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7.7Students should be supported at\nschool in the use of diabetes technol-ogy, such as CGM systems, CSII, con-nected insulin pens, and AID systems,\nas recommended or prescribed by their\nhealth care team. E\n7.8Initiation of CSII and/or AID early,\neven at diagnosis, in the treatment\nof diabetes can be bene ficial dep... | [
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of diabetes can be bene ficial depend-\ning on a person ’s or caregiver ’sn e e d s\nand preferences. C\nTechnology is rapidly changing, but\nthere is no one-size- fits-all approach to\ntechnology use in people with diabetes.Insurance coverage can lag behind de-\nvice availability, people ’s interest in de- | [
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vice availability, people ’s interest in de-\nvices and willingness for adoption canvary, and health care teams may have\nchallenges in keeping up with newly re-\nleased technology. An American Diabe-\ntes Association resource, which can beaccessed at consumerguide.diabetes.org,\ncan help health care professionals and | [
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can help health care professionals and\npeople with diabetes make decisions as\nto the initial choice of devices. Other\nsources, including health care profes-\nsionals and device manufacturers, can\nhelp people troubleshoot when dif fi-\nculties arise (1 –10).\nEducation and Training | [
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culties arise (1 –10).\nEducation and Training\nIn general, no device used in diabetesmanagement works optimally withouteducation, training, and ongoing support.\nThere are multiple resources for online\ntutorials and training videos as well as writ-\nten material on the use of devices. People\nwith diabetes vary in co... | [
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with diabetes vary in comfort level with\ntechnology, and some prefer in-person\ntraining and support. Those with moreeducation regarding device use have\nbetter outcomes (1,2); therefore, the\nneed for additional education should beperiodically assessed, particularly if out-comes are not being met. Better out-comes ca... | [
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without the training and education of\nhealth care professionals. The assessmentof competencies in diabetes technology iscrucial for prescribers, certi fied diabetes | [
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and education specialists, pharmacists,nurses, and anyone involved in the care ofpeople with diabetes. These competenciesare described as basic, fundamental, inter-mediate, and advanced and are speci fict o\nthe role of each health care team member(11). In addition, the health care team ’s | [
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knowledge and competency are evenmore relevant when people with diabetesare started on advanced diabetes technol-\nogies, such as AID systems. In such sit-\nuations, training is vital and shouldinclude a discussion about realistic ex-pectations for the ability of the initi-ated system to achieve glucose goals,\nthe sys... | [
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the system ’s features and limitations,\nand the best way to utilize the new sys-\ntem to maximize the bene fits it can of-\nfer (12).\nUse in Schools\nInstructions for device use should beoutlined in the student ’sd i a b e t e sm e d i c a l | [
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management plan (DMMP). A backupplan should be included in the DMMP forpotential device failure (e.g., BGM, CGM,and/or insulin delivery devices). Schoolnurses and designees should complete\ntraining to stay up to date on diabetes | [
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training to stay up to date on diabetes\ntechnologies prescribed for use in theschool setting. Updated resources tosupport diabetes care at school, includingtraining materials and a DMMP template,\ncan be found online at diabetes.org/\nsafeatschool.\nInitiation of Device Use | [
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safeatschool.\nInitiation of Device Use\nThe use of CGM devices should be con-sidered from the outset of the diagnosisof diabetes that requires insulin manage-ment (3,4). This allows for close tracking\nof glucose levels with adjustments of insu-\nlin dosing and lifestyle modi fications and | [
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lin dosing and lifestyle modi fications and\nremoves the burden of frequent BGM. Inaddition, early CGM initiation after diag-nosis of type 1 diabetes in youth has\nbeen shown to decrease A1C levels and\nis associated with high parental satisfac-tion and reliance on this technology fordiabetes management (5,6). Training ... | [
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alarm/alert settings when initiating CGMis crucial to avoid alarm overload. In ap-propriate individuals, early use of AID sys-tems or insulin pumps may be considered.Interruption of access to CGM is associ-ated with a worsening of outcomes(7,13); therefore, it is important for in-dividuals on CGM to have consistentacce... | [
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BLOOD GLUCOSE MONITORING\nRecommendations\n7.9People with diabetes should be\nprovided with blood glucose monitor-\ni n g( B G M )d e v i c e sa si n d i c a t e db ytheir circumstances, preferences, and\ntreatment. People using CGM devices\nmust also have access to BGM at alltimes. A\n7.10 People who are taking insuli... | [
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7.10 People who are taking insulin\nand using BGM should be encouragedto check their blood glucose levelswhen appropriate based on their insu-\nlin therapy. This may include check-\ning when fasting, prior to meals andsnacks, after meals, at bedtime, in\nthe middle of the night, prior to, dur-\ning, and after exercise,... | [
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ing, and after exercise, when hypogly-\ncemia is suspected, after treating low\nblood glucose levels until they arenormoglycemic, when hyperglycemia\nis suspected, and prior to and while\nperforming critical tasks such as driv-ing.B\n7.11 Health care professionals should | [
