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(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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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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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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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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[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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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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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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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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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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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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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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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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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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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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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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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 ... | [
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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... | [
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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 | [
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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... | [
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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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-0.03334870561957359,
0.011575357057154179,
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0.07188667356967926,
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0.007046995218843222,
0.01271670963615179,
0.028190791606903076,
0.03712305426597595,
0.017039... |
quent recommendations include review-\ning the presence and trends or patterns | [
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0.014627336524426937,
0.03738553449511528,
-0.025872275233268738,
0.02... |
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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0.02154705859720707,
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0.03733696788549423,
-0.06299196183681488,
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Real-time Continuous Glucose Monitoring\nDevice Use in Pregnancy\nRecently, CGM indication has been ex- | [
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-0.13606035709381104,
0.... |
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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-0.02615... |
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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-0.04847681149840355,
-0.055174488574266434,
0.... |
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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0.06531237065792084,
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0.0146... |
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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-0.08841869235038757,
-0.0392... |
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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0.07257305085659027,
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0.04418962076306343,
-0.09828577190637589,
-0.0347324... |
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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0.08999518305063248,
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-0.03373027220368385,
0.046955764293670654,
-0.09747239202260971,
0.0046832... |
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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0.0004684277519118041,
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0.0026425218675285578,
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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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0.028331441804766655,
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-0.0... |
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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0.045899443328380585,
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-0.002525848103687167,
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0.004341038875281811,
-0.04733248054981232,
-0.042578138411045074,
-0.08217893540859222,
0.0079... |
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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0.03092723712325096,
-0.034552477300167084,
0.047100041061639786,
0.06261688470840454,
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0.07996298372745514,
0.1235298439860344,
-0.04069024324417114,
0.023732900619506836,
0.03599986433982849,
-0.019697152078151703,
-0.035233817994594574,
0.03107... |
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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0.02832021377980709,
-0.08309005945920944,
0.016749201342463493,
-0.03229272738099098,
0.019376805052161217,
0.058741532266139984,
0.13623158633708954,
-0.07144354283809662,
0.012045771814882755,
-0.06215285137295723,
0.005230494774878025,
-0.0507100485265255,
0.0020... |
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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0.017849715426564217,
-0.06624620407819748,
0.016439227387309074,
-0.050400156527757645,
0.01838602125644684,
0.03685363382101059,
0.16074198484420776,
-0.0635257214307785,
-0.027791397646069527,
-0.03963664546608925,
0.013627349399030209,
-0.049924906343221664,
0.05... |
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... | [
-0.02370535023510456,
0.058136746287345886,
-0.0599181167781353,
0.026104124262928963,
-0.02993064746260643,
-0.04626121744513512,
0.12119513005018234,
0.0943225845694542,
-0.06676501780748367,
-0.0019444323843345046,
0.011677960865199566,
0.026278316974639893,
-0.060846664011478424,
0.001... |
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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0.03726374730467796,
-0.015727072954177856,
-0.01749720424413681,
0.008035768754780293,
0.015360339544713497,
0.12680628895759583,
0.1454205960035324,
-0.06524622440338135,
-0.04432566836476326,
0.12559574842453003,
-0.013614765368402004,
-0.048927709460258484,
0.0794... |
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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0.013807613402605057,
-0.046070925891399384,
0.004570919554680586,
0.03904404491186142,
0.05325275659561157,
0.1593981385231018,
-0.14456363022327423,
-0.010529100894927979,
0.09440456330776215,
-0.022470759227871895,
-0.043895334005355835,
0.07... |
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... | [
0.00017640892474446446,
0.053305961191654205,
0.034761328250169754,
0.0445377342402935,
0.03810030221939087,
0.006521150004118681,
0.1294974833726883,
0.07830379158258438,
-0.06893099099397659,
-0.03002774715423584,
0.0025834187399595976,
-0.045382123440504074,
-0.0992230698466301,
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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-0.0694010779261589,
0.006144220009446144,
-0.027879076078534126,
-0.021535661071538925,
0.08215641230344772,
0.10923920571804047,
-0.04427319020032883,
-0.014897387474775314,
-0.04736163839697838,
-0.019905099645256996,
-0.03258679807186127,
0... |
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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0.022474441677331924,
-0.059404537081718445,
0.01687368005514145,
-0.010197148658335209,
0.001324932207353413,
0.08815709501504898,
0.1454552710056305,
0.03677760809659958,
-0.022499453276395798,
-0.0016810636734589934,
0.044453274458646774,
-0.05815714970231056,
0.02... |
substances such as mannitol and sorbitol,when administered intravenously or as a\ncomponent of peritoneal dialysis solution, | [
0.058392979204654694,
-0.06868797540664673,
-0.01994478702545166,
-0.01322826836258173,
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0.01455166470259428,
-0.014747923240065575,
0.08437716215848923,
0.09179617464542389,
0.011239535175263882,
0.008556739427149296,
0.07129324972629547,
-0.04945120960474014,
0.02321... |
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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0.0030534635297954082,
-0.0035700916778296232,
-0.020920274779200554,
-0.09952609241008759,
-0.021814066916704178,
0.0458160936832428,
0.10310819745063782,
-0.0068611325696110725,
-0.01952461153268814,
-0.05213147774338722,
0.07210104167461395,
-0.0464806854724884,
-... |
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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-0.02328304946422577,
-0.058462295681238174,
-0.009158559143543243,
-0.05072496458888054,
-0.0013476897729560733,
0.12644974887371063,
0.08426796644926071,
-0.08376292139291763,
-0.018086744472384453,
-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,
-0.010035524144768715,
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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0.001417092396877706,
0.015365179628133774,
-0.010606395080685616,
0.03248829394578934,
-0.027219258248806,
0.003450099378824234,
0.1500096321105957,
-0.03210523724555969,
-0.00013212962949182838,
-0.03343019634485245,
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... | [
-0.028549840673804283,
-0.07042614370584488,
-0.035236209630966187,
-0.018585970625281334,
-0.020128140226006508,
-0.11317253112792969,
-0.001254901522770524,
0.08750100433826447,
0.05610082671046257,
-0.01555423904210329,
-0.00992980133742094,
0.004049303010106087,
-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 | [
0.021787328645586967,
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0.05595718324184418,
-0.06173789128661156,
0.006380715407431126,
0.025793135166168213,
0.09561065584421158,
0.09404788166284561,
-0.022194162011146545,
-0.0020483091939240694,
0.05524883419275284,
-0.06501124799251556,
0.02... |
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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0.04158007726073265,
-0.01896769367158413,
0.03401878848671913,
-0.10252741724252701,
0.04571962356567383,
0.14767412841320038,
0.13477671146392822,
0.024781694635748863,
0.06377681344747543,
0.013687685132026672,
-0.031094612553715706,
-0.05290205776691437,
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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0.019207388162612915,
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0.00048286528908647597,
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0.15010914206504822,
0.10801676660776138,
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-0.014268964529037476,
0.050724197179079056,
0.04610047489404678,
-0.03372938558459282,
0.0... |
(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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0.03213731572031975,
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-0.04194962605834007,
0.15700623393058777,
0.05757570266723633,
-0.0596059188246727,
-0.022611036896705627,
0.03305918350815773,
0.103124238550663,
-0.003974169492721558,
0.008282... |
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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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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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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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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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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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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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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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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0.009513704106211662,
... |
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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-0.0... |
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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0.... |
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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-0.06629372388124466,
0.052... |
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