American Diabetes Association Standards of Medical Care in Diabetes—2022

Title: “Chapter 7: Diabetes Technology: Standards of Medical Care in Diabetes - 2022.”

Journal: Diabetes Care; 45(Suppl. 1):S97–S112, 2022 | https://doi.org/10.2337/dc22-S007

Author: American Diabetes Association Professional Practice Committee

Introduction

The American Diabetes Association (ADA) Standards of Medical Care (SOC) in Diabetes provides one of the most respected and current guidelines for diabetes care. Updated annually, the recommendations are intended to provide clinicians, patients, researchers, and payers with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care, as well as guidelines for medical, pharmaceutical and lifestyle management.

Grading of Clinical Evidence - “A” ratings are based on large well-designed clinical trials (meta-analysis, RCTs, multi center trials) and considered the strongest category. “B” (well-conducted cohort studies) and “C” (poorly controlled or uncontrolled studies) ratings are given for supportive evidence, not as strong as “A.” An “E” rating is given for expert consensus or clinical experience (no evidence from clinical trials).

Recommendations

Real time continuous glucose monitoring (RT-CGM) (A) or intermittently scanned continuous glucose monitoring (IS-CGM) (B) should be offered for diabetes management in adults with diabetes on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).	RT-CGM (B) or IS-CGM (E) should be offered for diabetes management in youth with type 1 diabetes on MDI or CSII who are capable of using the device safely (either by themselves or with a caregiver).	Initiation of CGM, CSII or Automated Insulin Delivery (AID) early in the treatment of diabetes can be beneficial. (C)
In patients on MDI and CSII, RT-CGM devices should be used as close to daily as possible for maximal benefit. A IS-CGM devices should be scanned frequently, at a minimum once every 8 h. (A)	Periodic use of RT-CGM or IS-CGM or use of professional CGM can be helpful for diabetes management in circumstances where continuous use of CGM is not appropriate, desired, or available.¹ (C)	RT-CGM (A) or IS-CGM (C) can be used for diabetes management in adults with diabetes on basal insulin.
AID systems should be offered for diabetes management to youth and adults with T1D. (A)	Systems that combine technology and online coaching can be beneficial in treating pre-diabetes and diabetes for some individuals. (B)	Insulin pump therapy can be offered for diabetes management to youth and adults on MDI with T2D. (A)

Discussion Points

Updated guidelines state CGM should be offered for all adults on MDI and CSII who are capable of using the device safely.

The ADA strengthened its language recommending CGM for all adults on insulin, now stating that CGM “can be used” by those on basal-only therapy.

RT-CGM (B) or IS-CGM (E) should be offered for diabetes management in youth with T1D on MDI or CSII.

icon

Key Insights

The ADA supports the “Beyond A1C” movement, noting, “Time in Range, time below range, and time above range” are all useful tools for guiding changes in therapy; this can help providers gain more insight into their patients’ glycemic control and provides more personalized and actionable care.²
The ADA also strengthened its language recommending CGM for all adults on insulin, now stating that CGM “can be used” by those on basal-only therapy.
Given that A1C does not provide information on glycemic variability, the use of CGM-derived metrics can help patients identify variability to reduce their risk of hypoglycemia.²
Consistent with other studies we have seen³, the ADA states that early initiation of CGM can be beneficial.
The ADA is starting to recognize digital coaching and digital self management as effective methods in diabetes care.
While RT-CGM and IS-CGM both have been recognized by the ADA in the same category, important benefits of RT-CGM have been noted in recent studies, supporting higher level of evidence of its use.^4,5

This guide is for concept illustration only. All images are representational.

1. American Diabetes Association Professional Practice Committee; 7. Diabetes Technology: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S97–S112. https://doi.org/10.2337/dc22-S007

2. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019;42:1593–1603

3. Mulinacci G, Alonso GT, Snell-Bergeon JK, Shah VN. Glycemic Outcomes with Early Initiation of Continuous Glucose Monitoring System in Recently Diagnosed Patients with Type 1 Diabetes. Diabetes Technol Ther. 2019 Jan;21(1):6-10

4. Reddy M, Jugnee N, El Laboudi A, Spanudakis E, Anantharaja S, Oliver N. A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycaemia. Diabet Med 2018;35:483–490

5. Hásková A, Radovnická L, Petruželková L, et al. Real-time CGM is superior to flash glucose monitoring for glucose control in type 1 diabetes: the CORRIDA randomized controlled trial. Diabetes Care 2020;43:2744–2750

LBL-1000379 Rev001

Download

Contact Us

If you are a healthcare provider and want to learn more about Dexcom, please fill out the form and a representative will contact you. If you are a Dexcom User or Patient, please contact Dexcom here.

