors for subsequent level 3\nhypoglycemia.Hypoglycemia Risk Assessment\nAssessment of an individual’ sr i s kf o rh y p o -\nglycemia includes evaluating clinical r... | [
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glycemia includes evaluating clinical risk\nfactors as well as relevant social, cultural,and economic factors ( Table 6.5 ). Recom-\nmendations 6.11 –6.17 group individuals\nwith diabetes into two hypoglycemia riskcategories with clinical signi ficance. Indi- | [
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viduals at risk for hypoglycemia are thosetreated with insulin, sulfonylureas, or me-glitinides; clinically signi ficant hypoglyce- | [
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mia is rare among individuals taking otherdiabetes medication classes (92,93). Indi-viduals at high risk for hypoglycemia arethe subset of individuals at risk for hypogly-cemia who either have a major hypoglyce-mia risk factor or have multiple other riskfactors (determined by the health care pro-fessional incorporating... | [
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health care pro-fessional incorporating clinical judgment)(Table 6.5 ). This risk strati fication is based | [
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on epidemiologic studies of hypoglycemia\nrisk (87,88,92,94– 97). Validated tools have\nbeen developed to estimate hypoglyce-mia risk using predominantly electronic\nhealth record data (98 –100). However,\nthese tools do not include all of the im-\nportant hypoglycemia risk factors, andmore research is needed to determ... | [
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how they can best be incorporated into\nclinical care.\nAmong individuals at risk for hypoglyce-\nmia, prior hypoglycemic events, especiallylevel 2 or 3 events, are the strongest risk\nfactors for hypoglycemia recurrence and\nseverity (96,101 –103). Hypoglycemia his-\ntory should be assessed at every clinicalencounter ... | [
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mic event frequency, severity, precipi-\ntants, symptoms (or lack thereof), andapproach to treatment. It is essential tocorrelate home glucose readings, bothfrom glucose meters and CGM systems,\nwith symptoms and treatment, as individ- | [
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with symptoms and treatment, as individ-\nuals may experience and treat hypoglyce-mic symptoms without checking theirglucose level (104), treat normal glucose\nvalues as hypoglycemic, or tolerate hypo-\nglycemia without treatment either be-cause of lack of symptoms or to avoidhyperglycemia.\nIndividuals at risk for hyp... | [
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Individuals at risk for hypoglycemia\nshould also be screened for impaired hy-poglycemia awareness (also called hypo-glycemia unawareness or hypoglycemia-associated autonomic failure) at least\nyearly. Impaired hypoglycemia awareness\nis defined as not experiencing the typical | [
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is defined as not experiencing the typical\ncounterregulatory hormone release atlow glucose levels or the associated symp-toms, which often occurs in individuals\nwith long-standing diabetes or recurrent\nhypoglycemia (105). Individuals with impairedhypoglycemia awareness may experienceconfusion as the first sign of hypo... | [
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which can create fear of hypoglycemia andseverely impact quality of life (106). Impairedhypoglycemia awareness dramatically in-creases the risk for level 3 hypoglycemia\n(107). The Clark and Gold scores are vali- | [
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(107). The Clark and Gold scores are vali-\ndated questionnaires to assess impaired hy-poglycemia awareness (108,109). However,these questionnaires may be impractical forroutine clinical use. A recommended strat-\negy is to screen for impaired hypoglycemia | [
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egy is to screen for impaired hypoglycemia\nawareness by asking individuals whetherthey ever have low blood glucose withoutfeeling symptoms, or by asking at what\nblood glucose levels they typically begin to\nfeel symptoms (and what those symptomsTable 6.5 —Assessment of hypoglycemia risk among individuals treated with | [
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insulin, sulfonylureas, or meglitinides\nClinical/biological risk factors Social, cultural, and economic risk factors\nMajor risk factors\n/C15Recent (within the past 3 –6 months) level 2\nor 3 hypoglycemia\n/C15Intensive insulin therapy*\n/C15Impaired hypoglycemia awareness\n/C15End-stage kidney disease | [
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/C15Impaired hypoglycemia awareness\n/C15End-stage kidney disease\n/C15Cognitive impairment or dementiaMajor risk factors/C15Food insecurity\n/C15Low-income status§\n/C15Homelessness\n/C15Fasting for religious or cultural reasons\nOther risk factors/C15Multiple recent episodes of level 1hypoglycemia\n/C15Basal insulin ... | [
