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but did not signi ficantly lower overall\nrates of emergency department visits,hospitalizations, or hyperglycemia.\nReal-time Continuous Glucose Monitoring\nCompared With Intermittently Scanned\nContinuous Glucose Monitoring\nIn adults with type 1 diabetes, three RCTs\nhave been conducted comparing isCGM\nand rtCGM (97 ... | [
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and rtCGM (97 –99). In two of the stud-\nies, the primary outcome was a reductionin time spent in hypoglycemia, and rtCGM\nshowed greater bene fits compared with\nisCGM (97,98). In the other study, the pri-mary outcome was improved TIR, andrtCGM also showed greater bene fits com- | [
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p a r e dw i t hi s C G M( 9 9 ) .Ar e t r o s p e c t i v eanalysis also showed improvement in TIR\nwith rtCGM compared with isCGM (100).\nA more recent 12-month real-world non-\nrandomized study compared rtCGM with\nisCGM in adults with type 1 diabetes. At12 months, A1C levels, time in level 1 hypo-\nglycemia ( <70 m... | [
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glycemia ( <70 mg/dL [ <3.9 mmol/L]), and\ntime in level 2 hypoglycemia ( <54 mg/dL\n[<3.0 mmol/L]) were all lower in the rtCGM\ngroup than in the isCGM group; similarly,the TIR was higher in the rtCGM group than\nin the isCGM group (101).Data Analysis | [
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in the isCGM group (101).Data Analysis\nThe abundance of data provided byCGM offers opportunities to analyze datafor people with diabetes more granu-larly than previously possible, provid-ing additional information to aid inachieving glycemic goals. A variety ofmetrics have been proposed (102) andare discussed in Secti... | [
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Goals and Hypoglycemia. ”CGM is es-\nsential for creating an ambulatory glu-cose pro file and providing data on TIR, | [
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percentage of time spent above andbelow range, and glycemic variability(103). Data analysis can be burdensomewithout a systematic approach to its re-view. Several efforts have been made tostreamline the interpretation of CGMreports to assist health care professio-nals in their daily practice. These havevarious, but ove... | [
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practice. These havevarious, but overall similar, approaches.The initial steps are focused on assessingthe suf ficiency and quality of data; subse- | [
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quent recommendations include review-\ning the presence and trends or patterns | [
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ing the presence and trends or patterns\nof hypoglycemia, followed by hyper-glycemia patterns and trends. Someauthors also suggest approaches tochanging therapy plans based on thedata reviewed that enable health careprofessionals to make a simple yetcomprehensive review and plan ofcare even within the time constraintso... | [
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Real-time Continuous Glucose Monitoring\nDevice Use in Pregnancy\nRecently, CGM indication has been ex- | [
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Device Use in Pregnancy\nRecently, CGM indication has been ex-\npanded to include pregnancy for DexcomG7, FreeStyle Libre 2, and FreeStyle Libre 3,which will enhance care in this population(109,110). Prior data from one well-d e s i g n e dR C Ts h o w e dar e d u c t i o ni nA 1 Cl e v -els in pregnant adults with typ... | [
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on MDI or insulin pump therapy and using\nrtCGM in addition to standard care; CGMusers experienced more pregnancy-speci fic\nTIR (63 –140 mg/dL [3.5– 7.8 mmol/L]) and | [
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TIR (63 –140 mg/dL [3.5– 7.8 mmol/L]) and\nless time in hyperglycemia (111). Thisstudy demonstrated the value of rtCGMin pregnancy complicated by type 1 dia-betes by showing a mild improvement inA1C levels and a signi ficant improvement\nin the maternal glucose TIR for pregnancy(63–140 mg/dL [3.5– 7.8 mmol/L]), with- | [
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out an increase in hypoglycemia, as wellas reductions in large-for-gestational-agebirths, infant hospital length of stay, andsevere neonatal hypoglycemia (111). Anobservational cohort study that evaluateddiabetesjournals.org/care Diabetes Technology S131\n©AmericanDiabetesAssociation | [
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the glycemic variables reported using rtCGM\nand isCGM found that lower mean glucose,\nlower standard deviation, and a higher per-\ncentage of TIR were associated with lower\nrisks of large-for-gestational-age births and\nother adverse neonatal outcomes (112).\nData from one study suggested that the\nuse of rtCGM-repor... | [
