Endocrine Society Releases Insulin Pump Guidelines

New guidelines sponsored by the US Endocrine Society in conjunction with the American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology endorse broader use of insulin pumps and continuous glucose monitors in patients with diabetes.

The guidelines answer a call from the Clinical Guidelines Subcommittee of the Endocrine Society for practice guidelines related to the use of diabetes technology.
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Overall, 6 recommendations were developed:

  1. Continuous subcutaneous insulin infusion (CSII) should be used over daily injections in patients with type 1 diabetes who have not achieved their A1C goal, or in those who have achieved their goal but continue to experience glucose variability.
  2. CSII should be used in patients with type 2 diabetes mellitus with poor glycemic control despite insulin therapy, oral agents, and lifestyle modifications.
  3. CSII should be continued in patients admitted to the hospital when safe and appropriate.
  4. Before prescribing CSII, the patient’s mental and psychological status, as well as prior adherence, should be considered.
  5. Patients should be encouraged to use embedded bolus calculators in CSII.
  6. Real-time continuous glucose monitoring devices should be used in adults with type 1 diabetes who have hemoglobin A1C levels above target, in those with well-controlled type 1 diabetes who are willing to use the devices daily, and short term use in patients with type 2 diabetes with A1C levels of 7% or higher.

“Continuous subcutaneous insulin infusion and continuous glucose monitoring have an important role in the treatment of diabetes. Data from randomized controlled trials are limited on the use of medical devices, but existing studies support the use of diabetes technology for a wide variety of indications,” the authors concluded.

—Michael Potts

Reference:
Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology—continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline [published online September 2, 2016]. J Clin Endocrinol Metab. doi: http://dx.doi.org/10.1210/jc.2016-2534