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/C15Basal insulin therapy*\n/C15Age$75 years †\n/C15Female sex\n/C15High glycemic variability ‡\n/C15Polypharmacy\n/C15Cardiovascular disease\n/C15Chronic kidney disease (eGFR <60 mL/min/\n1.73 m\n2or albuminuria)\n/C15Neuropathy\n/C15Retinopathy\n/C15Major depressive disorderOther risk factors/C15Low health literacy\n... | [
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/C15Alcohol or substance use disorder\nMajor risk factors are those that have a consistent, independent association with a highrisk for level 2 or 3 hypoglycemia. Other risk factors are those with less consistent evidenceor a weaker association. These risk factors are identi fied through observational analyses | [
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and are intended to be used for hypoglycemia risk strati fication. Individuals considered at\nhigh risk for hypoglycemia are those with $1 major risk factor or who have multiple other | [
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risk factors (determined by the health care professional incorporating clinical judgment)(87,88,92,94 –97,113,146). Proximal causes of hypoglycemic events (e.g., exercise and sleep)\nare not included. eGFR, estimated glomerular filtration rate. *Rates of hypoglycemia are | [
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highest for individuals treated with intensive insulin therapy (including multiple daily injectionsof insulin, continuous subcutaneous insulin infusion, or automated insulin delivery systems), fol-\nlowed by basal insulin, followed by sulfonylureas or meglitinides. Combining treatment with insu- | [
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lin and sulfonylureas also increases hypoglycemia risk. †Accounting for treatment plan and\ndiabetes subtype, the oldest individuals (aged $75 years) have the highest risk for hypogly-\ncemia in type 2 diabetes; younger individuals with type 1 diabetes are also at very high | [
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-0.029365... |
risk. ‡Tight glycemic control in randomized trials increases hypoglycemia rates. In observa-\ntional studies, both low and high A1C are associated with hypoglycemia in a J-shaped rela-\ntionship. §Includes factors associated with low income, such as being underinsured or living | [
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in a socioeconomically deprived area.diabetesjournals.org/care Glycemic Goals and Hypoglycemia S119\n©AmericanDiabetesAssociation | [
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are), and follow up positive responses with\na more detailed evaluation (105,110).\nOther notable clinical and biological risk\nfactors for hypoglycemia are older age, mul-timorbidity, cognitive impairment, chronic\nkidney disease and end-stage kidney dis- | [
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... |
kidney disease and end-stage kidney dis-\nease in particular, CVD, depression, andneuropathy (92,93). Female sex has alsobeen found to be an independent risk fac-\ntor for hypoglycemia in multiple studies, al- | [
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tor for hypoglycemia in multiple studies, al-\nthough the mechanisms of this relationshipare unclear and require further research(92). Cognitive impairment has a strong bi-directional association with hypoglycemia,\nand recurrent severe hypoglycemic epi-\nsodes were associated with a greater de-cline in psychomotor and... | [
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after long-term follow-up of the DCCT/EDIC\ncohort (111). Therefore, cognitive function\nshould be routinely assessed among olderadults with diabetes.\nThere are a number of important social,\ncultural, and economic hypoglycemia risk\nfactors that should considered. Food inse- | [
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factors that should considered. Food inse-\ncurity is associated with increased risk ofhypoglycemia-related emergency depart-ment visits and hospitalizations in low-\nincome households, and this was shown\nto be mitigated by increased federal nutri-tion program benefi ts (112). In general, in-\ndividuals with low annual... | [
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dividuals with low annual household\nincomes (93), individuals who live in so-\ncioeconomically deprived areas (96), andindividuals who are underinsured (97) orhomeless (113) experience higher rates ofemergency department visits and hospital-\nizations for hypoglycemia. Clinicians should | [
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izations for hypoglycemia. Clinicians should\nalso be aware of cultural practices thatmay in fluence glycemic management\n(which are discussed in detail in Section 5,\n“Facilitating Positive Health Behaviors ”),\nsuch as fasting as part of religious obser-\nvance. Fasting may increase the risk for hy-poglycemia among in... | [
