Diabetes has become a leading cause of death worldwide. Although there is no cure for diabetes, blood glucose monitoring combined with appropriate medication can enhance treatment efficiency, alleviate the symptoms, as well as diminish complications. Continuous glucose monitoring (CGM) devices are considered to be the best candidates for diabetes therapy.
Dr Pratik Choudhary, senior lecturer and consultant in diabetes at King’s College in London, was recently one of the keynote speakers at the Society of Endocrinology, Metabolism, and Diabetes of South Africa (SEMDSA) congress on the topic of new technology in diabetes.
“Blood glucose is a biological parameter which is influenced by almost all physiological body regulators and unlimited environmental impacts. In contrast to this eminently moving element, from the discovery of insulin and its therapeutic use in diabetes, a paradoxical mode of insulin management has been followed,” states E. Renard et al, in the study, Moving to a dynamic view of diabetes: a cornerstone on the road toward glucose control.
“During the two last decades, technology has enabled tools that fully change this paradigm. Insulin infusion from miniaturised pumps has first allowed dynamic, prospective or corrective adjustments of insulin delivery. Moreover, the combination of continuous adjustable insulin delivery and permanent monitoring of glucose level has opened the way to efficient prediction and anticipation,” states Renard.
What is continuous glucose monitoring?
Continuous glucose monitoring enables the patient to continuously monitor their glucose levels, allowing them to track trends and patterns. It requires a small piece of equipment, a glucose sensor and a transmitter that measures their interstitial glucose levels every five minutes, meaning the patients will receive 288 readings every day, compared to approximately three to six readings per day when they use a traditional finger-prick, blood glucose monitor.
Alerts and alarms can be set to warn the patient when glucose readings are reaching upper and lower limits. Some CGM devices also allow for remote monitoring by care partners and even healthcare professionals.
The advances of technology
Choudhary said that new technology in diabetes care can be divided into two different groups. The first that he labels as proximate devices and that a patient will use and wear on a one-on-one basis technology, and the second is the distant technologies that the healthcare provider uses to manage a large basis of patients.
“To maintain successful diabetes care and outcomes we need a number of behaviours from patients with both type 1 and 2 diabetes.”
“When a patient records this data, it provides the healthcare provider with real data for that individual, that can help the clincian make better decisions about care in combination with the patient,”said Choudhary.
Mobile apps and smart technology
According to him, technology can and will drive patient behaviours. For instance, through the use of mobile apps, people can access general health behaviours. Social networks offer a patient peer support through support groups, and the user can also facilitate access to healthcare professionals.
Proximal devices can assist patients and healthcare providers in analysing data and making daily treatment adjustments based on data instead of relying on estimated glucose readings.
Although someone can be trained to do the tasks required for diabetes, “Only a machine can do this over and over again for the rest of their life,” making the process of capturing actual and factual data much more reliable,” said Choudhary.
“I really struggle to find any justification not to use a dose advisor meter or app to assist a patient in achieving glucose control. Cloud technology further enables patients and healthcare providers to share data and analyse readings and make informed decisions about treatment.”
“Using the available data and analytics that these devices and apps are able to provide us with, we can fine-tune treatment and advise accordingly – this is where the field of diabetes care and treatment is growing,” said Choudhary.
Study findings: OpT2mise
A study by Dr Yves Reznik et al; Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial, states that many patients with advanced type 2 diabetes do not meet their glycated haemoglobin targets. Previous randomised controlled studies comparing the efficacy of pump treatment and multiple daily injections for lowering HbA1C in insulin-treated patients have yielded inconclusive results.
Reznik et al concluded that the results of the OpT2mise RCT showed that, “In patients with poorly controlled type 2 diabetes despite using multiple daily injections of insulin, pump treatment can be considered as a safe, effective in improving glycaemic control and is a valuable treatment option.”
Glucose monitoring devices
“The evidence shows that people can reduce A1c, or reduce hypos (periods of low blood sugar) with the help of CGM devices, especially if baseline levels are high,” said Choudhary.
Choudhary said that the main benefits of personal CGM systems for patients are ‘governed by available data and the way we use CGM as per NICE guidance’.
Implantable CGM devices
The first long-term implantable CGM device was launched in 2016 in Norway and Denmark.
Current CGM systems in the market include glucose sensors from Dexcom (G4, G5), and Medtronic (Enlite, Enlite 2), which require a new insertion every 7-14 days. The Eversense CGM uses a 90-day implanted sensor that is placed in the upper arm in a five to ten minute in-office procedure.
“There is a lot of simple technology available that does offer a wide reach. Smart devices and technology needs to deliver quality, efficiency and improvement. I think there is a lot of simple tech that is inexpensive but offers quality and delivers small benefits to a large number of people out there,” explained Choudhary.
“For people who really struggle, there is advanced technology that they can use, however it is expensive and only a hand-full of the population can afford to use this it.
“A cure is not around the corner. Access to improved care, smart technology and patient education is where the real value lies for healthcare professionals in the future of diabetes care and treatment.
“The transistion between automated care and human care, however, should be carefully monitored, because technology can always fail, and the person with diabetes will need to have the skills to manage this,” Choudhary concluded.