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use of rtCGM-reported mean glucose is su-\nperior to use of the glucose management\nindicator and other calculations to estimate\nA1C levels given the changes to A1C levelsthat occur in pregnancy (113). Two studies\nemploying intermittent use of rtCGM\nshowed no difference in neonatal out-\ncomes in individuals with ty... | [
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comes in individuals with type 1 diabetes\n(114) or gestational diabetes mellitus (115).\nAt this time, data are insuf ficient for recom-\nmending the use of CGM in all pregnantpeople with type 2 diabetes or GDM\n(116,117). The decision of whether touse CGM in pregnant individuals with\ntype 2 diabetes or GDM should be ... | [
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type 2 diabetes or GDM should be individ-\nualized based on treatment plan, circum-\nstances, preferences, and needs. Although\nCGM systems for use in pregnancy do not\nrequire calibrations and are approved for\nnonadjunctive use, when using CGM in\ndiabetes and pregnancy, determination of\nglucose levels by finger stic... | [
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glucose levels by finger stick may be neces-\nsary in certain circumstances, such as inthe setting of hypoglycemia or hypergly-cemia outside the recommended CGM\ntargets (63 –140 mg/dL [3.5– 7.8 mmol/L])\nduring pregnancy.\nUse of Professional and Intermittent\nContinuous Glucose Monitoring\nProfessional CGM devices, wh... | [
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Continuous Glucose Monitoring\nProfessional CGM devices, which provide\nretrospective data, either blinded or un-\nblinded, for analysis can be used to identify\npatterns of hypoglycemia and hyperglyce-\nmia (118,119). Professional CGM can be\nhelpful to evaluate an individual ’sg l u c o s e | [
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helpful to evaluate an individual ’sg l u c o s e\nlevels when either rtCGM or isCGM isnot available to the individual or theyprefer a blinded analysis or a shorter ex-\nperience with unblinded data. It can beparticularly useful in individuals using\nagents that can cause hypoglycemia, as\nthe data can be used to evalu... | [
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the data can be used to evaluate peri-\nods of hypoglycemia and make medica-\ntion dose adjustments if needed. It canalso be useful to evaluate periods of\nhyperglycemia.\nSome data have shown the bene fito fi n -\ntermittent use of CGM (rtCGM or isCGM) in\nindividuals with type 2 diabetes on noninsu-lin and/or basal in... | [
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In these RCTs, people with type 2 diabetes\nnot on intensive insulin therapy used CGMintermittently compared with those ran-\ndomized to BGM. Both early (70) and late\nimprovements in A1C levels were found(70,120). Use of professional or intermittent\nCGM should always be coupled with analy-\nsis and interpretation for... | [
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sis and interpretation for people with dia-\nbetes, along with education as needed to\nadjust medication and change lifestyle be-haviors (121 –123).\nSide Effects of Continuous Glucose\nMonitoring Devices\nContact dermatitis (both irritant and al-\nlergic) has been reported with all devices\nthat attach to the skin (18... | [
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that attach to the skin (18,124,125). In\nsome cases, this has been linked to thepresence of isobornyl acrylate, a skin\nsensitizer that can cause an additional\nspreading allergic reaction (126 –128). It is\nimportant to ask CGM users periodically\nabout adhesive reactions, as tape formu- | [
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about adhesive reactions, as tape formu-\nlations may change over time. Patch test-ing can sometimes identify the cause of\ncontact dermatitis (129). Identifying and\neliminating tape allergens is important toensure the comfortable use of devices\nand promote self-care (130 –133). The Pan- | [
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and promote self-care (130 –133). The Pan-\nther Program offers resources in Englishand Spanish at pantherprogram.org/skin\n-solutions. In some instances, using an im-\nplanted sensor can help avoid skin reac-t i o n si nt h o s es e n s i t i v et ot a p e( 1 3 4 , 1 3 5 ) .\nSubstances and Factors Affecting\nContinuo... | [
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0.05485... |
Continuous Glucose Monitoring Accuracy\nSensor interference due to several med-\nications/substances is a known potential\nsource of CGM sensor measurement errors(Table 7.4 ). While several of these substan-\nces have been reported in the variousCGM brands ’user manuals, additional in- | [
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terferences have been discovered after themarket release of these products. Hydroxy-\nurea, used for myeloproliferative disorders\nand hematologic conditions, is one of themost recently identi fied interfering sub-\nstances that cause a temporary increase insensor glucose values discrepant from ac-tual glucose values (1... | [
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substances such as mannitol and sorbitol,when administered intravenously or as a\ncomponent of peritoneal dialysis solution, | [
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component of peritoneal dialysis solution,\nmay increase blood mannitol or sorbitolconcentrations and cause falsely elevatedreadings of sensor glucose (142). Therefore,it is crucial to routinely review the medica-tions and supplements used by the personwith diabetes to identify possible interfer-ing substances and advi... | [
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ingly on the need to use additional BGM if\nsensor values are unreliable due to thesesubstances.\nINSULIN DELIVERY\nInsulin Syringes and Pens\nRecommendations\n7.23 For people with insulin-requiring\ndiabetes on MDI, insulin pens are pre- | [
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-0.005244657397270203,
0.037721842527389526,
-0.06995352357625961,
... |
diabetes on MDI, insulin pens are pre-\nferred in most cases. Still, insulin syringesmay be used for insulin delivery consider-ing individual and caregiver preference,insulin type, availability in vials, dosing\nTable 7.4— Continuous glucose monitoring devices interfering substances\nMedication Systems affected Effect\... | [
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0.02250547707080841,
-0.0397518090903759,
-0.02508813887834549,
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0.013710713014006615,
0.1409190148115158,
0.05822250619530678,
-0.031283747404813766,
0.02153968997299671,
-0.003622704651206732,
0.11320503056049347,
-0.03245126083493233,
0.070687... |
Medication Systems affected Effect\nAcetaminophen\n>4 g/day Dexcom G6, Dexcom G7 Higher sensor readings than actual glucose\nAny dose Medtronic Guardian Higher sensor readings than actual glucose\nAscorbic acid (vitamin C), >500 mg/day FreeStyle Libre 14 day, FreeStyle Libre 2,\nFreeStyle Libre 3Higher sensor readings ... | [
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0.07977274805307388,
-0.030082954093813896,
-0.0... |
FreeStyle Libre 3Higher sensor readings than actual glucose\nHydroxyurea Dexcom G6, Dexcom G7, Medtronic Guardian Higher sensor readings than actual glucose\nMannitol (intravenously or as peritoneal\ndialysis solution)Senseonics Eversense Higher sensor readings than actual glucose\nSorbitol (intravenously or as periton... | [
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-0.10172729939222336,
0... |
Sorbitol (intravenously or as peritoneal\ndialysis solution)Senseonics Eversense Higher sensor readings than actual glucoseS132 Diabetes Technology Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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therapy, cost, and self-management ca-\npabilities. C\n7.24 Insulin pens or insulin injection\naids are recommended for people withdexterity issues or vision impairment orwhen decided by shared decision-making to facilitate the accurate dos-\ning and administration of insulin. C\n7.25 Connected insulin pens can be\nhel... | [
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0.0507722... |
helpful for diabetes management and\nmay be used in people with diabetestaking subcutaneous insulin. E\n7.26 FDA-approved insulin dose calcu-\nlators/decision support systems may behelpful for calculating insulin doses. C\nInjecting insulin with a syringe or pen\n(143–159) is the insulin delivery method | [
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(143–159) is the insulin delivery method\nused by most people with diabetes(149,160), although inhaled insulin is also\navailable. Others use insulin pumps or\nAID devices (see\nINSULIN PUMPS AND AUTO-\nMATED INSULIN DELIVERY SYSTEMS , below). For | [
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INSULIN PUMPS AND AUTO-\nMATED INSULIN DELIVERY SYSTEMS , below). For\npeople with diabetes who use insulin, in-sulin syringes and pens are both able todeliver insulin safely and effectively forthe achievement of glycemic targets. In-\ndividual preferences, cost, insulin type, | [
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dividual preferences, cost, insulin type,\ndosing therapy, and self-managementcapabilities should be considered whenchoosing among delivery systems. Trialswith insulin pens generally show equiva-lence or small improvements in glycemicoutcomes compared with using a vial\nand syringe. Many individuals with dia- | [
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0.0... |
and syringe. Many individuals with dia-\nbetes prefer using a pen because of itssimplicity and convenience. It is impor-tant to note that while many insulintypes are available for purchase as ei-ther pens or vials, others may be avail-able in only one form or the other, and\nthere may be signi ficant cost differences | [
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there may be signi ficant cost differences\nbetween pens and vials (see Table 9.4\nfor a list of insulin product costs with\ndosage forms). Insulin pens may allowpeople with vision impairment or dex-terity issues to dose insulin accurately(161– 163), and insulin injection aids are\nalso available to help with these issu... | [
