Skip to main content

09-23-2017 | Insulin pumps | Review | Article

Keeping Up with the Diabetes Technology: 2016 Endocrine Society Guidelines of Insulin Pump Therapy and Continuous Glucose Monitor Management of Diabetes

Journal: Current Diabetes Reports

Authors: Alfonso Galderisi, Elise Schlissel, Eda Cengiz

Publisher: Springer US


Purpose of Review

Decades after the invention of insulin pump, diabetes management has encountered a technology revolution with the introduction of continuous glucose monitoring, sensor-augmented insulin pump therapy and closed-loop/artificial pancreas systems. In this review, we discuss the significance of the 2016 Endocrine Society Guidelines for insulin pump therapy and continuous glucose monitoring and summarize findings from relevant diabetes technology studies that were conducted after the publication of the 2016 Endocrine Society Guidelines.

Recent Findings

The 2016 Endocrine Society Guidelines have been a great resource for clinicians managing diabetes in this new era of diabetes technology. There is good body of evidence indicating that using diabetes technology systems safely tightens glycemic control while managing both type 1 and type 2 diabetes.


The first-generation diabetes technology systems will evolve as we gain more experience and collaboratively work to improve them with an ultimate goal of keeping people with diabetes complication and burden-free until the cure for diabetes becomes a reality.
Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRefPubMed
Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359(14):1464–76.CrossRefPubMed
•• Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363(4):311–20. The results of the landmark clinical trial demonstrated that sensor-augmented pump therapy improves glycemic control significantly in adult and pediatric subjects with inadequately controlled type 1 diabetes as compared to insulin therapy.
Panel FCCaCTD. FDA Executive Summary. Dexcom G5 Mobile Continuous Glucose Monitoring System, Dexcom, Inc. July 21, 2016 meeting of the Clinical Chemistry and Clinical Toxicology Devices Panel P120005/S041.
Peters AL, Ahmann AJ, Battelino T, Evert A, Hirsch IB, Murad MH, et al. Diabetes technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(11):3922–37.CrossRefPubMed
Reznik Y, Cohen O. Insulin pump for type 2 diabetes: use and misuse of continuous subcutaneous insulin infusion in type 2 diabetes. Diabetes Care. 2013;36(Suppl 2):S219–25.CrossRefPubMedPubMedCentral
Reznik Y. Continuous subcutaneous insulin infusion (CSII) using an external insulin pump for the treatment of type 2 diabetes. Diabetes Metab. 2010;36(6 Pt 1):415–21.CrossRefPubMed
Reznik Y, Huang S. Group OmS. Reductions in A1C with pump therapy in type 2 diabetes are independent of C-peptide and anti-glutamic acid decarboxylase antibody concentrations. Diabetes Technol Ther. 2014;16(11):816–8.CrossRefPubMedPubMedCentral
Reznik Y, Cohen O, Aronson R, Conget I, Runzis S, Castaneda J, et al. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Lancet. 2014;384(9950):1265–72.CrossRefPubMed
Pickup JC, Reznik Y, Sutton AJ. Glycemic control during continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes: individual patient data meta-analysis and meta-regression of randomized controlled trials. Diabetes Care. 2017;40(5):715–22.CrossRefPubMed
(ICER) IFCaER. Controversies in the Management of Patients with Type 2 Diabetes. 2014.
Berthe E, Lireux B, Coffin C, Goulet-Salmon B, Houlbert D, Boutreux S, et al. Effectiveness of intensive insulin therapy by multiple daily injections and continuous subcutaneous infusion: a comparison study in type 2 diabetes with conventional insulin regimen failure. Horm Metab Res. 2007;39(3):224–9.CrossRefPubMed
