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Key Points
➤ Hypoglycemia is associated with a number of unwanted outcomes
including distress in those with diabetes and their caregivers,
reductions in quality of life, and reductions in medication adherence,
leading to increased risks for diabetes-related comorbidities.
➤ Individuals with type 1 diabetes (T1D) may have clinically significant
episodes of hypoglycemia as often as twice per week.
➤ Those with type 2 diabetes (T2D) are at lower risk for hypoglycemia
unless they have specific clinical characteristics that increase that
risk, including the use of medications known to be associated with
hypoglycemia (e.g., insulin, sulfonylureas), long duration of diabetes,
and renal and/or hepatic dysfunction.
• Real-time continuous glucose monitoring (CGM) involves the use of devices that
measure interstitial glucose every 1–5 minutes and automatically transmit these data
to a device, such as a receiver, smart phone, or an insulin pump, providing real-time
feedback for the user.
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The lastest version of these devices come equipped with
alerts that can aid the user in making real-time adjustments in their diabetes therapy,
including in insulin dosing.
• Intermittently scanned CGM involves devices that measure interstitial glucose every
1–5 minutes and transmit these data to a device, such as a receiver or smart phone,
providing feedback for the user.
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Unlike real-time CGM, intermittently scanned CGM
requires that the user purposefully scan their sensor to obtain information and older
technology may not provide real-time predictive alerts. Those that provide predictive
alerts are preferred as they can identify and prevent hypoglycemia.
• Algorithm-driven insulin pump (ADIP) therapy involves the use of an insulin pump
combined with a CGM device, which then allows for changes in basal insulin delivery
based on an individual's real-time glycemic data. The changes in insulin dose are based
on mathematical algorithms programmed into the insulin pump. These devices are also
referred to as "sensor-driven" or "sensor-augmented insulin pump therapy." Devices
termed "hybrid" or "hybrid closed-loop systems" provide changes to basal insulin and
may deliver mini-correction boluses in response to hyperglycemia but require the
user to give an insulin bolus with meals. All of these terms are found in the medical
literature, including in the studies identified for these guidelines. ADIP is the term used
to refer to all currently available forms of automated insulin delivery through devices in
this guideline.
Definition of Terms