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also available to help with these issues.\n(For a helpful list of injection aids, see\nconsumerguide.diabetes.org/collections/injection-aids). Inhaled insulin can beuseful in people who have an aversionto injection.\nThe most common syringe sizes are\n1m L ,0 . 5m L ,a n d0 . 3m L ,a l l o w i n gd o s e s\nof up to 10... | [
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of up to 100 units, 50 units, and 30 units,\nrespectively, of U-100 insulin. Some 0.3-mLsyringes have half-unit markings, whereasother syringes have 1- to 2-unit increment\nmarkings. In a few parts of the world, insu-lin syringes still have U-80 and U-40 mark-\nings for older insulin concentrations and\nveterinary insu... | [
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veterinary insulin, and U-500 syringes are\navailable for the use of U-500 insulin. Syrin-\nges are generally used once but may be\nreused by the same individual in resource-\nlimited settings with appropriate storageand cleansing (163).\nInsulin pens offer added convenience by\ncombining the vial and syringe into a si... | [
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combining the vial and syringe into a single\ndevice. Insulin pens, allowing push-button\ninjections, come as disposable pens with\nprefilled cartridges or reusable insulin pens\nwith replaceable insulin cartridges. Pens\nvary with respect to dosing increment and\nminimal dose, ranging from half-unit doses | [
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minimal dose, ranging from half-unit doses\nto 2-unit dose increments, with the latteravailable in U-200 insulin pens. U-500 pens\ncome in 5-unit dose increments. Some re-\nusable pens include a memory function,\nwhich can recall dose amounts and timing.\nConnected insulin pens are insulin pens\nwith the capacity to re... | [
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0... |
with the capacity to record and/or transmit\ninsulin dose data. Insulin pen caps are alsoavailable and are placed on existing insulin\npens and may assist with calculating insulin\ndoses and by providing a memory function.\nSome connected insulin pens and pen caps\ncan be programmed to calculate insulin\ndoses, can be ... | [
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0.0438... |
doses, can be synced with select CGM sys-\ntems, and can provide downloadable datareports. These pens and pen caps are use-\nful to people with diabetes for real-time\ninsulin dosing and allow clinicians to retro-\nspectively review the insulin delivery times\nand in some cases doses and glucose data\nin order to make ... | [
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... |
in order to make informed insulin dose\nadjustments (164). A quantitative studyshowed that people with diabetes pre-\nferred connected pens because of their\nability to log insulin doses and glucose lev-\nels automatically (164).\nNeedle thickness (gauge) and length are\nother considerations. Needle gauges range | [
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other considerations. Needle gauges range\nfrom 22 to 34, with a higher gauge indicat-ing a thinner needle. A thicker needle cangive a dose of insulin more quickly, while athinner needle may cause less pain. Nee-dle length ranges from 4 to 12.7 mm, withsome evidence suggesting that shorterneedles (4 –5 mm) lower the ri... | [
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0.060... |
muscular injection with erratic absorptionand possibly the development of lipohy-pertrophy. When reused, needles may beduller and thus injections may be morepainful. Proper insulin injection techniquei sar e q u i s i t ef o rr e c e i v i n gt h ef u l ld o s eo f\ninsulin with each injection. Concerns with | [
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0.01831... |
insulin with each injection. Concerns with\ntechnique and use of the proper technique\nare outlined in Section 9, “Pharmacologic\nApproaches to Glycemic Treatment. ”\nBolus calculators have been developed\nto aid dosing decisions (165 –170). These\nsystems are subject to FDA approval to\nensure safety and ef ficacy in t... | [
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ensure safety and ef ficacy in terms of al-\ngorithms used and subsequent dosingrecommendations. People interested inusing these systems should be encour-\naged to use those that are FDA approved.\nHealth care professional input and edu-cation can be helpful for setting the initial\ndosing calculations with ongoing foll... | [
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up for adjustments as needed.\nInsulin Pumps and Automated\nInsulin Delivery Systems\nRecommendations\n7.27 AID systems should be offered for\ndiabetes management to youth and\nadults with type 1 diabetes Aand other\ntypes of insulin-de ficient diabetes E\nwho are capable of using the devicesafely (either by themselves ... | [