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7.11 Health care professionals should\nbe aware of the differences in accu-racy among blood glucose meters.Only meters approved by the U.S.\nFood and Drug Administration (FDA)\n(or comparable regulatory agenciesfor other geographical locations) with\nproven accuracy should be used, with\nunexpired test strips purchased... | [
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unexpired test strips purchased from\na pharmacy or licensed distributor and\nproperly stored. E\n7.12 Although BGM in people on non-\ninsulin therapies has not consistently\nshown clinically signi ficant reductions\nin A1C levels, it may be helpful when\naltering meal plans, physical activity\nplans, and/or medications... | [
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plans, and/or medications (particularly\nmedications that can cause hypoglyce-mia) in conjunction with a treatment\nadjustment program. E\n7.13 Health care professionals should\nbe aware of medications and otherfactors that can interfere with glucosediabetesjournals.org/care Diabetes Technology S127\n©AmericanDiabetesA... | [
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meter accuracy and provide clinical\nmanagement as indicated. E\nMajor clinical trials of insulin-treated peo-\nple with diabetes have included BGM as\npart of multifactorial interventions to dem-\nonstrate the benefi t of intensive glycemic\nmanagement on diabetes complications\n(14). BGM is thus an integral component | [
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(14). BGM is thus an integral component\nof effective therapy for individuals using in-\nsulin. In recent years, CGM has emerged\nas a method for the assessment of glucose\nlevels (discussed below). Glucose monitor-\ning allows people with diabetes to evalu-ate their individual responses to therapy\nand assess whether ... | [
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and assess whether glycemic goals are be-\ning safely achieved. Integrating results into\ndiabetes management can be a useful tool\nfor guiding medical nutrition therapy and\nphysical activity, preventing hypoglycemia,\nor adjusting medications (particularly pran-dial insulin doses or correction bolus\ndoses). The spec... | [
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doses). The speci ficn e e d sa n dg o a l so ft h e\nperson with diabetes should dictate BGMfrequency and timing or the consideration\nof CGM use. As recommended by the de-vice manufacturers and the U.S. Food and\nDrug Administration (FDA), people with\ndiabetes using CGM must have access\nto BGM for multiple reasons, ... | [
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to BGM for multiple reasons, including\nwhenever there is suspicion that the CGM\nis inaccurate, while waiting for warm-up,\nwhen there is a disruption in CGM trans-mission, for calibration (if needed) or if a\nwarning message appears, when CGM sup-\nplies are delayed, and in any clinical setting\nwhere glucose levels ... | [
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where glucose levels are changing rapidly\n(>2 mg/dL/min), which could cause a dis-\ncrepancy between CGM and blood glucose\nvalues.\nMeter Standards\nGlucose meters meeting FDA guidancefor meter accuracy provide the most\nreliable data for diabetes management.There are several current standards for | [
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the accuracy of blood glucose meters, butt h et w om o s tu s e da r et h o s eo ft h eI n t e r -\nnational Organization for Standardization\n(ISO) (ISO 15197:2013) and the FDA. Thecurrent ISO and FDA standards are com-\npared in Table 7.1 . In Europe, currently\nmarketed meters must meet current ISOstandards. In the ... | [
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keted meters must meet the standardunder which they were approved, which\nmay not be the current standard. More-\nover, the monitoring of current accuracypostmarketing is left to the manufac-\nturer and not routinely checked by an in-\ndependent source.\nPeople with diabetes assume their | [
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dependent source.\nPeople with diabetes assume their\nglucose meter is accurate because it isFDA cleared, but that may not be thecase. There is substantial variation in the\naccuracy of widely used BGM systems\n(15,16). The Diabetes Technology Society\nBlood Glucose Monitoring System Surveil- | [
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Blood Glucose Monitoring System Surveil-\nlance Program provides information onthe performance of devices used for BGM\n(diabetestechnology.org/surveillance/). In\none analysis, 6 of the top 18 best-sellingglucose meters met the accuracy stan-\ndard (17). In a subsequent analysis with\nupdated glucose meters, 14 of 18 ... | [
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updated glucose meters, 14 of 18 glucose\nmeters met the minimum accuracy re-\nquirements (18). There are single-meterstudies in which bene fits have been\nfound with individual meter systems,but few studies have compared metershead-to-head. Certain meter system char-\nacteristics, such as the use of lancing de-\nvices ... | [
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vices that are less painful (19) and the\nability to reapply blood to a strip with an\ninsufficient initial sample, or meters with\nintegrated speech that can read aloud\nglucose levels for visually impaired indi-\nviduals (20), may also be bene ficial to\npeople with diabetes (21) and may make\nBGM less burdensome to pe... | [
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0.01554632093757391,
-0.018384557217359543,
-0.027068568393588066,
-0.08504101634025574,
0.04563920199871063,
0.03800979256629944,
0.12247082591056824,
0.004898578394204378,
-0.03139285743236542,
0.05867024138569832,
0.013418414629995823,
-0.03720963001251221,
0.0923... |
