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Key Points Î Advances in the pharmacokinetics and pharmacodynamics of insulin products and in the methods of insulin delivery and glucose monitoring are geared toward improving glucose control, minimizing hypoglycemia, and improving quality of life. Two such advances are continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (RT-CGM). Î Success of these devices and technologies is directly linked to the level to which people are educated, capable, and willing to use them. Î This guideline attempts to assess all available data on existing and emerging technologies and procedures for improving glucose control for patients with diabetes. Treatment Insulin Pump Therapy Without Sensor Augmentation Î Endocrine Society (ES) recommends CSII over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1|⊕⊕⊕) Î ES recommends CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. (1|⊕⊕ ) Î ES suggests CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2|⊕⊕ ) Insulin Pump Therapy in Type 2 Diabetes Mellitus Î ES suggests CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2|⊕⊕ ) Grading System Strength of Recommendation 1 = strong 2 = weak U = ungraded Quality of Evidence ⊕⊕⊕⊕ = high ⊕⊕⊕ = moderate ⊕⊕ = low ⊕ = very low

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