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caregiver). The choice of device should\nbe made based on the individual ’sc i r -\ncumstances, preferences, and needs. A\n7.28 Insulin pump therapy alone with\nor without a sensor-augmented pumplow-glucose suspend feature shouldbe offered for diabetes management\nto youth and adults on MDI with\ntype 1 diabetes Aor ot... | [
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to youth and adults on MDI with\ntype 1 diabetes Aor other types of\ninsulin-de ficient diabetes Ewho are\ncapable of using the device safely (ei-ther by themselves or with a care-giver) and are not able to use or do\nnot choose an AID system. The choice\nof device should be made based onthe individual ’sc i r c u m s t... | [
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ences, and needs. A\n7.29 Insulin pump therapy can be\noffered for diabetes management toyouth and adults on MDI with type 2diabetes who are capable of using\nthe device safely (either by them-\nselves or with a caregiver). The choiceof device should be made based on\nthe individual ’sc i r c u m s t a n c e s ,p r e f... | [
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ences, and needs. A\n7.30 Individuals with diabetes who\nhave been using CSII should havecontinued access across third-party\npayers. Ediabetesjournals.org/care Diabetes Technology S133\n©AmericanDiabetesAssociation | [
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0.047... |
Insulin Pumps\nInsulin pumps have been available in the\nU.S. for over 40 years. These devices de-\nliver rapid-acting insulin throughout theday to help manage glucose levels. Mostinsulin pumps use tubing to deliver insu-\nlin through a cannula, while a few attach\ndirectly to the skin without tubing. AIDsystems, which... | [
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0.07167978584766388,
-0.02203279361128807,
0.03788... |
rates based on sensor glucose values, are\npreferred over nonautomated pumps andMDI in people with type 1 diabetes.\nMost studies that compare MDI with\ninsulin pump therapy have been rela-tively small and of short duration. How-ever, a systematic review and meta-\nanalysis concluded that pump therapy | [
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-0.0011161864968016744... |
analysis concluded that pump therapy\nhas modest advantages for lowering A1Clevels (/C00.30% [95% CI /C00.58 to /C00.02])\nand for reducing severe hypoglycemia\nr a t e si nc h i l d r e na n da d u l t s( 1 7 1 ) .R e a l -\nworld data on insulin pump use in individ-uals with type 1 diabetes show bene fits in | [
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A1C levels and hypoglycemia reductions aswell as total daily insulin dose reduction( 1 7 2 ) .T h e r ei sn oc o n s e n s u st og u i d e\nchoosing which form of insulin adminis-\ntration is best for a given individual, andresearch to guide this decision-making\np r o c e s si sn e e d e d( 1 7 1 ) .T h u s ,t h ec h ... | [
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p r o c e s si sn e e d e d( 1 7 1 ) .T h u s ,t h ec h o i c e\nof MDI or an insulin pump is often basedupon the characteristics of the personwith diabetes and which method is most\nlikely to bene fitt h e m .D i a b e t e s W i s e\n(diabeteswise.org/) and DiabetesWise\nPro (pro.diabeteswise.org/), for health\ncare pr... | [
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care professionals, and the PANTHER\nProgram (pantherprogram.org/device-comparison-chart) have helpful web-\nsites to assist health care professionals and\npeople with diabetes in choosing diabetesdevices based on their individual needs and\nthe features of the devices. Newer systems,\nsuch as sensor-augmented pumps an... | [
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such as sensor-augmented pumps and AIDsystems, are discussed below.\nAdoption of pump therapy in the U.S.\nshows geographical variations, whichmay be related to health care profes-sional preference or center characteris-tics (173,174) and socioeconomic status,\nas pump therapy is more common in in- | [
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as pump therapy is more common in in-\ndividuals of higher socioeconomic status,as reflected by private health insurance,\nfamily income, and education (173,174).Given the additional barriers to optimaldiabetes care observed in disadvantaged\ngroups (175), addressing the differences | [
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groups (175), addressing the differences\nin access to insulin pumps and otherdiabetes technologies may contribute to\nfewer health disparities.\nPump therapy can be successfully started\nat the time of diagnosis (176,177). Practicalaspects of pump therapy initiation include\nassessment of readiness of the person with | [
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assessment of readiness of the person with\ndiabetes and their family, if applicable (al-though there is no consensus on whichfactors to consider in adults [178] or chil-\ndren and adolescents with diabetes), se-\nlection of pump type and initial pumpsettings, individual/family education onpotential pump complications ... | [
