5
Treatment
Recommendation 1
➤ Endocrine Society (ES) recommends CGM rather than self-monitoring
of blood glucose (SMBG) by fingerstick for patients with T1D
receiving multiple daily injections (MDIs). (1|⊕⊕
)
Remarks:
▶ Comprehensive patient education on how to use and troubleshoot CGM devices
and interpret these data is critically important for maximum benefit and successful
outcomes.
▶ SMBG continues to be necessary to validate or confirm CGM values; e.g., when
symptoms do not match sensor glucose values and during the sensor warm-up period.
Therefore, patients using CGM must continue to have access to SMBG.
Recommendation 2
➤ ES suggests using real-time CGM and ADIPs rather than MDIs with
SMBG three or more times daily for adults and children with T1D.
(2|⊕⊕
)
Remark:
▶ Fingerstick blood glucose monitoring may still be necessary to validate or confirm
CGM values; therefore, with respect to use and insurance coverage, there will be times
when SMBG must be used.
Recommendation 3
➤ ES suggests real-time CGM be used rather than no CGM for
outpatients with T2D who take insulin and/or sulfonylureas and are at
risk for hypoglycemia. (2|⊕
)
Remarks:
▶ Professional CGM is a diagnostic tool used for the short-term investigation of an
individual's glycemic profile to determine glycemic patterns and to assist with
therapeutic management.
▶ Personal CGM is a tool for patients to use in real time at home to assist the patient
and their HCPs in making both short- and long-term adjustments in their
therapeutic management.
Recommendation 4
➤ ES suggests initiation of CGM in the inpatient setting for select
inpatients at high risk for hypoglycemia. (2|⊕
)
Remarks:
▶ This should be done via a hybrid approach in which CGM use is combined with
periodic point-of-care blood glucose (POC-BG) testing to validate the accuracy of
CGM.
▶ Inpatient CGM use is not currently approved by the U.S. Food and Drug
Administration (FDA) but currently has enforcement discretion. It has been used
in hospitals recently with Emergency Use Authorization during the COVID-19
pandemic.
