Los Angeles—Even though Medicare doesn’t cover the devices for patients older than 65, the Endocrine Society has issued a Clinical Practice Guideline recommending continuous glucose monitors (CGMs) as the gold standard of care for adults with type 1 diabetes.

The guideline was published online and will appear in the November 2016 print issue of the Journal of Clinical Endocrinology & Metabolism (JCEM).

“Studies have found that people with Type 1 diabetes who use CGMs are able to maintain better control of their blood sugar without increasing episodes of hypoglycemia when blood sugar drops to dangerous levels, compared to those who self-monitor blood glucose with periodic fingersticks,” said task force chair Anne L. Peters, MD, of the University of Southern California’s Keck School of Medicine in Los Angeles, CA. “Scientific evidence supports the use of CGM technology in individuals with Type 1 diabetes whose blood sugar is above the targeted level as well as those whose blood glucose is well managed.”

The strongest recommendation was for use of CGM technology in patients with type 1 diabetes who are able and willing to use the monitors. CGMs also can be used on a short-term, intermittent basis for individuals with type 2 diabetes who have blood glucose above targeted levels, according to the guidelines.

Medicare does not cover the technology for adults 65 and older, and the Endocrine Society continues to call for that coverage to be added to improve outcomes and reduce hypoglycemic events in older adults.

In another recommendation, the task force urged the use of insulin pumps instead of multiple daily insulin injections in individuals with type 1 diabetes who have not met their hemoglobin A1C goals and are willing and able to use the device. Insulin pumps, which are often used in conjunction with CGMs, also are recommended for patients with frequent hypoglycemia or glucose variability, and those who require increased insulin-delivery flexibility or improved satisfaction with their diabetes care.

Patients with type 2 diabetes who were not meeting their glycemic goals also are candidates for insulin pump use, according to the authors.

Regardless of which treatment technologies are used, the guideline recommends that all patients and healthcare providers be properly educated and trained to use CGM, especially since those will be essential with emerging technologies such as artificial pancreas devices.

“A device’s success is directly linked to an individual’s willingness to use and understand the technology,” Peters said. “It is crucial to ensure patients are comfortable with any devices they decide to incorporate into their treatment plans.”

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