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with insulin or insulin secretagogues if not\nproperly planned for, so clinicians need toengage these individuals to codevelop a di-abetes treatment plan that is safe and re-\nspectful of their traditions (114).\nYoung children with type 1 diabetes and\nthe elderly, including those with type 1 and | [
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the elderly, including those with type 1 and\ntype 2 diabetes (115,116), are noted as be-ing particularly vulnerable to hypoglycemia\nbecause of their reduced ability to recognize\nhypoglycemic symptoms and effectivelycommunicate their needs. Individualizedglycemic goals, patient education, nutritionintervention (e.g.,... | [
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overnight hypoglycemia when speci fically\nneeded to treat low blood glucose), physicalactivity management, medication adjust-\nment, glucose monitoring, and routine clinical | [
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ment, glucose monitoring, and routine clinical\nsurveillance may improve outcomes (105).CGM with automated low-glucose suspendand automated insulin delivery systems havebeen shown to be effective in reducing hypo-glycemia in type 1 diabetes (117). For peoplewith type 1 diabetes with level 3 hypoglyce-\nmia and hypoglyc... | [
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mia and hypoglycemia unawareness that per-\nsists despite medical treatment, human islettransplantation may be an option, but the ap-proach remains experimental (118,119).\nHypoglycemia Treatment | [
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Hypoglycemia Treatment\nHealth care professionals should counselindividuals with diabetes to treat hypogly-cemia with fast-acting carbohydrates atthe hypoglycemia alert value of 70 mg/dL(3.9 mmol/L) or less (120 –122). Individu- | [
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0.0053685... |
als should be counseled to recheck theirglucose 15 min after ingesting carbohy-drates and to repeat carbohydrate ingestionand seek care for ongoing hypoglycemia.These instructions should be reviewed ateach clinical visit.\nFor most individuals, 15 g carbohydrates\nshould be ingested. Individuals using auto-mated insuli... | [
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mended to ingest 5 –10 g carbohydrates\n(except for hypoglycemia with exercise or\nwith signi ficant overestimation of carbohy-\ndrate/meal bolus) (123). The acute glyce-mic response to food correlates betterwith the glucose content than with the to-tal carbohydrate content. Pure glucose is\nthe preferred treatment, but... | [
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the preferred treatment, but any form of\ncarbohydrate that contains glucose willraise blood glucose. Added fat may slowa n dt h e np r o l o n gt h ea c u t eg l y c e m i cr e -sponse. Carbohydrate sources high in pro-tein may increase insulin secretion andshould not be used to treat hypoglycemia(124). Ongoing insuli... | [
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secretagogues may lead to recurrent hypo-\nglycemia unless more food is ingested afterrecovery.\nGlucagon\nThe use of glucagon is indicated for thetreatment of hypoglycemia in people un-able or unwilling to consume carbohy-drates by mouth. All individuals treatedwith insulin or who are at high risk of hypo-glycemia as ... | [
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scribed glucagon. For these individuals,\nclinicians should routinely review their ac-cess to glucagon, as appropriate glucagonprescribing is very low in current practice(125,126). An individual does not need tobe a health care professional to safely ad-\nminister glucagon. Those in close contact | [
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... |
minister glucagon. Those in close contact\nwith, or having custodial care of, these in-dividuals (family members, roommates,school personnel, childcare professionals,\ncorrectional institution staff, or coworkers)\nshould be instructed on the use of gluca-gon, including where the glucagon productis kept and when and ho... | [
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0.06... |
It is essential that they be explicitly edu-\ncated to never administer insulin to individ-uals experiencing hypoglycemia. Glucagonwas traditionally dispensed as a powder that\nrequires reconstitution prior to injection. | [
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0.004... |
requires reconstitution prior to injection.\nHowever, intranasal and ready-to-inject glu-cagon preparations are now widely availableand are preferred due to their ease of admin-\nistration resulting in more rapid correction of\nhypoglycemia (127 –130). Although physical | [
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... |
hypoglycemia (127 –130). Although physical\nand chemical stability of glucagon is im-proved with newer formulations, care should\nbe taken to replace glucagon products when\nthey reach their expiration date and storeglucagon based on speci fic product instruc-\nt i o n st oe n s u r es a f ea n de f f e c t i v eu s e .... | [