BGM less burdensome to perform.Counterfeit Strips\nPeople with diabetes should be advised\nagainst purchasing or reselling preownedor secondhand test strips, as these may\ngive incorrect results. Only unopened and\nunexpired vials of glucose test strips shouldbe used to ensure BGM accuracy.\nOptimizing Blood Glucose\nM... | [
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0.03913590684533119,
-0.0397070050239563,
-0.019179120659828186,
-0.07274851202964783,
0.01577320508658886,
0.03758731111884117,
0.11524896323680878,
-0.05845720320940018,
-0.040292225778102875,
0.00441763224080205,
0.0014665403869003057,
-0.062128107994794846,
0.05700... |
Optimizing Blood Glucose\nMonitoring Device Use\nOptimal use of BGM devices requires\nproper review and interpretation of databy both the person with diabetes and\nthe health care professional to ensure\nthat data are used in an effective andtimely manner. In people with type 1 dia-betes, there is a correlation between | [
-0.04017273709177971,
0.03446505218744278,
-0.049332428723573685,
-0.011747249402105808,
-0.08962774276733398,
0.005377749912440777,
0.11416787654161453,
0.05392197519540787,
-0.07993143796920776,
0.006279513705521822,
-0.03564269468188286,
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-0.08341910690069199,
0.011... |
greater BGM frequency and lower A1C\nlevels (22). Among those who check theirblood glucose at least once daily, manyreport taking no action when results are\nhigh or low (23). Some meters now pro-\nvide advice to the user in real time whenmonitoring glucose levels (24), whereas\nothers can be used as a part of inte- | [
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0.02956352010369301,
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-0.06592977046966553,
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0.04366098716855049,
0.15041281282901764,
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-0.046570658683776855,
0.0... |
others can be used as a part of inte-\ngrated health platforms (25). Peoplewith diabetes should be taught how touse BGM data to adjust food intake,\nphysical activity, or pharmacologic therapy\nto achieve speci fic goals. The ongoing\nneed for and frequency of BGM shouldbe reevaluated at each routine visit to\nensure it... | [
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-0.059135887771844864,
-0.022266071289777756,
-0.0722494125366211,
0.036332760006189346,
0.07840543985366821,
0.09027387946844101,
-0.0784473717212677,
-0.0252095814794302,
-0.058080658316612244,
0.042313721030950546,
-0.052296169102191925,
0.03... |
ensure its effective use (22,26,27).\nPeople With Diabetes on Intensive Insulin\nTherapies\nBGM is especially important for people\nwith diabetes treated with insulin to\nmonitor for and prevent hypoglycemiaand hyperglycemia. Most individuals onintensive insulin therapies (multiple daily\ninjections [MDI] or insulin pu... | [
-0.04073920100927353,
0.07766632735729218,
-0.03409355506300926,
-0.003960526082664728,
-0.05176366865634918,
0.015632767230272293,
0.07910037785768509,
0.05542520806193352,
-0.09789543598890305,
-0.021428247913718224,
-0.06617717444896698,
0.04633806645870209,
-0.0563737116754055,
0.00131... |
injections [MDI] or insulin pump therapy)\nshould be encouraged to assess glucoselevels using BGM (and/or CGM) prior tomeals and snacks, at bedtime, occasion-\nally postprandially, prior to, during, and\nTable 7.1 —Comparison of ISO 15197:2013 and FDA BG meter accuracy standards\nSetting FDA (287,299) ISO 15197:2013 (3... | [
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0.042355719953775406,
-0.0644928440451622,
0.013693578541278839,
-0.07361793518066406,
0.007013959344476461,
0.04268958047032356,
0.047851238399744034,
-0.06224200502038002,
-0.027348792180418968,
-0.07628313452005386,
0.02239738591015339,
-0.026441512629389763,
0.066... |
Setting FDA (287,299) ISO 15197:2013 (300)\nHospital use 95% within 12% for BG $75 mg/dL\n95% within 12 mg/dL for BG <75 mg/dL\n98% within 15% for BG $75 mg/dL\n98% within 15 mg/dL for BG <75 mg/dL95% within 15% for BG $100 mg/dL\n95% within 15 mg/dL for BG <100 mg/dL\n99% in A or B region of consensus error grid ‡ | [
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0.01137098204344511,
0.006773542147129774,
-0.018077915534377098,
-0.033414360135793686,
-0.023343492299318314,
0.031172269955277443,
0.19534634053707123,
0.0008361454820260406,
-0.03668375685811043,
0.01742895506322384,
-0.018620887771248817,
-0.020661357790231705,
0... |
99% in A or B region of consensus error grid ‡\nHome use 95% within 15% for all BG in the usable BG range †\n99% within 20% for all BG in the usable BG range †\nBG, blood glucose; FDA, U.S. Food and Drug Administration; ISO, International Organization for Standardization. To convert mg/dL to mmol/L, see | [
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-0.07395599782466888,
-0.001204756204970181,
-0.037534039467573166,
-0.03033801168203354,
0.0169351939111948,
0.15986184775829315,
-0.005160389933735132,
0.00407656142488122,
-0.004583263769745827,
-0.028835687786340714,
-0.002875180449336767,
... |
endmemo.com/medical/unitconvert/Glucose.php. †The range of blood glucose values for which the meter has been proven accurate and will pro-\nvide readings (other than low, high, or error). ‡Values outside of the “clinically acceptable ”A and B regions are considered “outlier ”readings | [
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0.04088154435157776,
-0.10253725200891495,
-0.0012606073869392276,
-0.06749299168586731,
-0.045951325446367264,
-0.02518257312476635,
0.11172182857990265,
0.0038452998269349337,
-0.01710587739944458,
-0.05895787104964256,
0.005035542417317629,
-0.056529514491558075,
... |
and may be dangerous to use for therapeutic decisions (301).S128 Diabetes Technology Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.0008683958440087736,
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0.03599833697080612,
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0.0065765418112277985,
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0.10779346525669098,
-0.042985185980796814,
-0.... |
after physical activity, when they sus-\npect hypoglycemia or hyperglycemia, af-\nter treating hypoglycemia until they are\nnormoglycemic, and prior to and while\nperforming critical tasks such as driving. For\nmany individuals using BGM, this requires\nchecking up to 6 –10 times daily, although in- | [
