On Dec 11th 2023, the American Diabetes Association (ADA) published its new "Standards of Care" in the journal Diabetes Care. Although these guidelines are primarily focused on the United States, they have a significant global impact, as it is the most comprehensive set of guidelines on the treatment of diabetes, which is also updated annually based on the latest scientific literature.

"We are really excited to be releasing the 2024 Standards of Care. For those of you that are less familiar with what the Standards of Care are, they're essentially the global guidelines for the care of individuals with diabetes and those at risk. Each year, we publish a new version with dozens of new things and that's what we'll talk about today and answer your questions. This is performed through an extensive review of the scientific literature and an inter-professional team called the Professional Practice Committee that really are experts across the breadth of diabetes and represent all types of different professionals within the diabetes ecosystem. And so, we're really excited to share this with all of you today." - Dr Bob Gabbay, Chief Scientific and medical Officer, ADA - ADA's Press Conference on the 2024 Standards of Care

The full document of the ADA Standards of Care 2024 runs to a whopping 328 pages and is available for free at this link: Link to the full document. 

To facilitate the application of the guidelines, the ADA has also published an overview of the changes from the 2023 edition, which can be found here: Link to overview of revisions.

ADA 2024 Highlights Diabetes Technology as Essential Element of Diabetes Care

General recommendations around the use of glucose sensors and Automated Insulin Delivery (AID) systems can be found in section 7 "Diabetes Technology".

The basic principles of these guidelines have remained largely unchanged:

• CGM is recommended in all adults with diabetes taking insulin, and in adolescents on intensive insulin therapy.
  • 7.14 Real-time CGM (rtCGM) A or intermittently scanned CGM (isCGM) B should be offered for diabetes management in adults with diabetes on multiple daily injections (MDI) or CSII who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs.
  • 7.15 rtCGM A or isCGM B should be offered for diabetes management in adults with diabetes on basal insulin who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs.
  • 7.16 rtCGM A or isCGM E should be offered for diabetes management in youth with type 1 diabetes on MDI or CSII who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs.
  • 7.17 rtCGM or isCGM should be offered for diabetes management in youth with type 2 diabetes on MDI or CSII who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs. E
• Automated insulin delivery systems are recommended in all people with type 1 diabetes and other forms of insulin-deficient diabetes. 
  • 7.27 AID systems should be offered for diabetes management to youth and adults with type 1 diabetes A and other types of insulin-deficient diabetes E who are capable of using the device safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs. A
• People using open-source automated insulin delivery systems should be supported by their healthcare provider.
  • 7.31 Individuals with diabetes may be using systems not approved by the FDA, such as do-it-yourself closed-loop systems and others; health care professionals cannot prescribe these systems but should assist in diabetes management to ensure the safety of people with diabetes. E

Discover the New Nuances in the Guidelines around Diabetes Technology

However, there are some important nuances around diabetes technology that have changed. 

We are happy to go over the changes in the ADA-2024 guidelines compared to the 2023 version:

• 7.2 Initiation of continuous glucose monitoring (CGM) should be offered to people with type 1 diabetes early in the disease, even at time of diagnosis. A
  • This new recommendation highlights the importance of starting glucose sensors early in people with type 1 diabetes, even at diagnosis, to achieve good glucose control early.
• 7.3 Consider establishing competencies based on role in practice setting for health care professionals working with diabetes technology. E
  • This new recommendation emphasises the need for healthcare providers to acquire sufficient knowledge about the use of diabetes technologies. The text refers to a overview of the competences that different healthcare providers should have. Furthermore, it also emphasises that teams starting up AID systems in particular need to be well trained, and refers to the recently published consensus recommendations around AID systems.
• 7.8 Initiation of CSII and/or AID early, even at diagnosis, in the treatment of diabetes can be beneficial depending on a person's or caregiver's needs and preferences. C
  • This recommendation added "even at diagnosis" to recommend early use of insulin pumps and/or AID systems for people with type 1 diabetes even at diagnosis.
• 7.15 rtCGM A or isCGM B should be offered for diabetes management in adults with diabetes on basal insulin who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individual's circumstances, preferences, and needs.
  • The grade of evidence for the use of flash glucose monitors was adjusted from C to B to reflect the benefits of intermittently scanned CGM in less intensively treated people with type 2 diabetes.
• Table 7.4 Continuous glucose monitoring devices interfering substances
  • This table was updated. The alleged interference of alcohol in Guardian sensors was omitted, and the newer sensors such as Dexcom G7 and FreeStyle Libre3 were explicitly named, making the overview slightly clearer.