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with infusion set failure), transition from\nMDI, and introduction of advanced pumpsettings (e.g., temporary basal rates andextended/square/dual-wave bolus).\nOlder individuals with type 1 diabetes\nbene fit from ongoing insulin pump ther- | [
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bene fit from ongoing insulin pump ther-\napy. There are no data to suggest thatmeasurement of C-peptide levels or anti-bodies predicts success with insulin pump\ntherapy (179,180). Additionally, the fre-\nquency of follow-up does not in fluence | [
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quency of follow-up does not in fluence\noutcomes. Access to insulin pump ther-apy, including AID systems, should be al-lowed or continued in older adults as it is\nin younger people.\nComplications of the pump can be\ncaused by issues with infusion sets (dis-\nlodgement and occlusion), which place in-\ndividuals at ris... | [
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dividuals at risk for ketosis and DKA and\nthus must be recognized and managedearly (181). Other pump skin issues includelipohypertrophy or, less frequently, lipoa-trophy (182,183) and pump site infection\n(184). Discontinuation of pump therapy is | [
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(184). Discontinuation of pump therapy is\nrelatively uncommon today; the frequencyhas decreased over the past few decades,and its causes have changed (184,185).\nCurrent reasons for attrition are problems\nwith cost or wearability, loss of insurance,dislike for the pump, suboptimal glycemicoutcomes, or mood disorders ... | [
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or depression) (186).\nInsulin Pumps in Youth\nThe safety of insulin pumps in youth\nhas been established for over 15 years(187). Studying the effectiveness of in-\nsulin pump therapy in lowering A1C lev-\nels has been challenging because of thepotential selection bias of observationalstudies. Participants on insulin p... | [
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therapy may have a higher socioeco-\nnomic status that may facilitate betterglycemic outcomes (188) versus MDI. Inaddition, the fast pace of development\nof new insulins and technologies quickly | [
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of new insulins and technologies quickly\nrenders comparisons obsolete. However,RCTs that compared insulin pumps andMDI with rapid-acting insulin analogsdemonstrated a modest improvementin A1C levels in participants on insulinpump therapy (189,190). Observational\nstudies, registry data, and meta-analyses | [
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studies, registry data, and meta-analyses\nhave also suggested an improvement inglycemic outcomes in participants on in-sulin pump therapy (191 –193). Data sug-\ngest that insulin pumps reduce the ratesof severe hypoglycemia compared withMDI (193 –196).\nThere is also evidence that insulin | [
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There is also evidence that insulin\npump therapy may reduce DKA risk(193,197) and diabetes complications,particularly retinopathy and peripheralneuropathy in youth, compared with MDI(178). In addition, treatment satisfaction\nand quality-of-life measures improved on | [
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and quality-of-life measures improved on\ninsulin pump therapy compared with MDI(198,199). Therefore, insulin pumps canbe used safely and effectively in youth\nwith type 1 diabetes to assist with achiev-\ning targeted glycemic outcomes while re-ducing the risk of hypoglycemia and DKA,improving quality of life, and prev... | [
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long-term complications. Based on shared\ndecision-making by people with diabetesand health care professionals, insulinpumps may be considered in all chil-\ndren and adolescents with type 1 diabe-\ntes. In particular, pump therapy may bethe preferred mode of insulin deliveryfor children under 7 years of age (200). | [
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Because of a paucity of data in adoles-\ncents and youth with type 2 diabetes,there is insuf ficient evidence to make\nrecommendations.\nCommon barriers to pump therapy\nadoption in children and adolescents areconcerns regarding the physical interfer-ence of the device, discomfort with theidea of having a device on the ... | [
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therapeutic effectiveness, and financial\nburden (191,201).\nSensor-Augmented Pumps\nSensor-augmented pumps (or partial closed-\nloop systems) consist of three compo-\nnents: an insulin pump, a CGM system,\nand an algorithm that automates insulinsuspension when glucose is low or is pre-dicted to go low within the next 3... | [
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and these systems have been approved\nby the FDA. The Automation to SimulatePancreatic Insulin Response (ASPIRE) trialof 247 people with type 1 diabetesshowed that sensor-augmented insulin\npump therapy with a low-glucose suspend\nfunction signi ficantly reduced nocturnalS134 Diabetes Technology Diabetes Care Volume 47,... | [
