The American Diabetes Association’s 2024 standards of care emphasize continuous blood glucose monitoring by people with diabetes.
Joanne Rinker, CBDCE Board of Directors, discussed some of the biggest changes in the 2024 ADA Standards of Care during a presentation at the International Conference on Advanced Technologies and Treatments for Diabetes. Many of the changes revolved around the importance of CGM use, including for people with type 2 diabetes who use basal insulin.
“There were three main messages. The first is that there is a huge push for the use of CGM. Any adult taking insulin, even if it is basal insulin, should be offered a CGM. The second message focused specifically on how time in the interval is directly correlated with microvascular complications. That means if we see that the time in the range is not 70% or higher, that’s a time for us. not only should we talk to people with diabetes about blood sugar management, but we also need to talk to them about screening for complications. The last message put a lot of emphasis on hypoglycemia awareness. If there is frequent hypoglycemia in a patient, then there needs to be a discussion at every appointment about hypoglycemia, making sure they understand how to prevent hypoglycemia and how to treat it,” said Rinker.
Joanne Rinker spoke, for Healioabout revisions to technology-related standards of care, why CGM access is recommended for more people with diabetes, and how physicians should use CGM readings to improve care in their practices.
Why is it essential to offer CGM for people with type 1 diabetes?
There is much more information that CGM provides. When we look at HbA1c, it gives us an average blood sugar, but those people might have highs of 400 mg/dL and lows of 40 mg/dL. When we look at the CGM data, we can see where the problems are and identify them and focus on that.
The use of CGM is increasing because we can identify those trends and work to tighten that time frame and reduce the risks of microvascular complications. You need to wear a CGM to know your range time, and knowing your range time will help you estimate if you are at risk for complications.
First, the time in the interval should be analyzed. So what are the trends? Do they often have low glucose 3 to 4 hours after a meal? The ADA recommends regular human insulin, either injected or inhaled, because they have a shorter duration of action.
Hypoglycemia should always be investigated because it is an emergency. But you should also look at hyperglycemia trends. Do they have high blood sugar 2 hours after a meal? If they are, what conversations should we have with the patient? Are there things I can do on their meal plan? Am I getting enough exercise? When do they exercise? Are they taking their medication as prescribed?
What are some obstacles that doctors might face in recommending CGM for more patients?
Joanne Rinker said cthe biggest barrier is time. Doctors are not given enough time with their patients. There are so many access gaps in this country in terms of diabetes care and education specialists. If patients’ only interaction is with the doctor, they only spend 8 to 10 minutes with them if they’re lucky. There is not enough time to talk about new technologies. One of the biggest reasons we have therapeutic inertia is that there is so little time to have a conversation with the patient about making changes in their care, whether it’s a change in medication or a change in technology.
There is also cost and patient preference. These are probably our three biggest barriers. I think doctors would be willing to offer CGM if they really had the time to be able to have those conversations.
Does the ADA’s New Recommendation on Hypoglycemia Therapies Link to New Diabetes Technology Recommendations?
Yes, because now we have this benefit of not only seeing the numbers with the CGM, but we can also see when the glucose is dropping. It draws our attention to what percentage of time people spend in hypoglycemia and how we get them out of it.
Before the advent of CGM, a person with diabetes who was not feeling well had to check their blood sugar first, because many of the sensations of low blood sugar can be the same as very high blood sugar. Now with CGM, as soon as the glucose drops and we see the down arrow, alarms go off and people treat it. I’m not going hypoglycemic, Rinker concluded.
Photo credit: Joanne Rinker/Linkedin