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0.060067467391490936,
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0.07753241062164307,
0.06625201553106308,
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-0.032776735723018646,
0.01319095864892006,
0.05669903755187988,
-0.0361764021217823,
0.04516... |
checking up to 6 –10 times daily, although in-\ndividual needs may vary. A database studyof almost 27,000 children and adolescentswith type 1 diabetes showed that, after ad-\njusting for multiple confounders, increased\ndaily frequency of BGM was signi ficantly as-\nsociated with lower A1C levels ( /C00.2% per\naddition... | [
0.002033655531704426,
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0.061571087688207626,
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0.1220843493938446,
0.053425680845975876,
-0.03956201300024986,
-0.023780256509780884,
0.01231153029948473,
0.020318513736128807,
-0.05889030545949936,
0.039... |
additional check per day) and with fewer\nacute complications (28).\nPeople With Diabetes Using Basal Insulin\nand/or Oral Agents and Noninsulin\nInjectables\nThe evidence is insuf ficient regarding\nwhen to prescribe BGM and how often\nmonitoring is needed for insulin-treated\npeople with diabetes who do not use\ninten... | [
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0.031088082119822502,
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0.05498483031988144,
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0.01043505035340786,
0.08844135701656342,
0.08677852153778076,
-0.05908589065074921,
0.003095129504799843,
0.0034234861377626657,
0.04689761623740196,
-0.05359114706516266,
0.053239... |
intensive insulin therapy, such as those\nwith type 2 diabetes taking basal insulin\nwith or without oral agents and/or non-\ninsulin injectables. However, for thosetaking basal insulin, assessing fasting\nglucose with BGM to inform dose ad-\njustments to achieve blood glucose tar-\ngets results in lower A1C levels (29... | [
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-0.06783857941627502,
0.03766672685742378,
-0.06073242425918579,
-0.040128469467163086,
0.04543353244662285,
0.10370150208473206,
-0.0649588331580162,
0.014718196354806423,
-0.035146698355674744,
0.04833303764462471,
-0.06924031674861908,
0.04031... |
gets results in lower A1C levels (29,30).\nIn people with type 2 diabetes not\ntaking insulin, routine glucose monitor-ing may be of limited additional clinical\nbene fit. By itself, even when combined\nwith education, this practice has shown\nlimited improvement in outcomes (31 –34). | [
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0.02766576036810875,
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0.03693847358226776,
-0.05212053284049034,
-0.020269712433218956,
0.02669566683471203,
0.09272915869951248,
-0.01534033939242363,
0.004134410060942173,
-0.04198139160871506,
0.07083327323198318,
-0.05644192546606064,
-0.01474... |
limited improvement in outcomes (31 –34).\nHowever, for some individuals, glucosemonitoring can provide insight into the\nimpact of nutrition, physical activity, and\nmedication management on glucose levels.\nGlucose monitoring may also be useful in\nassessing hypoglycemia, glucose levels dur- | [
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0.05901874974370003,
-0.022401252761483192,
0.016850300133228302,
-0.02861069142818451,
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-0.00041188980685546994,
0.06277475506067276,
-0.05497579649090767,
0.010626137256622314,
-0.06560483574867249,
0.026769060641527176,
-0.09980010986328125,
... |
assessing hypoglycemia, glucose levels dur-\ning intercurrent illness, or discrepancies be-tween measured A1C and glucose levels\nwhen there is concern an A1C result may\nn o tb er e l i a b l ei ns p e c i fic individuals (for\nmore details, see Section 2, “Diagnosis and\nClassifi cation of Diabetes ”). It may be use- | [
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0.027466468513011932,
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0.017234504222869873,
-0.02879345789551735,
0.022150808945298195,
0.02345728687942028,
0.09687695652246475,
-0.026451852172613144,
-0.005589420907199383,
-0.04490242153406143,
-0.04655027016997337,
-0.046810995787382126,
0... |
Classifi cation of Diabetes ”). It may be use-\nful when coupled with a treatment adjust-ment program. In a year-long study of\ninsulin-naive people with diabetes with\nsuboptimal initial glycemic outcomes, agroup trained in structured BGM (a paper\ntool was used at least quarterly to collect\nand interpret seven-point ... | [
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0.0033955154940485954,
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0.021775471046566963,
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0.10714710503816605,
0.135769322514534,
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0.07102686911821365,
-0.016892151907086372,
-0.018... |
and interpret seven-point BGM pro files\ntaken on three consecutive days) reducedtheir A1C levels by 0.3% more than that of\nthe control group (35). A trial of once-daily\nBGM that included enhanced feedbackfrom people with diabetes through mes-\nsaging found no clinically or statisticallysignificant change in A1C levels... | [
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-0.03205132111907005,
0.0628897175192833,
-0.05420348793268204,
0.04186799004673958,
0.05895121768116951,
0.1173250749707222,
-0.02710256725549698,
0.006616216152906418,
-0.05261218547821045,
-0.0009389346232637763,
-0.04301789775490761,
0.0011... |
(34). Meta-analyses have suggested that\nBGM can reduce A1C levels by 0.25 –0.3%\nat 6 months (36 –38), but the effect was\nattenuated at 12 months in one analysis\n(36). Reductions in A1C levels were greater(/C00.3%) in trials where structured BGM\ndata were used to adjust medications, butA1C levels were not changed s... | [
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-0.006266874261200428,
-0.013030724599957466,
0.01604587584733963,
-0.04929263889789581,
0.01577093079686165,