• 7.33 In people with diabetes using personal CGM, the use of CGM should be continued when clinically appropriate during hospitalisation, with confirmatory point-of-care glucose measurements for insulin dosing and hypoglycaemia assessment and treatment under an institutional protocol. B
  • This new recommendation emphasises continued personal CGM use in hospital, based on a protocol.

• 9.3 Early use of continuous glucose monitoring is recommended for adults with type 1 diabetes to improve glycaemic outcomes and quality of life and minimize hypoglycaemia. B
• 9.4 Automated insulin delivery systems should be considered for all adults with type 1 diabetes. A
  • These new recommendations in the chapter on the pharmacological treatment of diabetes (section 9), emphasise the early use of CGM and the use of AID systems in adults with type 1 diabetes.

Conclusion: don't wait to start CGM and AID systems in people with type 1 diabetes

"Once a person is diagnosed with type 1 diabetes, offering AID is more important to consider. Offering technology early in the course of the disease and not waiting, I think, is an important call out." - Dr Bob Gabbay, Chief Scientific and Medical Officer, ADA - ADA's Press Conference on the 2024 Standards of Care

An important shift in the 2024 guidelines is the strengthening of recommendations for the use of AID systems, advocating the early initiation of AID systems in people with type 1 diabetes.

As far as glucose sensors (CGM) are concerned, the guidelines have remained largely the same, but they were already greatly expanded last year. Indeed, since 2023, glucose sensors are also officially recommended in adults taking only basal insulin, instead of only in people on intensive insulin regimens.

In short, the ADA Standards of Care 2024 reflect the growing evidence around the use of CGM and AID systems in diabetes care. They emphasise the importance of early use of diabetes technology and provide stronger recommendations for AID systems in people with type 1 diabetes. The goal remains to improve diabetes treatment and enhance the quality of life of people with diabetes.

Free Opportunities to Become a Diabetes Technology Expert: The Diabetes Technology Expert Program

Are you interested in diabetes technology and want to learn how to make the most of different AID systems for better diabetes treatment? Then we have good news for you!

Our Diabetes Technology Expert Program offers you the chance to gain in-depth knowledge on how to use these advanced systems. Whether you are a healthcare provider supporting people with diabetes, or have diabetes yourself and want more control over your health, this program is for you.

In our program, you will learn:

1. Understand the operation of various AID systems, including the latest technologies such as MiniMed 780G, Tandem Control-IQ technology, Omnipod 5, mylife Loop and Diabeloop.
2. How to effectively use these systems to monitor and manage your glucose levels.
3. Practical tips and tricks to get the best results and improve quality of life.
4. Specific modules on open-source AID systems such as AndroidAPS and DIY Loop, highlighting how to use them safely.

The best news is that the modules on open-source AID systems are available for free to anyone who wants to learn. We believe in sharing knowledge and supporting people with diabetes and their caregivers to get the best care.

So what are you waiting for? Become a diabetes technology expert and improve treatment and quality of life for yourself or the people you support. Sign up for our programme today and start your journey to better diabetes care.

>> click here to access the full platform

>> click here for the free modules

All modules are available in English, German, Spanish, French and Dutch.

Together, we can reduce the impact of diabetes and create a healthier future. Join us and make a difference!

Kind regards,

Inge

PS: Should you decide to enroll in the Diabetes Technology Expert Program, you'll also gain access to our Monthly Zoom Expert Meetings, where we delve into patient cases specific to different Automated Insulin Delivery (AID) systems.

Here's a schedule of our meetings:

• October 26th, 2023: MiniMed 780G (Inge Van Boxelaer) - Recording available on the platform.
• November 22nd, 2023: Tandem Control-IQ (Tracey Stamates-Roerty) - Recording available on the platform.
• January 11th, 2024: mylife Loop system (Candice Ward).
• January 25th, 2024: Diabeloop (Speaker to be announced).
• February 29th, 2024: Omnipod 5 (Diana Isaacs).
• March 28th, 2024: AndroidAPS (Speaker to be announced).
• April 25th, 2024: DIY Loop (Speaker to be announced).
• May 23rd, 2024: iAPS (Speaker to be announced).
• June 20th, 2024: iLet from Beta Bionics (Speaker to be announced).