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Diabetes Technology in 2018: Where to Start, What to Know

Advances in technology aimed at making diabetes management simpler and better are plentiful, so where to start?

Diabetes Technology Update 2018Advances in diabetes technology are plentiful. Ask your healthcare provider which new device or technology might simplify or improve your diabetes management.

Even if you're a techno-phobe, you're likely to know that advances in technology aimed at helping those with type 1 and type 2 diabetes manage better are multiplying quickly. Your doctor or diabetes educator may have talked about continuous glucose monitoring (CGM), an artificial pancreas system, smart pens, smartphone apps and other options. Even if you are a techno-geek, it's enough to make your head spin.

So OnTrackDiabetes asked two experts to weigh in on what to know and do, and which advances look most promising in the immediate future.

First, What Fits?

Technology must be personalized to the person, says Amy Hess-Fischl, MS, RD, DN, BC-ADM, CDE, the transitional program coordinator at Kovler Diabetes Center, Chicago, and an editorial board member for OnTrack Diabetes.

Everyone must figure out which system or technology is their system or best bet, she says. That can start with an informed discussion between you and your diabetes educator or your doctor—but be sure your health care professional is up to speed on technology. (Not an easy question to ask them, but an important one that will serve you better in the long run.)

When she discusses technology with patients, Hess-Fischl takes their approach to management of their diabetes, among other factors, into account. For instance, the new closed-loop system (AKA the artificial pancreas) has wonderful features, but someone who wants to manipulate their insulin may not want to give up what they perceive as a good handle on control. But someone who is doing most things right but still struggling to lower their blood sugar may welcome the new system, she says.

Ask your healthcare provider to talk about pros and cons of technology options and what it might mean for you. For instance, the artificial pancreas is dubbed the ''self-driving car'' of diabetes management by David T. Ahn, MD, an associate clinical professor of medicine at the UCLA David Geffen School of Medicine, and Endocrinology and diabetes technology expert. If that appeals to you, it might be worth checking out.

Get Unbiased Input
OnTrack Diabetes asked Hess-Fischl and Dr. Ahn to pick the most promising technology that's available now or soon to be. Their lists are remarkably similar—and with the avalanche of advances, it is likely subject to revision within months.

#1. CGM Minus Calibration
The FreeStyle Libre continuous glucose monitoring (CGM) system requires no patient calibration, neither by fingerstick or manual data entry. It can replace traditional blood glucose monitoring. You wear a sensor on the back of the upper arm, which can be left in place for up to 10 days, and use a reader to get the levels. There's no transmitter, as other CGM systems include. You can spot trends and review eight hours of blood sugar level history.1

While this technology was first aimed at those with type 1 diabetes, Dr. Ahn predicts it will become popular for type 2 management as well.

#2. Artificial Pancreas (Closed-Loop System)
The prestigious Cleveland Clinic recently picked the top 10 medical innovations for 2018. At the top of the list? The hybrid closed-loop insulin delivery system. The Cleveland Clinic experts say the system "helps make Type 1 diabetes more manageable."Dr. Ahn and Hess-Fischl gave it top marks, too.

Medtronics makes it, known as the Minimed 670G system. Direct communication between the continuous glucose monitoring device and the insulin pump stabilizes blood glucose levels. The new technology replaces the so-called open loop system. With that, the patient had to access information from the CGM to decide how much insulin they needed to inject.3

Dr. Ahn calls the closed-loop system the self-driving care of diabetes, a good thing if it fits the patient's needs and preference. "People don't have to be putting in the mental energy and emotional energy of managing their diabetes," he tells OnTrack Diabetes. The system doesn't do everything, he says—just as the cruise control on a car keeps you from wandering from one lane to the next, but doesn't, say, change lanes for you.

#3. Smart Pens
This development may not make everyone's list, but Dr. Ahn says it is worth discussing. Smart pens are under development by a few companies, he says. One, Companion Medical's InPen, began shipping in December. It is meant for use with U-100 Lilly Humalog and Novo Nordisk Novolog rapid-acting insulin in users 12 years and above. It is a reusable injector pen with a smartphone interface, compatible with Apple IOS devices with IOS 10 or greater. An Android version is in the works.4

When paired via Bluetooth with a smartphone app, the system keeps tabs on how many insulin units were given at the last injection, when that occurred and other information. It is meant for those who inject insulin multiple times a day. It can deliver .5 to 30 units, dialed in half unit increments. The pen lasts a year without recharging.

It adds pump-like features to insulin pens, Dr. Ahn says. Similar products will be out from other companies soon, he predicts.

Dr. Ahn reports no disclosures. Hess-Fischl is a consultant for Abbott Diabetes Care.

Updated on: February 1, 2018
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