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©AmericanDiabetesAssociation | [
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hypoglycemia over 3 months without in-\ncreasing A1C levels (61). In a differentsensor-augmented pump, predictive low-glucose suspend reduced time spent withglucose <70 mg/dL from 3.6% at baseline\nto 2.6% (3.2% with sensor-augmentedpump therapy without predictive low-glucose suspend) without rebound hy-perglycemia dur... | [
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ized crossover trial (202). These devices\nmay offer the opportunity to reduce hy-poglycemia for those with a history ofnocturnal hypoglycemia. Additional stud-\nies have been performed in adults and\nchildren that show the bene fits of this\ntechnology (203 –205).\nAutomated Insulin Delivery Systems\nAID systems increa... | [
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AID systems increase and decrease insu-\nlin delivery based on sensor-derived glu-\ncose levels to mimic physiologic insulindelivery. These systems consist of threecomponents: an insulin pump, a CGM\nsystem, and an algorithm that determines | [
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system, and an algorithm that determines\ninsulin delivery. All AID systems on themarket today adjust basal delivery in realtime, and some deliver correction doses\nautomatically. While insulin delivery in\nclosed-loop systems eventually may betruly automated, currently used AID sys-tems require the manual entry of car... | [
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hydrates consumed or qualitative meal\nestimation announcements to calculateprandial doses, and adjustments for phys-ical activity must be announced in mostsystems. Multiple studies using various\nsystems with varying algorithms, pumps,\nand sensors have been performed inadults and children (206 –218). Evidence\nsugges... | [
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suggests AID systems reduce A1C levels\nand improve TIR (219– 231). They may\nalso lower the risk of exercise-related\nhypoglycemia (231) and may have psy-chosocial bene fits (232– 236). The use of | [
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AID systems depends on the preferenceo ft h ep e r s o nw i t hd i a b e t e sa n dt h es e -lection of individuals (and/or caregivers)who are capable of safely and effectively\nusing the devices.\nThe data from real-world studies on\nAID systems have substantiated the re-\nsults observed in RCTs and have con-firmed the... | [
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in people with type 1 diabetes. Bene fits\ninclude improvement in A1C levels, TIR,and other glucometrics as well as psycho-social bene fits (237– 242).\nFinally, real-world data showed that\nAID systems provide the same glycemicbenefits to Medicare and Medicaidbeneficiaries with type 1 and type 2 dia-\nbetes, emphasizing t... | [
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betes, emphasizing that access to this\ntechnology should be made available re-\ngardless of A1C levels and should be based\non the individual ’sn e e d s( 2 4 3 ) .\nAutomated Insulin Delivery Systems\nin Pregnancy\nThe use of AID systems in diabetesand pregnancy presents particular chal-\nlenges, as none of the curre... | [
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lenges, as none of the current FDA-\napproved systems have glucose goals\nthat are pregnancy speci fico ra l g o r i t h m s\ndesigned to achieve pregnancy-speci fic\nglucose goals. Initiating or continuing AID\nsystems during pregnancy needs to be as-sessed carefully. Selected individuals with\ntype 1 diabetes should be... | [
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type 1 diabetes should be evaluated as\npotential candidates for AID systems in\nthe setting of expert guidance. Moreover,\nif the decision is made to use these sys-tems in selected pregnant individuals, then\nusing assistive techniques, such as the\ncombination of sensor-augmented pump\nmode and hybrid closed-loop mod... | [
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mode and hybrid closed-loop mode at dif-\nferent time points in pregnancy or through-out the day, should be considered and\napplied as needed to achieve intended\ngoals (244). See Section 15, “Diabetes and\nPregnancy,” for more details.\nInsulin Pumps in People With Type 2 and\nOther Types of Diabetes\nTraditional insu... | [
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Other Types of Diabetes\nTraditional insulin pumps can be consid-\nered for the treatment of people withtype 2 diabetes who are on MDI as wellas those who have other types of diabe-tes resulting in insulin de ficiency, for\ninstance, those who have had a pancre-atectomy and/or individuals with cysticfibrosis (245 –249). ... | [
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0.01791... |
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