Diabetes goes digital
Advancements in technology are making diabetes management smarter – with less pokes and prods
Discover the tech that’s making it easier to manage your diabetes
Doctors handed Claire Bickel a diabetes diagnosis the day before her fifth birthday. Her mum, Francesca, learned to stick Claire’s finger to check her BGLs, and began monitoring her levels eight to 10 times daily. As a newly diagnosed kindergartener, Claire headed to school each day with a juice box in her backpack, just in case her BGLs dropped at school. That was more than a decade ago; Claire is now a high school student.
“In 2007, there was no way
[for me] to know what her levels were [at school], nothing that could tell [me] she was trending down.
I had to put all my faith into a five-year-old recognising she didn’t feel right and knowing she could sip on some juice if she didn’t feel well,” says Francesca.
Diabetes has always been a data-driven disease (the more you know about your numbers, the better equipped you are to manage your BGLs), but it hasn’t always been convenient to check BGLs or keep track of results, let alone predict where your BGL might be headed next, or monitor a loved one’s BGLs from afar.
Today, advances in glucosemonitoring technology and insulin-delivery systems are making all of that possible.
“The devices we use to manage our personal lives are penetrating into diabetes care and allowing patients to learn more about their condition,” says
Jennifer Sherr, a paediatric endocrinologist and associate professor in paediatrics at the Yale School of Medicine. All that information means two things: the ability to more effectively manage BGLs and the freedom to worry less over highs and lows.
UPGRADED METERS
Most meters work the same way: the user inserts a test strip, they prick their fingertip using a lancing device to get a tiny drop of blood, and the strip is touched to the blood to produce a meter result. Many meters let you save readings and add comments to that data. But seeing long-term trends or relaying your data to a loved one or provider? ➤
Historically, that has needed good old-fashioned pen and paper.
New models have Bluetooth (such as the Accu-Chek Guide or Contour Next One meters) or the capacity to wirelessly sync BGL results via mobile signal. Using the companion app, you can access and review results, record food, activity, and medication events, and see patterns. Many even let you set out-of-range alerts or reminders to check.
Plus, you can print and send reports to your support team.
CONTINUOUS GLUCOSE MONITORS (CGMS)
CGMs let users monitor glucose levels every few minutes across 24 hours a day. This can help track trends and see how your body reacts during exercise and at mealtimes. “If you go to a football game and someone takes a snapshot four times during the game, you’ll have a different perception of what happened than if you have a complete video that you can pause, rewind and home in on a particular play,” says Sherr. “The CGMs are like that video. They provide this whole other layer of information.” Many also allow instant sharing with loved ones, healthcare providers and caregivers via app or website.
With a CGM, the user inserts the device so a tiny sensor sits under the skin, where it measures interstitial glucose (the glucose between cells). A transmitter attached to the sensor then sends the data to a receiver (such as a pump, reader or smartphone).
Unlike traditional blood glucose meters, which measure capillary blood through finger sticks and provide instant measurements, CGMs have a few-minutes lag time. And they can take several hours to warm up before they begin reading BGLs. The upshot: CGMs provide trend lines over time, so you can see how often you stay within your target range – several models also sound an alarm when you veer outside of it.
Healthcare providers also benefit from the technology. “Now, I can see a patient’s tracings over a few weeks and make adjustments to his or her insulin pump settings much more accurately than if I’m looking at just a few dozen blood [glucose] levels over a one- or two-week period,” says Sasan Mirfakhraee, medical director of the Diabetes Management Center at the University of Texas Southwestern Medical Center. For people with type 2, even temporary use of a CGM can help with lifestyle and medication adjustments.
Each CGM offers different features. Medtronic’s Guardian Connect system requires fingerstick calibration to ensure accurate readings and has a seven-day wear time, but can be combined with innovative smartphone technology. Abbott’s newest version of the FreeStyle Libre has the longest approved wear time – 14 days – and takes readings when the sensor is scanned by the handheld reader or an iPhone using the FreeStyle LibreLink app. Plus, like the Dexcom G5, the FreeStyle
Libre doesn’t require finger sticks to calibrate. Dexcom G5 has a 10-day wear time and lets you automatically see glucose readings on a smart device and share that data.
INSULIN PUMPS
Pumps have been around for decades, but new technology makes insulin delivery safer,
sleeker and more hands-off. Pumps mimic a healthy pancreas by delivering a steady trickle of rapid-acting insulin 24 hours a day. This keeps BGLs stable between meals and at night, without the need for long-acting insulin. Wearers also use the pump to deliver bolus doses at mealtimes and when their BGL is elevated. Delivering insulin this way can make dosing more precise and easier to adjust in real time, and cut the risk of low or high BGLs.
Traditional pumps deliver a regular preset amount of insulin, but the latest pumps can tailor insulin to the amount of glucose in the blood, like a pancreas.
In 2017, Claire became the first paediatric patient in the US to go on the ‘artificial pancreas’ – Medtronic’s MiniMed 670G hybrid closed-loop system. The system combines an insulin pump with a sensor: the sensor measures BGLs and the pump uses an algorithm to alter insulin delivery based on those levels, 24 hours a day. “My previous pump would give me the same amount of insulin whether my blood glucose was 3.3 or 13.9mmol/L. But the Medtronic is tuned in to what I’m doing, so it keeps me in range,” says Claire.
The Medtronic 670G not only stops delivering insulin if your BGL dips too low and restarts when your levels recover, it can also increase the dose if your BGL rises above a programmed level. “And, the overnight control is beautiful,” says Sherr. “However, a hybrid approach means users still need to bolus for meals. With the Medtronic 670G, patients still need to calibrate their sensors, at least twice a day, and give a correction bolus if they are high.”
Medtronic is currently the only manufacturer that makes both a pump and a sensor designed to work in a closed-loop system: the 670G works with its Guardian 3 sensor. But it isn’t the only manufacturer with a high-tech pump. In fact, Tandem’s t:slim X2 can also be used to create a hybrid closed-loop system, with the Dexcom. The t:slim X2 has a sleek design (less than 2.5cm thick), a large touchscreen display, and it holds up to 300 units of insulin. Plus, it communicates with the Dexcom to predict low-bloodglucose events 30 minutes ahead of time, suspend insulin to avoid the low, and resume dosing once BGLs are on the rise.
FINDING THE RIGHT FIT
Within a few years, experts say, high-tech gadgets will greatly enhance people with diabetes’ ability to stay in their goal range. “But there’s not a one-size-fits-all solution,” says Sherr. “Instead, we have to tailor our suggestions to each individual patient.”
Overwhelmed? There’s a lot out there. Your doctor and diabetes educator are great resources. Also discuss with your healthcare team whether you are eligible for the Insulin Pump Program through JDRF Australia, or contact your health insurance to see if you have an appropriate level of cover.