Request a Visit from a Dexcom Representative

Request a G7 Sample

Request Stelo Education Materials

Request Purchasing Info for a Stelo Bulk Order

Please note: To ensure a successful transaction, please provide information that matches the Provider’s medical license information. A valid business address is required for a request to be fulfilled.

Do not include prefix (Mr., Mrs., Dr.)

As listed on Provider’s medical license (no MD, Jr., Sr.)

Please use the Provider’s NPI

Please provide Facility/Office address Only- We will not ship to home address

Is your patient on a connected pump device?

Yes

By submitting the above form, I certify that I am a licensed practitioner, authorized to receive and dispense samples of the Dexcom G6 Continuous Glucose Monitoring System and/or Dexcom‘s next generation product, Dexcom G7 (the "Samples"). I represent that I am requesting the Samples for evaluation purposes and that I will not (i) sell, resell, barter, return for credit or seek reimbursement for the use of the Samples, or (ii) for professional services for dispensing or evaluating the Samples, I also agree to inform my patients that they should not submit claims for reimbursement to any third party for any Samples.

The Samples are FDA cleared for use with a compatible smart device or separate piece of durable medical equipment called a receiver. Neither devices nor receivers are included in the Samples. Accordingly, and in light of the applicable G6 or G7 Dexcom Instructions for Use, you should dispense Samples only to a patient who (or whose authorized caregiver), in the exercise of your clinical judgment, (i) has reliable access to a compatible smart device and/or automated insulin delivery system, and (ii) is capable of safely using the Samples with their smart device, without the need for a separate dedicated receiver.

Please note that Medicare will reimburse for sensors only if the beneficiary also uses a receiver covered by Medicare. Accordingly, it is appropriate to give Samples to Medicare patients only if they have (in the case of the G6 Samples) or would be eligible to obtain (in the case of the G7 Samples), a Medicare-covered receiver.

You agree that you will not provide the Samples to any patients that are beneficiaries under the Maine or Colorado state Medicaid programs. I understand that Dexcom will be tracking, and if necessary, reporting and may be subject to disclosure requirements with respect to the provision of these Samples. I agree not to reuse any Samples. I acknowledge that Dexcom provides no warranties for the Samples other than the warranties outlined in the applicable Dexcom Instructions for Use. I will comply with all applicable federal, state and local laws in receiving and dispensing these Samples, and I agree to store and use these Samples in a manner consistent with the applicable Dexcom Instructions for Use. Dexcom is a registered trademark of Dexcom, Inc. in the United States and/or other countries. ©2023 Dexcom, Inc. All rights reserved.

LBL-1004145 Rev001

By submitting the above form, I certify that I am a licensed practitioner, authorized to receive and dispense these Dexcom G6 Continuous Glucose Monitoring Systems and/or Dexcom‘s next generation product, Dexcom G7 (the "Dexcom Education Devices") which are provided in the quantities listed above.

The Dexcom Education Devices are FDA cleared for use with a compatible smart device or separate piece of durable medical equipment called a receiver. Neither smart devices nor receivers are included with the Dexcom Education Devices. I understand that these Dexcom Education Devices are being requested for me and other healthcare professionals ("HCPs") for evaluation purposes to learn more about the Dexcom Education Devices and experience the benefits of the Dexcom Education Devices through a product demonstration, and that each HCP will need a compatible smart device for the product demonstration.

I acknowledge that Dexcom provides no warranties for the Dexcom Education Devices other than the warranties outlined in the applicable Dexcom Instructions for Use. I will comply with all applicable federal, state and local laws in receiving and dispensing these Dexcom Education Devices in a manner consistent with the applicable Dexcom Instructions for Use, and agree not to reuse any Dexcom Education Devices. I agree to receive, store, distribute, and/or use these Dexcom Education Devices in a manner consistent with the applicable Dexcom Instructions for Use and device labeling. I understand that Dexcom will be tracking, and if necessary, reporting and may be subject to disclosure requirements with respect to the provision of these Dexcom Education Devices. I understand and agree to properly dispose of the Dexcom Education Devices immediately following the completion of the product demonstration. The Dexcom Education Devices are being provided at no cost, without any expectation of remuneration, HCPs have no obligations under the federal supply schedule contract for participating in the product demonstration, and Dexcom waives any rights under this contract or applicable law to pursue a claim for the costs associated with the Dexcom Education Devices.

Dexcom is a registered trademark of Dexcom, Inc. in the United States and/or other countries. ©2023 Dexcom, Inc. All rights reserved.

By choosing to request info, you are granting Dexcom, Inc. permission to process your personal information to send you additional information and promotional communications related to Dexcom products. You may opt-out of these communications at any time. Dexcom respects the privacy and confidentiality of your personal information. The information you provide will be sent securely and subject to the Dexcom Terms of Use and Privacy Policy.