Table 3:

Consideration for use of diabetes technology systems based on patient characteristics, health status, and glycemic goals

Patient characteristics and Health status	Glycemic goal	Potential Benefits on Use of Diabetes Technology	Potential limitations of Use of Diabetes Technology
Healthy (few coexisting chronic illnesses, intact cognitive and functional status)	A1c goal 7.5% (58 mmol/mol)	Bluetooth pen: Can be used to keep track of adherence and educate patients regarding impact of missed or inaccurate dosing Pump: Capacity for small dose of insulin Assistance with insulin calculator and active insulin on board Provide flexibility CGM: Reduced need for finger sticks Alarm and alert can help with hypoglycemia fear and unawareness SHARE feature can be used to involve caregivers as needed	Need to evaluate cognitive function periodically Caregivers need to be trained to help especially with SHARE feature Alarms and Alert fatigue can cause anxiety
Community-dwelling patients receiving care in a skilled nursing facility for short-term rehabilitation	A1c is not a reliable measure, glycemic goal between 100–200 mg/dl (5.5–11 mmol/L)	Pump: May maintain tighter control needed during rehabilitation CGM: Can help lower risk of hypoglycemia especially if on insulin regimen	Need to train staff at the facility
Very complex/poor health (long-term care or end stage chronic illnesses or moderate-to-severe cognitive impairment or 21 ADL dependencies)	A1c <8.5% (69 mmol/mol)	Pump: Consider continuing pump in older adult with T1D if staff is able to support CGM: Continue CGM therapy to prevent unrecognized hypoglycemia episodes in those on multiple insulin injections or those who are not tolerating fingersticks	Need to train nursing home staff
Patients at end of life	avoid extreme of glucose level as hypo or hyperglycemia	Not much role in person with T2D CGM can help those with T1D to reduce burden of multiple fingersticks