Just as innovation has changed the way we shop, bank, and search for information, it’s transformed the way we manage chronic diseases like diabetes. These new technologies have made life easier for people with type 1 and type 2 diabetes.
Stick-Free Glucose Testing
Frequent needle sticks to test blood sugar are a crucial, but sometimes unpleasant part of the daily diabetes routine. Testing your blood sugar helps you make decisions about what you eat, exercise, and insulin dosing.
Continuous glucose monitoring, or CGM, helps you avoid the stick. It measures your blood sugar every few minutes via a tiny sensor inserted under the skin of your belly or arm, and sends the results wirelessly to a pump, smartphone, or other device.
The FreeStyle Libre was the first CGM system to not require a finger stick. To get your blood sugar number, you simply wave a reader over the sensor. The original Abbott’s FreeStyle Libre was wearable for up to 10 days, but the newest version is designed for 14-day wear.
The Dexcom G6 is approved as both a standalone CGM and for integration with automated insulin dosing systems.
In January 2020, Tandem Diabetes Care launched its t:slim X2 insulin pump with Control-IQ technology, which combines the Dexcom G6 CGM with an insulin pump to regulate insulin levels with little user effort. It’s the first system that both adjusts basal (background) insulin levels and delivers automatic bolus (mealtime) doses to prevent blood sugar from getting too low or too high.
“With the advent of CGM, we’re looking at a new phrase: ‘time-in-range.’ That’s the percentage of the day a person spends with their blood sugar in the range their doctor wants them to be in,” explains Jason Ng, MD, clinical associate professor of medicine in the University of Pittsburgh Medical Center Division of Endocrinology and Metabolism. “The monitor can check blood sugar every 5 minutes throughout the day, and it can catch fluctuations in a patient’s blood sugar that a finger stick can’t.”
The t:slim-Dexcom combination doesn’t just react to blood sugar changes, it predicts them. “Because the CGM is gathering evidence and accumulating data, the decision treatments are based on calculations of what your blood sugar will be in 30 minutes,” Ng explains. “It’s almost like a weather forecast. It can make changes before a patient hits that level to keep their blood sugar more stable.”
The next-generation CGM, the Dexcom G7, should come out in late 2020. “The sensor is a bit thinner than the G6, and it hopefully will have a longer lifespan,” Ng says.
Noninvasive Glucose Monitoring
CGMs cut down on finger sticks, but they still require a small needle under your skin. The ultimate aim is to create a CGM device that monitors blood sugar continuously, without having to stick anything under your skin.
A couple of products are trying to achieve this goal, including the sugarBEAT CGM, which measures blood sugar through a sticky patch placed on the skin. It launched in 2019 but isn’t yet available in the United States. AerBetic is another wearable device that measures blood sugar through chemical changes in breath gases. It’s still in the testing phase.
Ng says he hasn’t seen any evidence that these noninvasive sensors are superior to the under-the-skin sensors currently available. “I’ve had hundreds of patients on the minimally invasive sensor and most people say they can’t feel it.”
The future of insulin pumps is an automated, closed-loop system, also called an artificial pancreas because it acts more like your real organ. In this system, a CGM constantly checks your blood sugar level. The pump then uses an algorithm to determine whether you need insulin to lower your blood sugar or glucagon (a hormone that releases sugar from your liver) to raise it, and then automatically delivers the correct dose to keep your blood sugar steady day and night.
The Medtronic MiniMed 670G was the first hybrid closed-loop system. It continuously monitors blood sugar levels and automatically delivers insulin, but you still have to input the bolus insulin dose based on what you eat.
Actual closed-loop systems that deliver both insulin and glucagon are in development. The trouble has been finding a form of glucagon that’s stable enough to work in the pump.
Beta Bionics is developing the world’s first fully automated bionic pancreas, the iLet Bionic Pancreas System. It received the FDA’s Breakthrough Device designation in late 2019. “This would be the world’s first system that could do both,” Ng says. “I’m not sure we’re ever going to get to a true closed-loop system, but we’re getting close.”
Smart Pens offer the memory capability of a pump, without tethering you to your device. Products like InPen and Gocap connect via Bluetooth to a smartphone app that keeps track of your insulin dose and timing.
The new NovoPen Echo device offers the additional benefits of half-unit dosing increments. “That allows you to fine-tune the amount of insulin you need,” Ng says.
Ask Your Doctor
What are my blood sugar goals?
Your doctor may recommend that you keep your blood glucose in the 80–130 milligram/deciliter (mg/dL) range before meals, and less than 180 mg/dL 2 hours after meals.
How often do I need to test?
That depends on whether you have type 1 or type 2 diabetes, and what medicines you take to manage it. Typically, you’ll test several times a day, including before meals and bed.
If I have a CGM, do I still need to finger stick?
Many CGMs still require a finger stick to calibrate the machine, although you won’t need to stick as often as you did without it. Ask your doctor how often to do manual blood sugar checks.
What should I do if my levels are still too high?
See your doctor. You may need to adjust your medicine dose or make a few changes to your diet.
Diabetes Numbers Now
30.3 Million. Number of people in the United States who have diabetes.
95%. Percentage of people with type 2 diabetes (as opposed to other types of diabetes).
34%. Percentage of adults who have prediabetes.
48%. Percentage of adults ages 65 and older with prediabetes.
$ 7,900. The average annual medical expenses for someone with diabetes.
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