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0.036990243941545486,
0.11179383099079132,
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0.015783734619617462,
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-0... |
t i o n st oe n s u r es a f ea n de f f e c t i v eu s e .F o r\ncurrently available glucagon products and\nassociated costs, see Table 6.6 . Health insur-\nance providers may prefer only select gluca-gon products, so it is important to check\nindividuals’ insurance coverage and prescribe\nformulary products whenever ... | [
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0.0014736347366124392,
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0.09823276102542877,
0.11607687920331955,
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formulary products whenever possible.\nHypoglycemia Prevention\nA multicomponent hypoglycemia preven-\ntion plan ( Table 6.7 )i sc r i t i c a lt oc a r i n g\nfor individuals at risk for hypoglycemia.\nHypoglycemia prevention begins by es-\ntablishing an individual ’s hypoglycemia\nhistory and risk factors, as discuss... | [
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0.01243531517... |
history and risk factors, as discussed in\nHYPOGLYCEMIA RISK ASSESSMENT above. Structured\npatient education for hypoglycemia pre-vention and treatment is critical and hasbeen shown to improve hypoglycemiaoutcomes (131,132). Education should\nideally be provided through a diabetes | [
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0.005064... |
ideally be provided through a diabetes\nself-management education and supportprogram or by a trained diabetes educa-tor, although these services are not avail-\nable in many areas (133,134). If structured\neducation is not available, clinicians shouldeducate individuals at risk for hypoglyce-mia on hypoglycemia de finit... | [
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-... |
tions that may precipitate hypoglycemia(fasting, delayed meals, physical activity,and illness), blood glucose self-monitoring,avoidance of driving with hypoglycemia, step-\nby-step instructions on hypoglycemia treat- | [
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by-step instructions on hypoglycemia treat-\nment as discussed above, and glucagon useas appropriate (131).S120 Glycemic Goals and Hypoglycemia Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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... |
CGM can be a valuable tool for detect-\ning and preventing hypoglycemia in many\nindividuals with diabetes, and it is recom-mended for insulin-treated individuals, es-pecially those using multiple daily insulininjections or continuous subcutaneous in-sulin infusion. There is clinical trial evidencethat CGM reduces rate... | [
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0.016957944259047508,
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-0.044320814311504364,
0.0545... |
these populations. CGM can reveal asymp- | [
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0.004284354858100414,
0.07559480518102646,
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0.02... |
tomatic hypoglycemia and help identifypatterns and precipitants of hypoglycemicevents (135,136). Real-time CGM can pro-vide alarms that can warn individuals offalling glucose so that they can intervene(135,136). For more information on usingBGM and CGM for hypoglycemia preven-tion, see Section 7, “Diabetes Technology. ... | [
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An essential component of hypoglycemia\nprevention is appropriate modi fication\nto diabetes treatment in the setting ofintercurrent illness (discussed in detailbelow) or to prevent recurrent hypogly-\ncemic events. Level 2 or 3 hypoglycemic\nevents especially should trigger a reeval-uation of the individual ’s diabetes... | [
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plan, with consideration of deintensi fication\nof therapy within individualized glycemicgoals.Individuals with impaired awareness of\nhypoglycemia bene fit from, and should\nbe referred to, training programs that can\nreestablish awareness of hypoglycemia.\nFear of hypoglycemia and hypoglycemia\nunawareness often cooccu... | [
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unawareness often cooccur, so interven-\nt i o n sa i m e da tt r e a t i n go n eo f t e nb e n e fit\nboth (137). Formal, evidence-based train-\ning programs that have been developed\ninclude the Blood Glucose Awareness Train-\ning Program, Dose Adjusted for Normal Eat-\ning (DAFNE), and DAFNEplus (138– 140). | [
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ing (DAFNE), and DAFNEplus (138– 140).\nWhere these programs are not available,training can be provided through quali fied\nbehavioral health professionals, diabetes\neducators, or other professionals with expe-\nrience in this area, although this approach\nhas not been evaluated in clinical trials. In\naddition, severa... | [
