7. Diabetes Technology: Standards of Medical Care in Diabetes—2019

Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. Diabetes technology is the term used to describe the hardware, devices, and software that people with diabetes use to help manage blood glucose levels, stave off diabetes complications, reduce the burden of living with diabetes, and improve quality of life. Historically, diabetes technology has been divided into two main categories: insulin administered by syringe, pen, or pump, and blood glucose monitoring as assessed by meter or continuous glucose monitor. More recently, diabetes technology has expanded to include hybrid devices that both monitor glucose and deliver insulin, some automatically, as well as software that serves as a medical device, providing diabetes self-management support. Diabetes technology, when applied appropriately, can improve the lives and health of people with diabetes; however, the complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation. To provide some additional clarity in the diabetes technology space, the American Diabetes Association is, for the first time, adding a dedicated section on diabetes technology to the "Standards of Medical Care in Diabetes." For this first writing, the section will focus on insulin delivery and glucose monitoring with the most common devices currently in use. In future years, this section will be expanded to include software as a medical device, privacy, cost, technology-enabled diabetes education and support, telemedicine, and other issues that providers and patients encounter with the use of technology in modern diabetes care. INSULIN DELIVERY Insulin Syringes and Pens Recommendations 7.1 For people with diabetes who require insulin, insulin syringes or insulin pens may be used for insulin delivery with consideration of patient preference, insulin type and dosing regimen, cost, and self-management capabilities. B 7.2 Insulin pens or insulin injection aids may be considered for patients with dexterity issues or vision impairment to facilitate the administration of accurate insulin doses. C

<p>Multicenter Real-World Assessment of the Effectiveness of V-Go Wearable Insulin Delivery Device in Adult Patients with Type 2 Diabetes (ENABLE Study): A Retrospective Analysis</p>

“…These differences are important to consider when making therapeutic choices for insulin delivery and support why patch-like devices such as V-Go have gained acceptance as an insulin delivery option in the 2019 Standards of Medical Care in Diabetes issued by the ADA, and continue to gain recognition as an alternative to insulin syringes and pens. 8,21 The population of patients with diabetes is heterogeneous and complex, with the majority of patients having multiple comorbidities. 22 Diabetes duration is associated with an increased risk of macrovascular and microvascular events and death.…”

“…Advances in insulin delivery have simplified insulin therapy, 7 including completely disposable patch-like basal-bolus insulin delivery devices, which have recently been incorporated into the American Diabetes Association (ADA) standards of care as an alternative to insulin pen or syringe delivery. 8 These devices aim to simplify and optimize insulin delivery while addressing many patient concerns that may have contributed to poor adherence to a basal-bolus insulin regimen.…”

Digital Diabetes Care System Observations from a Pilot Evaluation Study in Vietnam

“…In standard practice, SMBG values are often ignored in the routine clinical visit, overlooking clinically significant data, which may assist in decision making [5]. Studies examining the glycemic benefits of SMBG have shown mixed results, whereby a major determinant of benefit was the extent to which patient education, as well as response to SMBG levels, was implemented [11][12][13]. A meta-analysis of studies that utilized automatic mobile transmission of SMBG levels showed a HbA1c benefit of −0.27 (95% CI: −0.03, −0.51) [14].…”

“…A meta-analysis of interventions incorporating individually tailored text messaging, with many messages addressing uploaded glucose values, demonstrated a meaningful 0.54% (95% CI: −0.08, −0.99) HbA1c reduction [15]. Thus, SMBG prescription to patients should be a part of a broad educational program, with ongoing instruction and regular evaluation in order to benefit from its use and justify it economically [7,11]. In our study, GlucoMe's digital diabetes system streamlined SMBG readings and utilized both automated messaging as well as human calls or messages, which were scheduled monthly with additional contact made as needed.…”

Benefits and harms of intensive glycemic control in patients with type 2 diabetes

“…This includes flash and real time continuous glucose monitors, insulin pumps, smart insulin pens, and mobile health platforms. Emerging, albeit inconsistent and weak, evidence suggests lower rates of hypoglycemia, improved glycemic control, and better quality of life with some of these devices 150. Finally, increasing focus on population health management and team based care, as well as rapid improvements in health information technology and data science, have enabled new approaches to diabetes management and care.…”