AACE calls for broader access to diabetes technology

Clinical takeaway: Discuss CGM with most adults with diabetes and offer AID to patients requiring physiologic insulin replacement, using shared decision-making, structured education, and individualized assessment rather than diabetes type or C-peptide level alone.

Continuous glucose monitoring (CGM), automated insulin delivery (AID), and connected insulin devices can improve glycemic outcomes, but cost, coverage, limited clinician training, and restrictive eligibility criteria continue to impede adoption.

The American Association of Clinical Endocrinology consensus statement updates its 2021 guidance in response to rapid advances in glucose sensing, insulin delivery, data analytics, and telemedicine. The multidisciplinary task force reviewed evidence for adults across outpatient, pregnancy, inpatient, and older-adult populations.

CGM is supported for all insulin-treated adults, regardless of delivery method or number of injections, and can also benefit adults with type 2 diabetes receiving noninsulin therapy. Clinicians should generally review at least 14 days of data with more than 70% active sensor time, focusing on time in range, time above and below range, glucose variability, mean glucose, and glucose management indicator.

For most adults, the suggested CGM goals remain more than 70% time at 70-180 mg/dL, less than 4% below 70 mg/dL, and less than 1% below 54 mg/dL. Targets should be individualized for older adults, patients with chronic kidney disease, and others at elevated hypoglycemia risk.

AID is a standard-of-care option for type 1 diabetes and may improve A1C and time in range in insulin-treated type 2 diabetes and other insulin-deficient states. The task force argued that “restrictions on the use of insulin pumps…based on C-peptide or other criteria, are not evidence-based and should be removed.”

Pregnant patients with type 1 diabetes should be offered CGM, while CGM may be considered in type 2 diabetes or gestational diabetes according to preferences, cost, and availability. AID during pregnancy requires careful selection, close monitoring, and frequent setting adjustments because many systems cannot fully accommodate pregnancy-specific targets or rapidly changing postpartum insulin needs.

Connected insulin pens or smart pen caps should be offered to adults using multiple daily injections to identify missed doses, support adherence, and guide treatment decisions. Insulin patches may reduce injection burden and improve glycemia and quality of life in type 2 diabetes, although adhesion, irritation, occlusion, and reliability remain concerns.

Hospitals should establish protocols allowing capable patients to continue personal CGM or pump use with trained staff and confirmatory point-of-care testing. Clinics should likewise standardize onboarding, data review, alert settings, and follow-up while addressing affordability, language, digital access, and device-related distress.

Continuous ketone monitoring is promising but remains investigational, with additional outcomes data needed before routine use.

"Advances in glucose monitoring and insulin delivery technologies have revolutionized diabetes care for individuals with all types of diabetes," the authors wrote, emphasizing that technology selection should be individualized through shared decision-making between clinicians and patients.

Source: McGill JB, et al. (2026 Sep 8) Endocr Pract. American Association of Clinical Endocrinology Consensus Statement: Use of Diabetes Technology for Management of Adults with Diabetes