There is no question that technology has improved the lives of people with diabetes, but for some people, embracing technology can be hard, especially if you have been doing the same thing for years. We are creatures of habit, and change is often difficult. According to a Harvard Business Review, the top reasons why people resist change include “excess uncertainty,” “loss of control” and it can seem like “more work.” I see this resistance reflected when I talk to my clients that continue using the same syringes and vials they did 30 years ago or eat the same meals and snacks because that is what they are familiar with. Change implies letting go of the familiar. “There is so much technology out there, that it can be overwhelming for patients or seem too difficult to understand.” Explains Lisette Caballero, a Nurse practitioner at Joe DiMaggio Pediatric Endocrinology Center.
What’s in it for you? Embracing these new technologies can mean a simpler way to manage your diabetes. Some of the benefits include not having to check blood sugars, to devices that remember insulin dosing, and more advanced tools like integrated pumps that work with continuous blood glucose monitors to deliver or suspend insulin based on blood glucose readings. Technology makes life easier for people with diabetes, says Caballero “It takes out a lot of the work and gets individuals motivated to do what they really need to do.” If you live with diabetes or know someone who does and has not yet embraced diabetes technology, fear not.
Here’s our guide to the newest tech products as seen in 2018 ADA Scientific Sessions held in Orlando, Florida in June. Find out more about what these technologies offer, how they can improve your diabetes management and if they are a right fit for you.
Continuous Glucose Monitors
Continuous glucose monitors (CGM’s) have been a game changer in the diabetes world. In recent years, CGMS have revolutionized not only how we view diabetes but also what we do to treat it. CGMS, monitor the body’s blood glucose in real time by sensing the glucose present in the tissue. They not only provide a blood glucose number but can capture the trend of change. The use of CGM has increased dramatically over the past years, especially in the very young from 4% use from 2010-2012 to 45% in 2015-2017, but the overall use is still low. Only about 7% of people with diabetes wear a sensor, which leaves around 20 million people with the potential to use this technology.
The benefits of CGM are many. The first being minimal to no finger checks. Say hello to smooth and clean fingers that will be free of poking. Regardless of insulin delivery type, the use of a sensor improves blood sugars and lowers A1C. Studies show that using CGM can be cost-effective in the long run, especially if you are used to checking BG multiple times a day. Limitations can include cost, fear of pain or discomfort. The cost of one sensor out of pocket can range from $80-160, which in a year adds up significantly. (For reference, the average person would go through 36 sensors in a typical year.) Fortunately, many sensors are now covered by Medicare and private insurances, but some will only cover a CGM if you are on multiple injections or have type 1 DM.
Here are the newest Continuous Glucose Monitor( CGM) options:
Dexcom just released the newest G6 sensor which does not require calibrations. Previously, two finger checks a day were necessary d to calibrate and maintain accuracy. Now, finger checks are eliminated and insulin dispensed based on the sensor, as per FDA approval. Alerts are set for both high and low blood sugars and are displayed through a smartphone. This is the only CGM approved for children 2 years and older. Other benefits include improved and painless (really!) insertion, ability to share blood sugars with others and slightly longer duration of 10 days vs. 7 days.
New to the US, but approved in Europe since 2014. This was the first sensor that required no calibrations, but unlike the Dexcom, there are no alerts for blood sugar highs and lows. The sensor is about the size of a quarter and just received FDA approval for two weeks of use between sensor changes. Blood glucose readings are displayed only when the device is swiped over the sensor, which for now can only be worn on the arm. Known as a flash glucose monitoring system, it does not require a smartphone or any other apps. Benefits include low cost, discrete wear and easy to use for even those who are not tech savvy. For more information visit Freestyle Libre
The first ever implantable sensor approved for use up to 90 days in the US. Think mini pacemaker that is inserted into the arm subcutaneously by a healthcare professional—you can’t do it yourself at home. The aim here is long-term disease management and the company hopes that by wearing a sensor that doesn’t require changing 3 or 4 times per month will reduce some of the burdens of living with diabetes. The sensor is 3mm by 16mm or about half the size of a pill. It has an antenna and is inserted in the back of the arm. A receiver is placed over it and blood glucose readings are transmitted via Bluetooth every 5 minutes. In terms of accuracy, this sensor outperforms both the Dexcom and the Freestyle libre, but it can be more invasive. Benefits include vibration alerts as well as mobile alerts, long-term durability, and accuracy. Visit Eversense Diabetes for more information.
Insulin Delivery Systems, Apps & Artificial Intelligence
- Personal assistant (Sugar IQ) There was one app that stood out at ADA, the first ever artificial intelligent personal assistant created by Medtronic and IBM’s Watson. The sugar IQ app reveals patterns that may be hard for some people with diabetes to notice. It uses artificial technology to give individual guidance and recommendations like missed insulin dosages, how certain foods impact blood glucose and daily routine habits. It also works with the Guardian Connect, Medtronic’s Continuous Glucose Monitor, to give insights into diabetes patterns and empowers individuals to take action.
- Smart Insulin Delivery, In Pen An insulin injector pen that uses Bluetooth and an app keeps track of how much insulin is given. It can simplify the tracking, monitoring and calculating insulin for people with diabetes. The app includes features like an insulin dose reminder, temperature alert, shareable reports and dose calculator. Unfortunately for Android users, the app is only available for Apple IOS for now. The pen can dose in 0.5 units, making this an excellent option for children or very insulin sensitive individuals. It can be used for Humalog and Novolog insulin cartridges.
Integrated Pumps and Sensors
Insulin pumps have been around for nearly 40 years. They provide a better way of delivering insulin since it mimics the body’s physiological way of supplying insulin. Studies show that pump therapy leads to lower HgA1C as well as reduced rates of hypoglycemia and diabetes ketoacidosis. Closed loop systems or sensor integrated pumps were a big buzzword in the Scientific Sessions. With the rise of CGM’s, it makes sense for companies to want to start developing products that can speak to the sensor and essentially “close the loop” by generating a smart algorithm to deliver insulin automatically. Below are the newest integrated system options:
- Tandem X2 This is the next generation of T-slim products and integrates the Dexcom G6 technology to predict and suspend insulin when blood glucose falls. Thus, reduce the time spent in hypoglycemia. A great feature for those experiencing hypoglycemia unawareness or for toddlers. Just like the previous T-slim pump versions, the screen is touchscreen and the pump is lightweight. This new version is expected to get an upgrade to current T-slim users later this month (August). Benefits include: modern appearance, touchscreen and software that’s easy to update.
- Medtronic 670G The first ever hybrid closed-loop pump to appear in the market. The 670G system consists of an updated continuous glucose monitor, Enlite, that measures the user’s glucose levels for up to seven days. When used in auto mode, it automatically adjusts basal (background) insulin every 5 minutes based on the CGM readings and can stop insulin for 30 minutes before reaching a low blood sugar. This pump is only approved in people 14 and older. Benefits include automatic insulin shut off and basal adjustment based on CGM readings and integrated meter.
- Omnipod Dash Omnipod is the only wireless (or tubeless) insulin pump in the US market. The new Dash features include a touchscreen Personal Diabetes Manager (PDM) which has Bluetooth wireless technology that enables it to communicate with smartphones. The PDM has been modernized to look more like an Android phone. Through the Omnipod View app, users and caregivers can monitor insulin pump data as well as display the CGM on the smartphone. Benefits include watertight features, tubeless design without the need to disconnect, and small, discrete size.
Technology is here to stay. It is time to leave the technophobia behind and embrace the changes entering the diabetes world. For the first time, people with diabetes can participate in activities never before thought possible—professional racecar driving, competing in the Olympics—or simply enjoying the daily routine with less worry about blood sugars.
Whether you have type 1 or type 2 diabetes, there are plenty of tech options for you. Not every device or app will work for every patient. Take the time to see if the technology can make your life easier and improve your blood glucose control. It works for me!