Diabetes and technology

With advances in technology, there are an increasing number of hardware, devices, and software available to help people with diabetes manage blood glucose levels, prevent complications, and improve quality of life. Dr Yau Ho Chung explains more about these new technologies.

What are the different diabetes technologies available?

For insulin delivery, there are different types of insulin pump, namely tethered pump and patch pump, but the basic principle is similar. A basal insulin is set to deliver small amounts of insulin at different basal rates, while a meal bolus is calculated and delivered at meal times. Correction bolus can be given to correct high blood glucose. For glucose monitoring systems, there are now blood glucose meters that can connect to mobile apps which will aid self-monitoring of blood glucose (SMBG) from the meter. There are also different kinds of continuous glucose monitor (CGM) namely real-time and intermittently scanned, also known as flash glucose monitor. These monitors measure the interstitial fluid glucose for 7-14 days. They can all work slightly differently; some will require SMBG for calibration, some can connect to mobile apps for which data can be stored and shared with others, some can scan the sensor with just the mobile phone. There are even some CGMs, which when connected to an insulin pump, can help in adjusting the insulin delivery as well (known as sensor augmented pump therapy).

What are the benefits of these new technologies compared with the traditional ones?

The insulin pump can offer people with diabetes a more flexible lifestyle and allows for better glucose control – for example adjusting different basal rates for different daily schedules, giving a meal bolus only when ready for a meal, or setting a temporary basal rate during exercise to prevent low blood glucose.

CGM measures interstitial fluid glucose continuously so there is a better idea on the glucose trend. When combined with the use of insulin pump, the algorithm helps to predict low blood glucose, thereby suspending insulin infusion on or before low blood glucose. This helps to reduce hypoglycaemia, especially at night time.

With the glucose profile generated from a CGM, both people with diabetes and healthcare providers can have a better understanding of the glucose trend. This can help to educate patients on behavioural modification and healthcare providers on treatment adjustment.

What are the disadvantages?

The information on glucose trends provided by CGMs can sometimes flood the patients and families with too much information causing distress. Therefore, it’s important to receive education and training from healthcare providers. On-going support should also be received when using a CGM.

As with all technology, there will be a chance of machine failure. Therefore, patients and families should be prepared to revert back to the traditional methods of insulin injections, and SMBG.

Can CGMs replace the traditional SMBG?

Although the interstitial fluid glucose levels in CGM usually correlate with blood glucose levels, there is a time lag between the two. This will result in a discrepancy between the CGM glucose and blood glucose values, especially when the blood glucose rises or drops very quickly. As a result, most healthcare providers suggest the patients check blood glucose when CGM glucose levels are too low or too high, before they decide on any intervention.

Do these technologies reduce the need for insulin injections and blood tests?

With the use of insulin pump, the number of insulin injections will be fewer. But pump users should change their infusion sets every 3 days and have insulin supplies in case of pump failure.

Also, for those using factory-calibrated CGM, most healthcare providers suggest that patients and families should still use SMBG regularly.

Are these technologies suitable for everyone with diabetes?

In principle, insulin pump therapy is appropriate for children and adolescents with diabetes, regardless of age. However, patients and families should understand how the insulin pump works, how to count carbohydrates correctly for meal bolus, how to decide for correction bolus, how to handle pump failure, etc, before they start using insulin pump.

Similarly, CGM provides lots of glucose readings but patients and families should receive training on how to handle these data, how to interpret them correctly and how to take action properly before they start using CGM.

If you would like more information please discuss with your healthcare providers. Although the internet has a lot of information on different diabetes technologies, people with diabetes and families are recommended to receive proper education and training before using an insulin pump or CGM.

Dr Yau Ho Chung
Specialist in Paediatrics
Prince of Wales Hospital
The Chinese University of Hong Kong

This feature was taken from YDA Today – you can read more past issues here.