WakeMed

Hillary Lockemer

Glucose Care Integrator

Long gone are the days of the insulin pump backpack (seriously, Google® it). Diabetes-related technology has advanced more rapidly than many of us pediatric endocrinologists thought possible.

The ability to monitor blood glucose levels is easier with the availability of personal glucometers, and these devices continue to get smaller and more accurate. Additionally, they integrate with phone apps, insulin pumps, and online software that allow patients and providers to more easily review data and trends.

Even more exciting is the improvement in continuous glucose meter (CGM) technology. While CGMs have been around for many years, only in the last few have they become accurate and comfortable enough to be used frequently. Most CGMs do not even require fingerstick calibrations, eliminating one of the greatest burdens experienced by individuals with diabetes. Some CGMs communicate with phone apps that allow users to set low and high glucose alerts and even permit the data to be viewed by multiple users. These functions have provided families a level of security that enables them to sleep through the night for the first time in years. An implantable CGM was recently FDA-approved for adult use and again offers a discrete and easy way to monitor glucose.

Insulin pumps are advancing in ways akin to cell phones: each new version is smaller, faster, and smarter. Pumps are becoming touchscreen so that they are more familiar to younger users. Pump companies are getting FDA approval to allow software downloads to be pushed to users, ensuring users can take immediate advantage of the latest technology rather than waiting 4-5 years until insurance allows an upgrade. And pumps are now communicating with CGMs in a “closed-loop hybrid” system where insulin delivery is suspended or increased based on CGM trend data. With both FDA-approved and DIY versions of this technology, but soon our patients with diabetes will no longer have to check their blood sugar, count carbs, or manually administer a bolus to keep blood sugars in a target range. This will truly be the next best thing to a cure.

“Insulin pumps are advancing in ways akin to cell phones: each new version is smaller, faster, and smarter.”

Insulin injection users are even benefitting from technology advancements. Pre-filled insulin pens are easier to use and more portable than insulin vials. The InPen® is a device that uses insulin cartridges and connects with a phone app to deliver insulin to 0.1 unit increments. It records the last insulin dose and time to minimize duplicate doses. The app can even account for insulin on board, allowing those who prefer injections to experience similar benefits to pump users.

On the provider side, we are seeing glucometer, CGM, and pump download software become more universal. Downloads can be done by the patient at home or by the clinic staff. This allows providers to get more accurate data on glucose levels, pump settings, and even challenges a patient might be having with their diabetes regimen.

Finally, while not specifically related to diabetes, our patients with diabetes are benefitting from the increasing use of telemedicine. Patients who may have otherwise struggled to attend visits are more consistent with their care. Additionally, education for newly diagnosed patients, CGM placement, or pump initiation, being conducted safely online given our current pandemic will likely continue to be a convenient alternative to in-person education.

Every day I see how my patients’ lives are bettered by diabetes-related technology. It still amazes me that in less than 100 years we have gone from the advent of insulin to nearly a true “artificial pancreas.” I cannot wait to see what the next several years bring in this field.