The American Association of Clinical Endocrinology (AACE) has issued its first ever guideline, “The Use of Advanced Technology in Management of Persons With Diabetes Mellitus” to construct a proper framework for the usage of advanced technology in the treatment of diabetes. These AACE guidelines were presented on May 28 during the AACE annual virtual meeting and simultaneously published in Endocrine practice. The main objective of this guideline is to educate doctors and people with diabetes with the use of continuous glucose monitoring (CGM), insulin pumps, connected pens, automated insulin delivery systems, telemedicine technologies, and smartphone apps. They also address safety considerations, special situations such as hospitalization, and implementation in clinical practice.

Until now, the American Association of Clinical Endocrinologists (AACE) has issued position statements or consensus statements on blood glucose management, continuous glucose monitoring systems, insulin pump management, and the integration of CGM and pump therapy, but this is the first time a clinical practice guideline has been published. The AACE diabetic scientific committee agreed that the time has come to create an evidence-based guideline because there is now enough gathered evidence, peer-reviewed literature, and randomized trials.

These AACE guidelines outlines several key points while using advanced diabetes technology :

• All persons with diabetes who are on intensive insulin therapy, which is defined as three or more injections per day or the use of an insulin pump, should use structured CGM. For persons with diabetes who have troublesome hypoglycemia, defined as frequent/severe or nocturnal hypoglycemia, real-time CGM should be preferred to intermittently scanned CGM. The guideline also contains metrics that describe how to interpret CGM data and what constitutes time in range, which are classified by diabetes type and situations including pregnancy.
• People with diabetes should be encouraged to use clinically validated smartphone apps to educate and reinforce diabetes self-management skills and boost involvement.
• Telemedicine is highly recommended for treating diabetic patients, providing education, and monitoring glucose and insulin data to see if therapy adjustments are required.
• All diabetics who use insulin delivery technology should receive thorough training on how to use and care for it. In the absence of pump therapy, using scientifically approved smartphone bolus calculators to reduce hypoglycemia or severe postprandial hyperglycemia is strongly advised.
• Clinicians should warn diabetics who use self-administered automated insulin administration systems that such devices have not been subjected to a thorough FDA evaluation for safety and efficacy.

A final section on implementation recommends that “the initiation and application of diabetes technology should be carried out by healthcare professionals who are trained, committed, and experienced in prescribing and directing the use of these tools. Clinicians should have the infrastructure to meet the needs of those with diabetes with the technology. “