-0.050370942801237106,
0.16141800582408905,
-0.03528033569455147,
-0.0076545714400708675,
-0.04977686330676079,
0.03897446393966675,
-0.012889847159385681,
-0... |
without such structured diabetes therapyadjustment (38). A key consideration is\nthat performing BGM alone does not lower\nblood glucose levels. To be useful, the infor-mation must be integrated into clinical andself-management treatment plans.\nGlucose Meter Inaccuracy | [
-0.034632351249456406,
0.05539602041244507,
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0.03383100405335426,
-0.0970345214009285,
0.005366445053368807,
0.038701366633176804,
0.10842359066009521,
-0.060013990849256516,
-0.04022602736949921,
-0.021758878603577614,
-0.0022585690021514893,
-0.04192843660712242,
0.0... |
Glucose Meter Inaccuracy\nAlthough many meters function well un-der various circumstances, health care pro-fessionals and people with diabetes mustbe aware of factors that impair meter ac-\ncuracy. A meter reading that seems discor- | [
-0.022862551733851433,
0.03793802484869957,
-0.07063313573598862,
0.07423412799835205,
-0.07067770510911942,
0.004244391806423664,
0.026944225654006004,
0.05458022654056549,
0.06030697748064995,
-0.04648473113775253,
0.034678343683481216,
-0.024073855951428413,
-0.046724606305360794,
-0.00... |
curacy. A meter reading that seems discor-\ndant with the clinical picture needs to beretested or tested in a laboratory. Healthcare professionals in intensive care unit\nsettings need to be particularly aware of\nthe potential for incorrect meter readingsduring critical illness, and laboratory-basedvalues should be us... | [
-0.02645302191376686,
-0.02385854348540306,
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-0.00756380008533597,
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-0.011037916876375675,
0.0022465079091489315,
0.10813185572624207,
-0.000956421485170722,
-0.040114495903253555,
0.04493480175733566,
-0.06986626982688904,
-0.0031089766416698694,
... |
Some meters give error messages if meter\nreadings are likely to be false (39).\nOxygen. Currently available glucose moni-\ntors use an enzymatic reaction linked to anelectrochemical reaction, either glucose ox-idase or glucose dehydrogenase (40). Glu-cose oxidase monitors are sensitive to the\noxygen available and sho... | [
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0.03609514236450195,
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0.003087027696892619,
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-0.036372046917676926,
-0.033801816403865814,
0.0646611899137497,
-0.00019077786419074982,
-0.03230350464582443,
0.04718538746237755,
-0.1235945075750351,
-0.008336000144481659,
0.0... |
oxygen available and should only be used\nwith capillary blood in people with normaloxygen saturation. Higher oxygen tensions(i.e., arterial blood or oxygen therapy) mayresult in false low-glucose readings, and\nlow oxygen tensions (i.e., high altitude, | [
0.00468847481533885,
0.024083955213427544,
-0.018493369221687317,
0.047226615250110626,
-0.0021297845523804426,
-0.06702776253223419,
0.007497182581573725,
0.06524298340082169,
-0.031124047935009003,
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0.03167092800140381,
-0.08237415552139282,
0... |
low oxygen tensions (i.e., high altitude,\nhypoxia, or venous blood readings) maylead to falsely elevated glucose readings.Glucose dehydrogenase– based monitors\nare generally not sensitive to oxygen.\nTemperature. Because the reaction is sen-\nsitive to temperature, all monitors have an\nacceptable temperature range (... | [
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0.018746618181467056,
-0.054107021540403366,
0.06710916012525558,
0.027709443122148514,
-0.05883153900504112,
-0.010101967491209507,
0.09808140248060226,
0.034651413559913635,
0.013102422468364239,
-0.00976219866424799,
-0.019353389739990234,
-0.013375183567404747,
0... |
acceptable temperature range (40). Most\nwill show an error if the temperature is un-acceptable, but a few will provide a readingand a message indicating that the value\nmay be incorrect. Humidity and altitude\nmay also alter glucose readings.Interfering Substances. T h e r ea r eaf e w\nphysiologic and pharmacologic f... | [
0.01436629518866539,
0.04323912784457207,
-0.019980406388640404,
0.04079548269510269,
-0.027731718495488167,
0.01622604764997959,
0.017020948231220245,
0.08451926708221436,
-0.02667526714503765,
0.004007931798696518,
0.028606396168470383,
-0.048814572393894196,
0.021312786266207695,
0.0634... |
physiologic and pharmacologic factors that\ninterfere with glucose readings. Most in-terfere only with glucose oxidase systems(40). They are listed in Table 7.2 .\nCONTINUOUS GLUCOSE\nMONITORING DEVICES\nSeeTable 7.3 for de finitions of types of\nCGM devices.\nRecommendations\n7.14 Real-time CGM (rtCGM) Aor in-\ntermitt... | [
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-0.008435106836259365,
-0.10071321576833725,
0.023479709401726723,
-0.008506790734827518,
0.027774620801210403,
0.06383633613586426,
0.1727055311203003,
-0.05101889371871948,
0.05728893354535103,
-0.03743557259440422,
-0.0272649098187685,
-0.0946788638830185,
0.06397... |
7.14 Real-time CGM (rtCGM) Aor in-\ntermittently scanned CGM (isCGM) B\nshould be offered for diabetes man-\nagement in adults with diabetes onmultiple daily injections (MDI) or CSIIwho are capable of using the devicessafely (either by themselves or with acaregiver). The choice of device should\nbe made based on the in... | [
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0.03475808724761009,
-0.0983375534415245,
-0.009432677179574966,
-0.05456814542412758,
0.01919415406882763,
0.09197234362363815,
0.09566069394350052,
-0.08256696164608002,
0.01172074768692255,
-0.01462567038834095,
-0.01789783127605915,
-0.035377126187086105,
0.055133... |
be made based on the individual ’sc i r -\ncumstances, preferences, and needs.\n7.15 rtCGM Aor isCGM Bshould be\noffered for diabetes management in\nadults with diabetes on basal insulinwho are capable of using the devicessafely (either by themselves or with acaregiver). The choice of device shouldbe made based on the ... | [