Boyle ME, Seifert KM, Beer KA, Apsey HA, Nassar AA, Littman SD, et al. Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period. J Diabetes Sci Technol. 2012;6(1):184–90.CrossRefPubMedPubMedCentral
Boyle ME, Seifert KM, Beer KA, Mackey P, Schlinkert RT, Stearns JD, et al. Insulin pump therapy in the perioperative period: a review of care after implementation of institutional guidelines. J Diabetes Sci Technol. 2012;6(5):1016–21.CrossRefPubMedPubMedCentral
Morviducci L, Di Flaviani A, Lauria A, Pitocco D, Pozzilli P, Suraci C, et al. Continuous subcutaneous insulin infusion (CSII) in inpatient setting: unmet needs and the proposal of a CSII unit. Diabetes Technol Ther. 2011;13(10):1071–4.CrossRefPubMed
Houlden RL, Moore S. In-hospital management of adults using insulin pump therapy. Can J Diabetes. 2014;38(2):126–33.CrossRefPubMed
Lansang MC, Modic MB, Sauvey R, Lock P, Ross D, Combs P, et al. Approach to the adult hospitalized patient on an insulin pump. J Hosp Med. 2013;8(12):721–7.CrossRefPubMed
Cook CB, Beer KA, Seifert KM, Boyle ME, Mackey PA, Castro JC. Transitioning insulin pump therapy from the outpatient to the inpatient setting: a review of 6 years’ experience with 253 cases. J Diabetes Sci Technol. 2012;6(5):995–1002.CrossRefPubMedPubMedCentral
Kopecký P, Mráz M, Bláha J, Lindner J, Svačina S, Hovorka R, et al. The use of continuous glucose monitoring combined with computer-based eMPC algorithm for tight glucose control in cardiosurgical ICU. Biomed Res Int. 2013;2013:186439.CrossRefPubMedPubMedCentral
O'Connell MA, Donath S, O'Neal DN, Colman PG, Ambler GR, Jones TW, et al. Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomised controlled trial. Diabetologia. 2009;52(7):1250–7.CrossRefPubMed
Deiss D, Bolinder J, Riveline JP, Battelino T, Bosi E, Tubiana-Rufi N, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29(12):2730–2.CrossRefPubMed
Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34(4):795–800.CrossRefPubMedPubMedCentral
Vigersky RA, Fonda SJ, Chellappa M, Walker MS, Ehrhardt NM. Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care. 2012;35(1):32–8.CrossRefPubMed
•• Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA. 2017;317(4):371–8. The randomized clinical multi-center trial results demonstrated the improvement in glycemic control for subjects with T1D using MDI therapy with CGM as compared to no CGM use
Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA. 2017;317(4):379–87.CrossRefPubMed
•• Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C, Group DS. Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: results From the DIAMOND Trial. J Diabetes Sci Technol. 2017:1932296817704445. The subgroup analysis from the DIAMOND Trial showed favorable impact of CGM use in improving HbA1c in subjects with T1D and T2D on MDI as compared to non-CGM use while managing diabetes.
Holzinger U, Warszawska J, Kitzberger R, Wewalka M, Miehsler W, Herkner H, et al. Real-time continuous glucose monitoring in critically ill patients: a prospective randomized trial. Diabetes Care. 2010;33(3):467–72.CrossRefPubMed
Agus MS, Wypij D, Hirshberg EL, Srinivasan V, Faustino EV, Luckett PM, et al. Tight glycemic control in critically ill children. N Engl J Med. 2017;376(8):729–41.CrossRefPubMedPubMedCentral
Dadlani V, Kudva YC. Continuous glucose monitor use and accuracy in hospitalized patients. Diabetes Technol Ther. 2016;18(8):449–51.CrossRefPubMedPubMedCentral
Cengiz E, Sherr JL, Weinzimer SA, Tamborlane WV. New-generation diabetes management: glucose sensor-augmented insulin pump therapy. Expert Rev Med Devices. 2011;8(4):449–58.CrossRefPubMedPubMedCentral
Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med. 2013;369(3):224–32.CrossRefPubMed
Buckingham BA, Raghinaru D, Cameron F, Bequette BW, Chase HP, Maahs DM, et al. Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis. Diabetes Care. 2015;38(7):1197–204.CrossRefPubMedPubMedCentral
