Latest News & Views in Diabetes Technology

1. Continuous Glucose Monitoring (CGM): Recommended for More Patients

One of the most notable updates is the expanded recommendation for CGM use, not just for those with type 1 diabetes but also for individuals with type 2 diabetes on glucose-lowering agents other than insulin. This recognizes the immense potential of CGM in providing actionable insights to patients and clinicians, even for those not on intensive insulin regimens.

• Type 1 Diabetes: The ADA emphasizes the early initiation of CGM, ideally at the time of diagnosis. Studies show that early CGM use improves glycemic control and enhances quality of life by reducing the burden of frequent glucose checks.
• Type 2 Diabetes: For adults on oral medications or GLP-1 receptor agonists, CGM can provide valuable data to refine treatment plans and engage patients in their diabetes management.
• Pregnant Individuals with Diabetes: The benefits of the use of CGM in pregnant women with type 1 diabetes to achieve glycemic and A1C goals was clarified. The potential benefits in women with type 2 diabetes and Gestational Diabetes was added.  Use of CGM is no longer advised against, instead use of CGM along with blood glucose monitoring to achieve glycemic goals is recommended. 

The ADA highlights the importance of an individualized approach to selecting diabetes technology. The choice of devices should align with each patient’s specific needs, preferences, and capabilities. For instance:

• Lifestyle Considerations: Whether a patient prioritizes discretion, simplicity, or advanced features like automated insulin delivery (AID) can guide device selection.
• Skills and Training: Patients’ comfort and skill level with technology must be considered to ensure successful adoption and sustained use.

This personalized approach empowers patients and enhances their confidence in managing their condition.

Technology alone is rarely enough—effective use requires education. The ADA underscores the need for:

• Initial Training: Comprehensive onboarding for patients and caregivers to understand the functionality, benefits, and maintenance of devices like CGMs, insulin pumps, or AID systems.
• Ongoing Support: Regular follow-ups, either in-person or remotely, to address challenges, optimize use, and ensure long-term adherence. Education on various potential substances or medical conditions that may affect glucose levels when measured by blood glucose meters.  Support and education for individuals using open-source closed-loop systems is recommended.
• Leveraging technology, such as CGMs, insulin pumps, and diabetes management apps, combined with virtual coaching to improve glycemic outcomes in individuals with diabetes and prediabetes
• Use of Technology in Hospital: Continuing the use of insulin pumps or AID in people with diabetes while hospitalized when supported by appropriate in-patient infrastructure and protocols is encouraged to achieve and maintain glycemic goals during an acute illness in a hospitalized setting. 

Healthcare providers, such as Diabetes Care & Education Specialists and primary care providers play a pivotal role in offering structured training and resources to help patients fully leverage these tools.

A particularly patient-centric update is the call for uninterrupted access to diabetes technology, regardless of age or A1C levels. The ADA recognizes that arbitrary thresholds for device eligibility can prevent patients from receiving potentially life-changing interventions. Key recommendations include:

• Ensuring third-party payors provide consistent coverage for CGM, continuous subcutaneous insulin infusion (CSII), and AID systems.
• Advocating for equitable access to technology, particularly for underserved populations.

This focus aligns with efforts to reduce disparities in diabetes care and promote health equity.

The ADA encourages the use of standardized reports, such as ambulatory glucose profiles and weekly summaries, to facilitate consistent and clear communication between patients and providers. These reports help:

• Interpret Data: Streamlining the analysis of CGM and insulin pump data.
• Guide Adjustments: Enabling more precise treatment adjustments based on patterns and trends.

This standardization not only simplifies care but also empowers patients by making their data more understandable and actionable.

Why These Updates Matter

The ADA’s latest standards reflect the transformative role of diabetes technology in modern healthcare. By expanding access to CGMs, prioritizing personalized care, and emphasizing education and equity, these guidelines aim to improve outcomes and quality of life for all individuals with diabetes. The integration of technology into routine care is no longer optional; it’s an essential component of achieving optimal diabetes management.

For healthcare providers, these updates serve as a roadmap to adopt innovative practices and ensure their patients benefit from the best available tools. For patients, they signify a commitment to accessible, effective, and patient-centered care.