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0.01108234841376543,
-0.09110143035650253,
0.0017617022385820746,
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0.015901265665888786,
0.1329449564218521,
0.12631987035274506,
-0.06669848412275314,
0.019474906846880913,
0.014199352823197842,
-0.017786147072911263,
-0.06598580628633499,
0.043... |
circumstances, preferences, and needs.\n7.16 rtCGM Aor isCGM Eshould be\noffered for diabetes management in\nyouth with type 1 diabetes on MDI\nor CSII who are capable of using thedevices safely (either by themselvesor with a caregiver). The choice of de-vice should be made based on the in-dividual ’s circumstances, pr... | [
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0.02263384871184826,
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0.009523033164441586,
0.06460157781839371,
0.13298779726028442,
-0.03679917752742767,
0.029145408421754837,
0.027184855192899704,
0.01487182080745697,
-0.08398646116256714,
0.048403... |
and needs.\n7.17 rtCGM or isCGM should be offered\nfor diabetes management in youth with\ntype 2 diabetes on MDI or CSII who arecapable of using the devices safely (ei-\nther by themselves or with a caregiver).Table 7.2 —Interfering substances for\nglucose meter readings\nGlucose oxidase monitors\nUric acid\nGalactoseX... | [
-0.06525605171918869,
0.026215318590402603,
-0.04144662618637085,
-0.0006458731950260699,
-0.016757264733314514,
0.021120242774486542,
0.0923532024025917,
0.11605561524629593,
-0.09328704327344894,
0.029130632057785988,
0.027090614661574364,
-0.013196157291531563,
-0.09213174134492874,
0.0... |
Uric acid\nGalactoseXylose\nAcetaminophen\nL-DOPA\nAscorbic acid\nGlucose dehydrogenase monitors using\npyrroloquinolinequinone cofactor\n(GDH/PQQ)\nIcodextrin (used in peritoneal dialysis)diabetesjournals.org/care Diabetes Technology S129\n©AmericanDiabetesAssociation | [
-0.048734840005636215,
-0.01019350066781044,
-0.0727616623044014,
-0.029538674280047417,
-0.07436469197273254,
0.02198927477002144,
0.007791707757860422,
0.09328017383813858,
0.04565548524260521,
-0.018154099583625793,
-0.011904491111636162,
0.0355418398976326,
-0.06948663294315338,
0.0213... |
The choice of device should be made\nbased on the individual ’sc i r c u m s t a n c e s ,\npreferences, and needs. E\n7.18 In people with diabetes on MDI or\nCSII, rtCGM devices should be used asclose to daily as possible for maximal\nbenefit.AisCGM devices should be\nscanned frequently, at a minimum once\nevery 8 h to... | [
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0.033451907336711884,
-0.037965744733810425,
-0.018676158040761948,
-0.03660224750638008,
0.011413369327783585,
0.10756722837686539,
0.10988809168338776,
-0.07519951462745667,
0.017384381964802742,
0.0373714454472065,
0.01868055947124958,
-0.022100603207945824,
0.0417... |
every 8 h to avoid gaps in data. A\nPeople with diabetes should have un-interrupted access to their supplies tominimize gaps in CGM. A\n7.19 When used as an adjunct to\npreprandial and postprandial BGM,CGM can help to achieve A1C tar-gets in diabetes and pregnancy. B\n7.20 Periodic use of rtCGM or isCGM | [
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0.018776044249534607,
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0.03618878871202469,
0.15815511345863342,
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0.016323715448379517,
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0.0... |
7.20 Periodic use of rtCGM or isCGM\nor use of professional CGM can behelpful for diabetes management incircumstances where consistent useof CGM is not desired or available. C\n7.21 Skin reactions, either due to irri-\ntation or allergy, should be assessed\nand addressed to aid in successful use\nof devices. E\n7.22 Pe... | [
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0.06982825696468353,
0.011051641777157784,
0.046956367790699005,
0.14279530942440033,
0.18922725319862366,
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0.03325068950653076,
0.01888939179480076,
-0.06707221269607544,
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0.07278238... |
of devices. E\n7.22 People who wear CGM devices\nshould be educated on potential in-terfering substances and other fac-tors that may affect accuracy. C\nCGM measures interstitial glucose (which\ncorrelates well with plasma glucose, al-\nthough at times, it can lag if glucose levelsare rising or falling rapidly). There ... | [
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0.007578960619866848,
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0.05206969752907753,
0.10205633193254471,
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0.027... |
basic types of CGM devices. The first type\nincludes those that are owned by the\nuser, unblinded, and intended for frequent\nor continuous use, including real-time\nCGM (rtCGM) and intermittently scanned\nCGM (isCGM). The second type is profes-\nsional CGM devices that are owned bypractices and applied in the clinic, w... | [
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0.06972789019346237,
0.12405440956354141,
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0.021220408380031586,
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0... |
provide data that are blinded or un-\nblinded for a discrete period of time. Thetypes of sensors currently available are\neither disposable (rtCGM and isCGM) or\nimplantable (rtCGM). Table 7.3 provides\nthe de finitions for the types of CGM de-\nvices. For people with type 1 diabetes | [
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0.020088599994778633,
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0.12124348431825638,
0.08291290700435638,
-0.07304749637842178,
0.049771931022405624,
0.04381536319851875,
-0.06004206836223602,
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vices. For people with type 1 diabetes\nusing CGM, frequency of sensor use isan important predictor of A1C lowering\nfor all age-groups (41,42). The frequency\nof scanning with isCGM devices is alsocorrelated with improved outcomes(43–46).\nSome real-time systems require calibra-\ntion by the user, which varies in freq... | [
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0.010976646095514297,
