An international task force convened by the American Association of Clinical Endocrinology has updated its guidance on advanced diabetes technology for adults, reviewing the evidence and reaching consensus through virtual meetings. It covers continuous glucose monitoring, automated insulin delivery, other insulin delivery devices, and — newly — continuous ketone monitoring.
The framing is shared decision making rather than eligibility rules, and much of the document deals with implementation: who benefits, what has to be in place for adoption to work, and the practical considerations that determine whether a device helps or is abandoned. That emphasis reflects where the field actually fails. The evidence that continuous glucose monitoring improves outcomes in insulin-treated diabetes is no longer contested; whether a given patient keeps wearing it is.
A consensus statement is expert opinion organised against the evidence, not new evidence, and this one is written for a health system where devices are largely reimbursed. In India, continuous glucose monitoring is bought episodically out of pocket and automated insulin delivery is rare, so the transferable parts are the implementation points: setting a specific question before starting a sensor, agreeing what will be reviewed, and planning what happens when funding runs out. The addition of continuous ketone monitoring is worth registering — it is the technology most likely to matter for anyone using an automated system or an SGLT2 inhibitor.
- Set a specific question before starting a sensor — post-meal excursions, nocturnal lows, dose titration
- Agree in advance who reviews the download and when, or the data will not change anything
- Plan for intermittent use where funding is episodic rather than treating it as failure
- Note the arrival of continuous ketone monitoring, particularly with automated delivery and SGLT2 inhibitors
- Technology does not replace structured education; it fails fastest where education is thinnest
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