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addition, several weeks of avoidance of hy-\npoglycemia can improve counterregulation\nand hypoglycemia awareness in many peo-ple with diabetes (141). Hence, individuals\nwith one or more episodes of clinically sig-\nnificant hypoglycemia may bene fitf r o ma t\nleast short-term relaxation of glycemic goals(142).\nINTERC... | [
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INTERCURRENT ILLNESS\nStressful events (e.g., illness, trauma, and\nsurgery) increase the risk for both hypergly-\ncemia and hypoglycemia among individuals\nwith diabetes. In severe cases, they may\nprecipitate diabetic ketoacidosis or a non-ketotic hyperglycemic hyperosmolar state,\nlife-threatening conditions that re... | [
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life-threatening conditions that require im-\nmediate medical care. Any individuals with\ndiabetes experiencing illness or other stress-\nful events should be assessed for the need\nfor more frequent monitoring of glucose; ke-\ntosis-prone individuals also require urine orblood ketone monitoring. Clinicians should | [
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reevaluate diabetes treatment during these\nevents and make adjustments as appropri-\nate. Clinicians should be aware of medi-\ncation interactions that may precipitate\nhypoglycemia. Notably, sulfonylureas in-\nteract with a number of commonly usedantimicrobials ( fluoroquinolones, clarithro- | [
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mycin, sulfamethoxazole-trimethoprim,metronidazole, and fluconazole) that can\ndramatically increase their effective dose,leading to hypoglycemia (143 –145). Clini-\ncians should consider temporarily decreas-\ning or stopping sulfonylureas when these\nantimicrobials are prescribed.\nFor further information on management | [
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antimicrobials are prescribed.\nFor further information on management\nhyperglycemia in the hospital, see Section16,“Diabetes Care in the Hospital. ”Table 6.7 —Components of hypoglycemia prevention for individuals at risk for\nhypoglycemia at initial, follow-up, and annual visits\nHypoglycemia prevention actionInitial\... | [
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visitEvery\nfollow-up visitAnnual\nvisit\nHypoglycemia history assessment \x13\x13 \x13\nHypoglycemia awareness assessment \x13\x13\nCognitive function and other hypoglycemia risk factor\nassessment\x13\x13\nStructured patient education for hypoglycemia\nprevention and treatment\x13\x13 * \x13*\nConsideration of contin... | [
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0.01... |
Consideration of continuous glucose monitoring needs \x13\x13 \x13\nReevaluation of diabetes treatment plan with\ndeintensi fication, simpli fication, or agent\nmodi fication as appropriate\x13\x13 † \x13†\nGlucagon prescription and training for close contacts\nfor insulin-treated individuals or those at high\nhypoglycemi... | [
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for insulin-treated individuals or those at high\nhypoglycemic risk\x13\x13\nTraining to reestablish awareness of hypoglycemia \x13‡ \x13‡\nThe listed frequencies are the recommended minimum; actions for hypoglycemia prevention | [
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should be done more often as needed based on clinical judgment. *Indicated with recurrenthypoglycemic events or at initiation of medication with a high risk for hypoglycemia.\n†Indicated with any level 2 or 3 hypoglycemia, intercurrent illness, or initiating interacting | [
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medications. ‡Indicated when impaired hypoglycemia awareness is detected.Table 6.6 —Median monthly (30-day) AWP and NADAC of glucagon formulations\nin the U.S.\nProduct Form(s)Median AWP*\n(min, max)Median NADAC*\n(min, max) Dosage(s)\nGlucagon Injection powder\nwith diluent for\nreconstitution$266 ($194, $369) $249 ($... | [
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0.03956066444516182,
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0.033790506422519684,
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0.014250963926315308,
0.005208083428442478,
0.0... |
reconstitution$266 ($194, $369) $249 ($225, $273) 1 mg\nGlucagon Nasal powder $337 $270 3 mg\nGlucagon Pre filled pen,\nprefilled syringe$368 $285 0.5 mg, 1 mg\nDasiglucagon Pre filled pen,\nprefilled syringe$371 NA 0.6 mg\nAWP , average wholesale price; max, maximum; min, minimum; NA, data not available; NADAC, | [
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National Average Drug Acquisition Cost. AWP and NADAC prices are as of August 2023.\n*Calculated per unit (AWP [147] or NADAC [148]; median AWP or NADAC is listed alonewhen only one product and/or price is described).diabetesjournals.org/care Glycemic Goals and Hypoglycemia S121\n©AmericanDiabetesAssociation | [