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0.02538701891899109,
0.07024925947189331,
0.10645236074924469,
-0.00010791464592330158,
0.01719999872148037,
-0.027309784665703773,
0.01602146588265896,
-0.04203612729907036,
0.... |
tion by the user, which varies in frequency\ndepending on the device. Additionally,some CGM systems are called adjunctive,meaning the user should perform BGM\nfor making treatment decisions such as\ndosing insulin or treating hypoglycemia.Devices that do not have this require-ment outside of certain clinical situations... | [
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0.1325829178094864,
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0.030568532645702362,
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0.007494479883462191,
0.07... |
BLOOD GLUCOSE MONITORING ,a b o v e )a r e\ncalled nonadjunctive (47 –49).\nOne speci fic isCGM device (Freestyle\nLibre 2 [no generic form available]) and\nthree speci fic rtCGM devices (Dexcom\nG6 [no generic form available], Dexcom\nG7 [no generic form available], and Free-Style Libre 3 [no generic form available])hav... | [
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0.09589017182588577,
0.10640870034694672,
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0.020379485562443733,
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0... |
(iCGM) devices (50). This is a higher stan-\ndard set by the FDA so that these devicescan be integrated with other digitally con-nected devices. Dexcom G6 rtCGM, Dex-com G7 rtCGM, and a modi fied version | [
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of Libre 2 and Libre 3 are FDA approvedfor use with AID systems. At this time, Dex-com G6 is integrated with four AID systems(t:slim ×2 with control IQ, Omnipod 5, iLet,and Mobi). Similarly, the Medtronic Guard-\nian 3 rtCGM (no generic available) and the | [
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ian 3 rtCGM (no generic available) and the\nMedtronic Guardian 4 rtCGM are FDA ap-proved for use with the 670/770G and780G AID systems, respectively.Benefits of Continuous Glucose\nMonitoring\nData From Randomized Controlled Trials\nMultiple randomized controlled trials (RCTs)\nhave been performed using rtCGM devices, | [
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0.13771291077136993,
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0.06071622297167778,
-0.06146334111690521,
0.04862112179398537,
-0.11000563949346542,
0.06220022... |
have been performed using rtCGM devices,\nand the results have largely been positivein terms of reducing A1C levels and/orepisodes of hypoglycemia, as long asparticipants regularly wore the devices(41,42,51 –73). The initial studies were | [
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0.015883758664131165,
-0.02515994757413864,
0.004774... |
done primarily in adults and youth withtype 1 diabetes on insulin pump therapyand/or MDI (41,42,51– 54,57– 67). The pri-\nmary outcome was met and showed ben-efit in adults of all ages (41,51,52,57,\n58,60,62,63,74– 77), including seniors (59, | [
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58,60,62,63,74– 77), including seniors (59,\n78,79). Data in children show that rtCGMuse in young children with type 1 diabe-tes reduced hypoglycemia; in addition,behavioral support of parents of youngchildren with diabetes using rtCGM\nshowed the bene fits of reducing hypo-\nglycemia concerns and diabetes dis- | [
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0.09022875130176544,
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0.0039... |
tress (41,66,80). Similarly, A1C levelreduction was seen in adolescents andyoung adults with type 1 diabetes usingrtCGM (65). RCT data on rtCGM use inindividuals with type 2 diabetes on MDI(69), mixed therapies (70,71), and basalinsulin (72,81) have consistently shownreductions in A1C levels and increasesin time in ran... | [
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0... |
[3.9–10 mmol/L]) but not a reduction in\nrates of hypoglycemia. The improve-ments in type 2 diabetes have largelyoccurred without changes in insulindoses or other diabetes medications.CGM discontinuation in individuals with\ntype 2 diabetes on basal insulin caused | [
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0.016... |
type 2 diabetes on basal insulin caused\npartial reversal of A1C reduction and TIRimprovements, suggesting that continuedCGM use achieves the greatest benefi ts\n(13). In addition, rtCGM bene fits were re-\nported in a mixed population (includingpeople not using insulin) of adults withTable 7.3 —Continuous glucose monito... | [
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0.03373883664608002,
0.09628857672214508,
0.100714311003685,
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0.04890482872724533,
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0.07098782807588577,
-0.09380778670310974,
-0.005845... |
Type of CGM Description\nrtCGM CGM systems that measure and display glucose levels continuously\nisCGM with and without alarms CGM systems that measure glucose levels continuously but require scanning for visualization and\nstorage of glucose values | [
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0.030849019065499306,
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0.046232111752033234,
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... |
storage of glucose values\nProfessional CGM CGM devices that are placed on the person with diabetes in the health care professional ’so ffice and\nworn for a discrete period of time (generally 7 –14 days). Data may be blinded or visible to the\nperson wearing the device. The data are used to assess glycemic patterns and... | [
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0.03479202091693878,
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0.05946001037955284,
0.10167422145605087,
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0.016764560714364052,
-0.051706694066524506,
0.0... |
and isCGM devices, these devices are clinic-based and not owned by the person with diabetes.\nCGM, continuous glucose monitoring; isCGM, intermittently scanned CGM; rtCGM, real-time CGM.S130 Diabetes Technology Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.0016832506516948342,