Pettus J, Edelman SV. Differences in use of glucose rate of change (ROC) arrows to adjust insulin therapy among individuals with type 1 and type 2 diabetes who use continuous glucose monitoring (CGM). J Diabetes Sci Technol. 2016;10(5):1087–93.CrossRefPubMedPubMedCentral
Wolpert HA. The nuts and bolts of achieving end points with real-time continuous glucose monitoring. Diabetes Care. 2008;31(Suppl 2):S146–9.CrossRefPubMed
Wolpert H. Establishing a continuous glucose monitoring program. J Diabetes Sci Technol. 2008;2(2):307–10.CrossRefPubMedPubMedCentral
•• Foster NC, Miller KM, Tamborlane WV, Bergenstal RM, Beck RW, TID Exchange Network. Continuous glucose monitoring in patients with type 1 diabetes using insulin injections. Diabetes Care. 2016;39(6):e81–2. The TIDExchange Registry data suggest that CGM can be beneficial for insulin injection users across all age-groups to achieve optimized metabolic control of TID.
Administration USFD. The 670G system—P160017—approval letter. 2016.
•• Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, et al. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155–63. The study by Garg et al. presents findings from the first FDA approved hybrid closed-loop system in the USA
Jazowski SA, Winn AN. The role of the FDA and regulatory approval of new devices for diabetes care. Curr Diab Rep. 2017;17(6):40.CrossRefPubMed
Weisman A, Bai JW, Cardinez M, Kramer CK, Perkins BA. Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(7):501–12.CrossRefPubMed
Tauschmann M, Allen JM, Wilinska ME, Thabit H, Stewart Z, Cheng P, et al. Day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes: a free-living, randomized clinical trial. Diabetes Care. 2016.
Thabit H, Elleri D, Leelarathna L, Allen J, Lubina-Solomon A, Stadler M, et al. Unsupervised overnight closed loop insulin delivery during free living: analysis of randomised cross-over home studies in adults and adolescents with type 1 diabetes. Lancet. 2015;385(Suppl 1):S96.CrossRefPubMed
Brown SA, Breton MD, Anderson SM, Kollar L, Keith-Hynes P, Levy CJ, et al. Overnight closed loop control improves glycemic control in a multicenter study of adults with type 1 diabetes. J Clin Endocrinol Metab. 2017.
Cengiz E. Closer to ideal insulin action: ultra fast acting insulins. Panminerva Med. 2013;55(3):269–75.PubMed
•• Cengiz E, Bode B, Van Name M, Tamborlane WV. Moving toward the ideal insulin for insulin pumps. Expert Rev Med Devices. 2016;13(1):57–69. The overview of insulin analog use in pumps, findings from the innovative ultra-fast acting insulin analog research and their integration in to the closed-loop system are summarized
Cengiz E. Undeniable need for ultrafast-acting insulin: the pediatric perspective. J Diabetes Sci Technol. 2012;6(4):797–801.CrossRefPubMedPubMedCentral
• Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care. 2015;38(6):971–8. The T1D Exchange Registry data by Miller et al. investigated the current status of glycemic control in subjects with T1D in the USA and revealed that 70% of patients have inadequate glycemic control
Blackman SM, Raghinaru D, Adi S, Simmons JH, Ebner-Lyon L, Chase HP, et al. Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy. Pediatr Diabetes. 2014;15(8):564–72.CrossRefPubMed
Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8):3411–9.CrossRefPubMed
Weinstock RS, Schütz-Fuhrmann I, Connor CG, Hermann JM, Maahs DM, Schütt M, et al. Type 1 diabetes in older adults: comparing treatments and chronic complications in the United States T1D Exchange and the German/Austrian DPV registries. Diabetes Res Clin Pract. 2016;122:28–37.CrossRefPubMed
DuBose SN, Weinstock RS, Beck RW, Peters AL, Aleppo G, Bergenstal RM, et al. Hypoglycemia in older adults with type 1 diabetes. Diabetes Technol Ther. 2016;18(12):765–71.CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »