New technologies like continuous glucose management and smart insulin pens aim to improve the lives of diabetes patients.
Diabetes technology is the term used to describe the hardware, devices, and software that help diabetic people to manage blood glucose levels, reduce diabetes complications, and improve quality of life. Historically, diabetes technology consisted of two main categories: insulin administered by syringe, pen, or pump, and blood glucose monitoring as assessed by a glucometer or continuous glucose monitor.
Pens allow injected medications to be delivered conveniently and accurately. Insulin pumps deliver insulin 24 hours a day via a catheter inserted under the skin. Fitness trackers and applications like LibreLink, GlucoseZone, and mySugr also help with diabetes management by monitoring blood sugar, movement, meals, heart rate and sleep. Some of the newer technologies in diabetes management are as follows:
- Continuous Glucose Monitoring (CGM)
Also known as stick free glucose monitoring, CGM involves a small sensor that is inserted under the skin of the arm or the belly. The results are sent either to a pump, smartphone or other device. CGMs highlight trends, produce spreadsheets and send alarms when the blood sugar levels go too low. The biggest advantage of CGMs is that it can help to monitor glucose levels every 5 minutes throughout the day thus easily capturing blood sugar fluctuations. It also gets rid of the constant pricking that needs to be done for a glucometer which is not only painful and uncomfortable but also provides only up to 5-6 readings a day.
FreeStyle Libre from Abbott Laboratories was the first ever CGM system to be introduced and it has a sensor that is wearable up to 14 days. It has a sensor and a reader. The sensor attaches to the back of the arm which measures the glucose levels present in the interstitial fluid. The reader is then passed over the sensor to show the reading.
In January 2020, Tandem Diabetes Care launched a hybrid model which combines the Dexcom G6 CGM (provides up to 288 readings a day) with an insulin pump to regulate insulin levels with little user effort. It is the first system that both adjusts basal (background) insulin levels and delivers automatic bolus (mealtime) doses to prevent blood sugar from getting too low or too high.
- Non-Invasive Glucose monitoring:
Despite CGM being an excellent alternative to the continuous finger pricking Glucometer, it is invasive as a sensor needs to be inserted underneath the skin. Non-invasive glucose monitoring involves using a patch over the skin or a watch. SugarBeat CGM from Neumara Medical measures blood glucose through a patch placed on top of the skin. AerBetic is another wearable device that measures fluctuations in blood sugar through the chemical changes in exhaled gases.
- Closed Loop Systems or Artificial Pancreas:
The future of insulin pumps is an automated, closed-loop system, also called an artificial pancreas. In this system, a CGM constantly checks the glucose levels and the pump then uses an algorithm to determine whether the patient needs insulin to lower the blood sugar or glucagon to raise it. The appropriate dose of the hormone is then delivered automatically to maintain the blood sugar levels.
The Medtronic MiniMed 670G was the first hybrid closed-loop system which monitors blood sugar levels and automatically delivers insulin.
Actual closed-loop systems that deliver both insulin and glucagon are still in development as it is hard to find a form of glucagon that is stable enough to be used for the pump. Beta Bionics is developing the world’s first fully automated bionic pancreas, the iLet Bionic Pancreas System which received the FDA’s Breakthrough Device designation in late 2019.
- Smart Insulin Pens:
A smart insulin pen is a reusable injector pen with an intuitive smartphone app that can help people with diabetes better manage insulin delivery. This smart system calculates and tracks doses and provides helpful reminders, alerts, and reports. They can come in the form of an add-on or a reusable form which uses prefilled cartridges instead of vials or disposable pens. Smart insulin pens are more affordable, easy to use, and offer many benefits and improvements for patients who depend upon insulin to manage their diabetes.
Diabetes technology of today incorporates hybrid devices that monitor glucose and deliver insulin, sometimes automatically, or through a software that serves as a medical device, providing diabetes self-management support. Diabetes technology can help to improve the lives and health of people with diabetes; however, the complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation.