How Technology Is Changing Life With Diabetes

glucose sensor

Innovative devices have automated and streamlined much of the work that goes into diabetes management. Here are just a few of the new gadgets that have made life easier for people with type 1 and type 2 diabetes.

Stick-Free Glucose Monitoring

Frequent needle sticks are a ritual of life with diabetes. Blood sugar testing -- often using a blood sample taken from your finger -- is a critical part of diabetes management. It helps you make decisions about the foods you eat, how you exercise, and how much medicine you take. You may need to stick your finger several times a day.

Continuous glucose monitoring, or CGM, helps you avoid the stick. It measures your blood sugar every few minutes via a tiny sensor inserted under your skin and can send the results wirelessly to a pump, smartphone, or other device.

The FreeStyle Libre was the first continuous glucose monitoring system to not require a fingerstick. To get your blood sugar number, you simply wave a reader over the sensor. The original FreeStyle Libre, approved in 2017, was wearable for up to 10 days, but a new version can be worn for 14 days. “The longer you can keep something in your body and not have to change it is a good thing,” says Deborah Greenwood, PhD, a registered nurse, certified diabetes educator, and diabetes care consultant at Deborah Greenwood Consulting in Sacramento, CA.

In March 2018, the FDA approved the Dexcom G6 -- a quarter-size device that continuously monitors your blood sugar level and sounds an alarm if it rises or falls too much. The newest Dexcom incarnation is the first device to be approved as both a standalone continuous glucose monitor and for use with automated insulin dosing systems. It doesn’t need to be calibrated with a fingerstick, which makes it easier to use, Greenwood says.

Implantable Sensor

One new CGM system essentially lets you forget about the sensor for 3 months at a time. After the Eversense CGM sensor is put under your skin, it continues to monitor your blood sugar every 5 minutes for the next 90 days. The sensor works by generating a light signal in response to the amount of glucose in your interstitial fluid -- the fluid just under your skin. That light signal is converted into a blood sugar reading, which is transmitted wirelessly to a compatible mobile device.

The advantage of a long-term wear sensor is that you don’t have to re-stick yourself every couple of weeks. Once your qualified health care provider implants the device, the sensor stays under your skin. But long-term wear could also be a disadvantage. “Some people think that’s really exciting, and other people say, ‘No way,’ ” Greenwood says.

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Noninvasive Monitoring

The ultimate aim is to create a CGM device that monitors blood sugar continuously without sticking anything under your skin. The UK-based company Nemaura is trying to achieve that goal with its SugarBEAT CGM, which it plans to submit to the FDA for approval this year. The device uses a sticky skin patch to painlessly pull a small amount of glucose from the interstitial fluid. In early study results, SugarBEAT wasn’t quite as accurate as CGM systems from Dexcom and other companies.

Greenwood is cautious about SugarBEAT and other noninvasive CGM products in development, some of which she says have oversold what they can do. “People get excited, and the products turn out not to be what anyone thinks,” she says. Whether SugarBEAT lives up to its claims remains to be seen.

Low Blood Sugar Prevention

Diabetes treatments are designed to lower high blood sugar, but taking too much insulin or other medicines can cause a big plunge. Low blood sugar makes you feel shaky, tired, sweaty, and pale. A big drop could be life-threatening.

Tandem’s t:slim X2 Insulin Pump with Basal-IQ Technology predicts whether your blood sugar levels are going to drop and stops insulin delivery when it senses a fall coming up. This helps prevent the up-and-down swings that can plague people with diabetes. “One of the big benefits of these newer systems is the quality of life,” Greenwood says. “When people don’t have swings, they feel better.”

Automated Insulin Delivery

Insulin is a mainstay of therapy for people with type 1 diabetes, and one way to deliver it is through a pump. Pumps are programmed to release a continuous dose of insulin (basal insulin) throughout the day. Users can also release insulin manually (a bolus dose) to adjust for the carbohydrates in their meals and snacks.

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 would then use an algorithm to determine how much insulin you need to lower your blood sugar to a target range or deliver glucagon (a hormone that releases sugar from your liver) to raise your blood sugar. It would automatically deliver the correct dose to keep your blood sugar steady day and night.

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“The ultimate goal is to take away the decision-making from people with diabetes, so they can just live their life and not constantly be thinking about diabetes,” Greenwood says.

Manufacturers haven’t achieved a true closed-loop system yet, but they’re close. The Medtronic MiniMed 670G was the first hybrid closed-loop system, meaning that 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.

True 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 an iLet Bionic Pancreas System with insulin/glucagon, which it plans to test in clinical trials by late 2019/early 2020. The company will seek FDA approval for an insulin-only version later this year.

“Right now, the way the artificial pumps are working, they can predict when your blood sugar is going to go low or high, but when you do go low, they can’t give you the glucagon to raise you back up. That’s what this pump is trying to do,” Greenwood says. “Once you have a dual-hormone system, that’s getting closer to the real closed loop.”

Smart Pens

Pumps record your blood sugar levels and insulin doses over time as they deliver insulin, but some people get tired of being connected to a pump, Greenwood says. The solution is a smart pen, which offers all the memory capability of a pump, without tethering you to your device.

Smart pens like InPen and Gocap connect via Bluetooth to a smartphone app that keeps track of your insulin dose and timing. InPen also helps you calculate the right dose. You can then share your dosing history with your doctor.

A new reusable insulin pen, called NovoPen Echo Plus, is on the way later this year. It will be able to store and download your last 800 shots (about 3 months’ worth) to another device and display the most recent dose on the cap. The data will connect with several diabetes monitoring systems, including Dexcom and Glooko, to help you better manage your diabetes.

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WebMD Magazine - Feature Reviewed by Brunilda Nazario, MD on March 06, 2019

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases: “Continuous Glucose Monitoring.”

Diatribe.org: “FreeStyle Libre in US Now Approved for 14-Day Wear and 1-Hour Warmup.”

Deborah Greenwood, PhD, registered nurse, certified diabetes educator; past president, American Association of Diabetes Educators.

FDA: “Eversense Continuous Glucose Monitoring System -- P160048," “t:slim X2 Insulin Pump with Basal-IQ Technology -- P180008.”

Nemaura Medical: "Nemaura Publishes Positive Data from SugarBEAT FDA Clinical Trial," “SugarBEAT: Spend more time in range," "Nemaura Announces Positive Results from its SugarBEAT European Clinical Program,"

Dexcom: "The Dexcom G6 Continuous Glucose Monitoring System."

Mayo Clinic: “Hypoglycemia: Symptoms & causes," “Blood sugar testing: When, why and how," “Diabetes management: How lifestyle, daily routine affect blood sugar.”

American Diabetes Association: “How Insulin Pumps Work.”

Diabetes Care: “Day and night closed-loop control using the integrated Medtronic hybrid closed-loop system in type 1 diabetes at diabetes camp.”

Diatribe: “What’s coming next from Beta Bionics and Bigfoot? Exciting next-gen automated insulin delivery.”

Michael Bachner, Novo Nordisk.

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