AACE Issues Recommendations on CGM and Insulin Pump Use

On October 13, the American Association of Clinical Endocrinologists (AACE) published two new consensus statements, one concerning continuous glucose monitoring (CGM) and the other on the topic of insulin pumps. The statements are intended to help health-care providers identify the best candidates for these types of therapy.


Continuous glucose monitoring systems provide real-time blood glucose estimations and can provide warnings to guard against highs and lows. (CGM devices use thin sensors inserted under the skin to measure glucose levels in interstitial fluid. The sensor sends this information to a receiver, which displays the current glucose concentration.) The AACE recommends that people with Type 1 diabetes who frequently have hypoglycemia (low blood glucose), have widely variable blood glucose levels, have an A1C (an indicator of blood glucose control over the previous 2–3 months) above their target level, or who need to lower their A1C without increasing their number of hypoglycemic events, as well as those who are pregnant or planning to become pregnant, are ideal candidates for using this technology. Children and adolescents who have achieved A1C levels below 7%, as well as children with Type 1 diabetes and A1C levels of 7% or higher who would be able to use a CGM device on a nearly daily basis are also included among the AACE’s list of ideal candidates.

Studies have indicated that the more consistently CGM is used, the more effective it is at helping maintain diabetes control. According to Irl B. Hirsch, MD, co-chair of the CGM task force, “Over the past few years, a number of randomized, controlled clinical trials have been undertaken to evaluate the impact of real-time CGM devices in the treatment of Type 1 diabetes. Several important observations have emerged. The most important is that the devices have to be used on a nearly daily basis to be effective in achieving and maintaining target A1C levels.”

The AACE suggests that longer-term studies be conducted with CGM to determine the effects of this type of monitoring over periods longer than 6 to 12 months.

Insulin pump therapy, which involves continuously infusing insulin into the body from a small reservoir of insulin, has been available since the late 1970’s. It provides an alternative to insulin injections. According to the AACE insulin pump task force, the best candidates for insulin pump therapy have either Type 1 diabetes or insulin-deficient Type 2 diabetes, perform four or more blood glucose checks and four or more insulin injections daily, are motivated to achieve tighter blood glucose control, and are “willing and intellectually and physically able to undergo the rigors of insulin pump therapy initiation and maintenance.”

The AACE press release on the insulin pump consensus statement notes that there is no official requirement for medical supervision of those using insulin pumps in the United States, and as a result, people often must rely solely on the manufacturer and their own efforts to learn how to manage their insulin pump treatment. It is therefore critical, the AACE release says, to select candidates who are well suited for this type of therapy.

To learn more, see the press releases on the continuous glucose monitoring consensus statement and the insulin pump management consensus statement on the Web site of the American Association of Clinical Endocrinologists. (Links to download the consensus statements are available in the press releases.) And be sure to check out our articles on continuous glucose monitoring and insulin pumps to learn more about these technologies.

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  • Judith Pease

    Now wouldn’t it be nice if medical insurance companies and Medicare covered CGM.

    Those of us on Medicare are going broke trying to use this system.

  • Marina

    I am a Medicare recipient; low income, and a type-1 for 48yrs; using pump therapy(fantastic).Wish I had done this long ago! Unfortunately can’t afford the CGM system, although this would make my life better; (Hypo-unawareness). When will Medicare jump on-board????

  • Sharon

    Nice article. I would love to be on the CGM. I think it would, in the long run, help diabetics to be healthier by lowering the A1C and staying out of hospitals. We are more inclined to be ill from unwatched blood glucose levels. We have enough to contend with without illness due to a lack of information on our glcose levels.
    Unfortunately, the CGM is expensive and. at present, is an out of pocket expense that a lot of us cannot afford.
    Wouldn’t it be cheaper for insurance companies and government to pay for the necessary supplies than to pay out the extrodinary hospital and medical expenses?

  • Anne

    As a newly diagnosed Type 2 diabetic and somewhat of a scientific control freak, I was paniced. I felt that I needed to know my glucose levels at “all” times. Hence, I saved and purchased a CGM. I have been both pleased and disappointed with the information that it provides. On the positive, I have been able to get the big picture of my high’s, low’s and able to perceive trends each day. I’m able to see the effects of food intake, exercise, stress, etc. This has certainly helped me to maintain A1c levels in the 5’s. I treasure the knowlege the meter is able to provide. Negatively, the cost of the sensors are about $35 each and last about 3-4 days. For this reason, I do not wear the meter everyday, but instead use it to periodically check my trends and ascertain if I’m staying within my glucose bounds. Also as an avid cyclist, I thought the meter would warn me when I’m going low. It does, but it turns out the interstitual glucose measurement lags about 20-30 minutes behind the finger stick reading. The term “Real Time” is misleading. This is “too late”, for someone exercising with intensity and going low quickly.

  • Julian A. Walden

    I have used such a system in the past developed by Minimed (Medtronic). I was told when I started with the system that I could use the sensors for six days if I wanted to, rather than the three days as approved by the AMA. I opted to do this because of the cost. I just couldn’t afford to spent $35 on a sensor every three days. I also found that the sensors are oftentimes injected into vein causing the small tube to fill with blood. At that point, you could just throw the sensor away. I probably cause some of my own dissatisfaction with the system by pushing the sensors to six days as I got very erratic readings, which did not agree at all with reading from my meter. In any case the cost of the system just killed it for me. If the total cost of such systems don’t get realistic for the average diabetic, then it will be only for the well to do diabetic population.

  • Cathy

    Hi, I am a diabetic of 47 years. I have had the pump for 15 years. It has made my life so much better. I took care of myself but now after all these years it is getting to me.
    I was lucky to have been given the transmitter to it. The Sensors are costing me $170 a month. I am out of work because of the diabetes and on a low income.
    I have been fighting with Medicare for 5 years to pay for the Sensor. I am in the 3ed appeal with them.I live in R.I. and have been calling and emailing to try to find someone or Co. to help me pay this every month. The Sensor took my A1c from 9.8 to 6.9 in 1 year !!!!

  • Roland

    Current iuinlsn pump/CGM devices are getting close to what you have described in the first step, the only difference being the automatic delivery of iuinlsn.This process though has a flaw that I see … it is an after the fact type of delivery. It waits for the BG to rise and then delivers or it waits until it is getting low before reducing/stopping the flow.It would be great if it worked (the iuinlsn) as soon as it entered the body and lasted only a very short time, but it can stay in the body, working for a few hours after being administered. I foresee problems with delivery based on current readings.The CGM accuracy move improve a tremendous amount before it could be regarded as trustworthy. I have used the technology (Minimed) and stopped because it was very seldom close to being accurate, Many times it would be 50% over or under the actual reading.I am not going to hold my breath