Technology has become a constant presence in our daily lives, impacting how we socialize, travel and even how we manage our health and well-being. The intersection between technology and healthcare is a powerful one, providing patients unprecedented access to their medical data, treatment options and healthcare team. For people managing chronic diseases, such as diabetes, the use of technology allows them greater autonomy and techniques for self-management.
This is an exciting time in the diabetes community as technology transforms the way both patients and physicians approach diabetes care. According to Elena Toschi, M.D., Staff Physician in the Adult Diabetes Section at Joslin Diabetes Center and Instructor in Medicine at Harvard Medical School, over the next year we can expect to see the following developments in diabetes technology and innovation:
- “Hybrid-closed loop” Insulin Pump: Medtronic is currently testing a new insulin pump, called the MiniMed 670G US. This pump is considered a “hybrid-closed loop” because it combines the use of a pump and a continuous glucose monitor (CGM), the Enlite 3. Based on the CGM reading, every five minutes the pump’s software will automatically increase or decrease basal insulin delivery to a target blood glucose of 120 mg/dl. However, users will still need to take bolus insulin, or fast acting insulin, for meals and during exercise.
- Bionic Pancreas: Ed Damiano, Ph.D., from Boston University, recently unveiled his plan to commercialize the Bionic Pancreas through a new public benefit corporation, Beta Bionics. They plan to test the next version of its fully integrated dual-chamber pump in a four-site bridging study at the end of 2016.
- Improvement in CGM Accuracy: Medtronic , Dexcom, Senseonics, Abbott, and Roche are all developing CGM sensors with lower mean absolute relative differences (MARD) of nine to 12 percent. MARD denotes the difference between finger stick calibrations and sensor glucose values. The focus is now shifting to on-body form factor, cost, connectivity, degree of patient burden and other differentiating factors. The hope is to offer smaller, less expensive, more convenient and clinically impactful sensors and software.
There are many groundbreaking innovations happening here at Joslin Diabetes Center as well. Joslin is one of the study sites for the Replace-BG study, which is sponsored by the Hemsley foundation.
The purpose of this study is to determine whether the use of glucose value from CGM alone without Blood Glucose confirmation is safe and effective for insulin dosing decision. “This study could help demonstrate that using CGM for insulin bolusing is safe and therefore would minimize the number of finger stick measurements per day, easing the burden of managing type 1 diabetes for patients, “said Dr. Toschi.
We are also one of the sites for the Diamond study, sponsored by Dexcom. This study evaluates if the addition of CGM use in T1DM and T2DM on multiple daily injections can help improve glycemic control. Thus far, the use of CGM has shown to be beneficial in improving glycemic control and reduction of hypoglycemic event in type 1 diabetes pump users. The data gather during this study regarding type 1 diabetes will be released at American Diabetes Association meeting in New Orleans this coming June.
Joslin also has a pilot study testing the use of the device diagnostic platform called Glooko, which integrates data from the glucometer, pump and CGM and then creates graphs integrating the data gathered from those devices. This enables both physicians and patients to review the integrated data together and help identify patterns or issues in their daily diabetes management.
Another ongoing study involves a web-based nutrition education program to guide patients with post-mealtime analysis and glucose optimization. This is done through the use of a new smartphone app, called Sugar Sleuth, for real-time data logging to identify factors causing glycemic variability.
Technology is an important part of diabetes care as it increases our knowledge and support for daily diabetes management tasks, such as blood glucose monitoring, diet, exercise, medications and more.
“The widespread use of diabetes technology among people with type 1 and type 2 diabetes indicates that there is an interest in using these methods to improve self-management and diabetes outcomes,” said Dr. Toschi. “However, caution should be used on the proper use of the technology to adequately balance the short-term and long-term challenges of diabetes.”
For more information or to schedule an appointment with a member of Joslin’s Insulin Pump Program, click here.