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7. Diabetes Technology: Standards\nof Care in Diabetes— 2024\nDiabetes Care 2024;47(Suppl. 1):S126 –S144 |https://doi.org/10.2337/dc24-S007American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes ”includes | [
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the ADA ’s current clinical practice recommendations and is intended to provide the\ncomponents of diabetes care, general treatment goals and guidelines, and tools to | [
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evaluate quality of care. Members of the ADA Professional Practice Committee, aninterprofessional expert committee, are responsible for updating the Standards ofCare annually, or more frequently as warranted. For a detailed description of ADA\nstandards, statements, and reports, as well as the evidence-grading system f... | [
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clinical practice recommendations and a full list of Professional Practice Committee\nmembers, please refer to Introduction and Methodology. Readers who wish to com-ment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.\nDiabetes technology is the term used to describe the hardware, device... | [
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ware that people with diabetes use to assist with self-management, ranging fromlifestyle modi fications to glucose monitoring and therapy adjustments. Historically, | [
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diabetes technology has been divided into two main categories: insulin administeredby syringe, pen, patch devices, or pump (also called continuous subcutaneous insulininfusion [CSII]) and glucose as assessed by blood glucose monitoring (BGM) or con-tinuous glucose monitoring (CGM). Diabetes technology has expanded to i... | [
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(CGM). Diabetes technology has expanded to include au-tomated insulin delivery (AID) systems, where CGM-informed algorithms modulateinsulin delivery, connected insulin pens, as well as diabetes self-management supportsoftware serving as medical devices. Diabetes technology, when coupled with educa-tion, follow-up, and ... | [
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when coupled with educa-tion, follow-up, and support, can improve the lives and health of people with diabe-tes; however, the complexity and rapid evolution of the diabetes technologylandscape can also be a barrier to implementation for people with diabetes, theircare partners, and the health care team. | [
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GENERAL DEVICE PRINCIPLES\nRecommendations\n7.1Diabetes devices should be offered to people with diabetes. A\n7.2Initiation of continuous glucose monitoring (CGM) should be offered to\npeople with type 1 diabetes early in the disease, even at time of diagnosis. A\n7.3Consider establishing competencies based on role in ... | [
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health care professionals working with diabetes technology. E\n7.4The type(s) and selection of devices should be individualized based on a\nperson ’s speci fic needs, preferences, and skill level. In the setting of an indi-\nvidual whose diabetes is partially or wholly managed by someone else (e.g., a | [
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young child or a person with cognitive impairment or dexterity, psychosocial,\nand/or physical limitations), the caregiver ’s skills and preferences are integral\nto the decision-making process. E*A complete list of members of the American\nDiabetes Association Professional Practice Committeecan be found at https://doi... | [
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Duality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association\nProfessional Practice Committee. 7. Diabetestechnology: Standards of Care in Diabetes —2024.\nDiabetes Care 2024;47(Suppl. 1):S126 –S144 | [
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Diabetes Care 2024;47(Suppl. 1):S126 –S144\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.7. DIABETES TECHNOLOGYS126 Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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7.5When prescribing a device, en-\nsure that people with diabetes and\ncaregivers receive initial and ongo-ing education and training, either in\nperson or remotely, and ongoing eval-\nuation of technique, results, and theability to utilize data, including up-\nloading/sharing data (if applicable), to\nmonitor and adju... | [
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monitor and adjust therapy. C\n7.6 People with diabetes who have\nbeen using CGM, continuous subcuta-\nneous insulin infusion (CSII), and/or\nautomated insulin delivery (AID) fordiabetes management should have\ncontinued access across third-party\npayers, regardless of age or A1C lev-els.E\n7.7Students should be suppor... | [
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0.02330027148127556,
-0.021355735138058662,
-0.0021073389798402786,
-0.09354019910097122,
0.01428... |
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