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0.... |
type 2 diabetes with reduction in A1C\nlevels, increase in TIR, and reductionof time in hyperglycemia ( >180 mg/dL\n[>10 mmol/L] and >250 mg/dL [ >13.8\nmmol/L]) (10).\nRCT data for isCGM are fewer but in-\ncreasing. One study was performed inadults with type 1 diabetes and met itsprimary outcome of a reduction in rate... | [
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of hypoglycemia (55). In adults with\ntype 2 diabetes using insulin, two stud-ies were done: one study did not meetits primary end point of A1C levels reduc-tion (82) but achieved a secondary end\npoint of a reduction in hypoglycemia, and | [
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point of a reduction in hypoglycemia, and\nthe other study met its primary end pointof an improvement in the Diabetes Treat-ment Satisfaction Questionnaire score as\nwell as a secondary end point of A1C\nlevel reduction (83). In a study of individ-uals with type 1 or type 2 diabetes takinginsulin, the primary outcome o... | [
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tion in severe hypoglycemia was not met\nand the incidence of severe hypoglycemiawas not signi ficantly different between\nisCGM users and the BGM group (84).\nOne study in youth with type 1 diabetes | [
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0.03775548189878464,
-0.024374017491936684,
0.0678... |
One study in youth with type 1 diabetes\ndid not show a reduction in A1C levels(85); however, the device was well re-ceived and was associated with an in-creased frequency of testing and improved\ndiabetes treatment satisfaction (85). A ran- | [
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0.07763094455003738,
-0.051440950483083725,
0.00... |
diabetes treatment satisfaction (85). A ran-\ndomized trial of adults with type 1 diabe-tes showed that the use of isCGM withoptional alerts and alarms resulted in re-\nduction of A1C levels compared with BGM\nuse (9). The bene fits of isCGM for adults\nwith type 2 diabetes not using insulin wererecently reported in an ... | [
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0.0163175780326128,
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0.001408935058861971,
-0.05607717111706734,
-0.0214379... |
the use of isCGM plus diabetes education\nversus diabetes education alone showeddecreased A1C levels and increased TIR aswell as increased time in tight target range(70–140 mg/dL [3.9– 7.8 mmol/L]) in the\nisCGM-plus-education group (8).\nObservational and Real-world Studies | [
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0.045524701... |
isCGM-plus-education group (8).\nObservational and Real-world Studies\nisCGM has been widely available in manycountries for people with diabetes, andthis allows for the collection of large\namounts of data across groups of people\nwith diabetes. In adults with diabetes,these data include results from observa-tional stu... | [
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0.0239... |
analyses of registry and population data\n(86,87). In individuals with type 1 diabeteswearing isCGM devices, most (46,86,88),but not all (89), studies have shown im-\nprovement in A1C levels. Reductions in\nacute diabetes complications, such asdiabetic ketoacidosis (DKA), episodes ofsevere hypoglycemia or diabetes-rela... | [
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0.01585289090871811,
-0.009177029132843018,
-0.06718128174543381,
0.0027681... |
coma, and hospitalizations for hypogly-\ncemia and hyperglycemia, have been ob-\nserved (46,89,90), with persistent effects\nobserved even after 2 years of CGM initi-\nation (91). Some retrospective/observa-\ntional data have shown an improvement\nin A1C levels for adults with type 2 diabeteson MDI (92), basal insulin ... | [
-0.014856639318168163,
0.002579222433269024,
-0.06433188170194626,
0.024712227284908295,
-0.03660581633448601,
0.03965830057859421,
0.0213911272585392,
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-0.03696964681148529,
0.0008679770398885012,
-0.05415794998407364,
0.03004205785691738,
-0.0557384118437767,
-0.01671... |
insulin or noninsulin therapies (94). In a\nretrospective study of adults with type 2\ndiabetes taking insulin, a reduction in\nacute diabetes-related events and all-\ncause hospitalizations was seen (95). Re-\nsults of self-reported outcomes varied,but where measured, people with diabe-\ntes had an increase in treatme... | [
-0.0020494682248681784,
0.01797540672123432,
-0.08763732761144638,
0.04161722958087921,
0.0028369624633342028,
-0.01799079403281212,
0.05863552540540695,
0.08076564967632294,
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-0.027682524174451828,
-0.038938332349061966,
0.08461400121450424,
-0.05707646906375885,
-0.... |
tes had an increase in treatment satisfac-\ntion with isCGM compared with BGM.\nIn an observational study in youth\nwith type 1 diabetes, a slight increase inA1C levels and weight was seen, but\nthe device was associated with a high\nuser satisfaction rate (87).\nR e t r o s p e c t i v ed a t af r o mr t C G Mu s ei n | [
-0.09260924160480499,
0.010844940319657326,
-0.05621035024523735,
0.05026876926422119,
-0.06566395610570908,
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0.04622834175825119,
-0.008526816964149475,
0.04464087635278702,
0.005767409689724445,
0.0168437... |
R e t r o s p e c t i v ed a t af r o mr t C G Mu s ei n\na Veterans Affairs population (96) with\ntype 1 and type 2 diabetes treated with\ninsulin showed that the use of rtCGM sig-\nnificantly lowered A1C levels and re-\nduced rates of emergency department\nvisits or hospitalizations for hypoglycemia\nbut did not signi... | [
-0.050192940980196,
0.04343431070446968,
0.020907515659928322,
0.080234594643116,
-0.012831566855311394,
0.034525591880083084,
0.05004622042179108,
0.14074891805648804,
-0.06520956754684448,
0.002000078558921814,
-0.009319177828729153,
0.05110563337802887,
-0.021760480478405952,
-0.0028064... |
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