With David T. Ahn, MD, and Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE
The introduction of new devices promises to make diabetes easier to manage, particularly with the variety of new technological innovations arriving at a fast and furious pace.
Already, some advances are making the often-dreaded finger pricks a thing of the past, while closed loop systems help automate insulin delivery and are termed by one expert as the ''the self-driving car'' of diabetes management.
Admittedly, it is difficult, even frustrating, to try and keep up with what's new and which technology innovation may benefit which people, so EndocrineWeb asked two experts to weigh in on what they see as the most promising new health-based devices —offering advances that don't just impress a tech expert but might just inspire and motivate people with diabetes who are looking for solutions to make self-managing their health easier and may even simplify their lives.
This list has been compiled with guidance from our two experts, with the understanding new products and solutions are being introduced daily so this list may need updating regularly.
Abbott's continuous glucose monitoring system (CGM), FreeStyle Libre, requires no patient calibration—neither by fingerstick or manual data entry.1 This newest approach to continuous glucose monitoring can replace the traditional blood glucose finger prick check. Instead, blood glucose levels are read through a sensor worn on the back of the upper arm. The sensor can be left in place for up to 10 days, according to the manufacturer.
Among the perks of the FreeStyle Libre versus other CGMs is that it has just two components, the sensor and the reader. Other systems typically also have a transmitter. The FreeStyle Libre user captures glucose readings by passing the hand-held reader over the sensor for a second. It's also possible for the user to follow personal blood glucose trends and review glucose levels history over eight hours. 1
Getting rid of finger pricks is welcomed by nearly all people with diabetes, Dr. Ahn says. So much so that he predicts this technology, aimed first at those with type 1 diabetes, will soon be embraced by the type 2 diabetes market.
Also called the world's first artificial pancreas, the hybrid closed-loop insulin delivery system took first place on the Cleveland Clinic's list of top 10 medical innovations for 2018.2 The system ''helps make Type 1 diabetes more manageable," the Cleveland Clinic experts predict. The system made the ''most promising'' list from both experts.
It's the Medtronic Minimed 670 G system. Direct communication between the continuous glucose monitoring device and the insulin pump produce a stabilize blood glucose. The new technology replaces the so-called open loop concept that requires patients to access information from the CGM to determine how much insulin they need to inject.3
According to Dr. Ahn, the closes loop system is ''creating the self-driving car of diabetes so people don't have to be putting in the mental energy and emotional energy of managing their diabetes.''
Among the features are a ''suspend before low'' option. This setting automatically stops insulin delivery 30 minutes before you reach your pre-selected low limits, then it restarts when your blood glucose levels recover, or normalize.
AutoMode is another very beneficial option. This setting adjusts basal insulin delivery every five minutes based on blood sugar levels so you stay in range automatically. The sensor can be worn for up to seven days.
Dr. Ahn compares the system to adaptive cruise control on a car—it does a lot of things, but not everything. The concept of adaptive cruise control keeps you in the same lane when you might otherwise wander, he says, but it won’t change lanes for you if that is was is needed.
Smart pens, under development by a few companies, was a top favorite on Dr. Ahn's list. One— Companion Medical's InPen—began shipping in December. According to the San Diego based company, the InPen is for use with U-100 Humalog and Novolog rapid-acting insulins in people with diabetes who are at least 12 years old.4
The InPen is a reusable injector device that has a smartphone interface. InPen is compatible with all iphones supporting iOS 10 or greater, as well as an Android smartphone version that is on its way according to the manufacturer.
By pairing via Bluetooh with the smartphone app, the InPen system keeps tabs on how many insulin units were given at the last injection, when they occurred, and other information. It's meant for those who must administer multiple daily subcutaneous injections of insulin to manage their diabetes. This pen can deliver 0.5 to 30 units, by dialing in half-unit increments, says Companion.
The InPen will last for one year with no recharging necessary.
According to Dr. Ahn, the InPen adds pump-like features to these insulin devices. You can look for similar products soon from other companies, he says, since more are already available in Europe.
Most importantly, diabetes self-care technology must be personalized, says Hess-Fischl. "Figure out what system is your system," she says, by discussing the options with a certified diabetes educator or a doctor who knows the technology.
For instance, she says, the artificial pancreas system has wonderful features, but may not work well for someone who wants to manipulate their insulin and not give up what they perceive as needed control. On the other hand, a person who is struggling to manage their blood sugar and finds themselves falling short in meeting glucose levels despite earnest efforts may do well with it, she says.
Consider your preference, as well as your comfort level with technology. "It becomes very personal," she says, so deciding which technology is best requires an in-depth discussion between the patient and the health care professional, and this may change as the device options evolve.
Dr. Ahn reports no disclosures. Hess-Fischl is a consultant for Roche Diabetes Care and on the speakers' bureau for Sanofi.