November is Diabetes Awareness Month, the perfect time to make sure you know about the latest tech helping diabetes patients lead healthier lives. From continuous glucose monitors (CGMs) that are smartphone-compatible to reusable injector smart pens, they all have potential to relieve your patients’ daily struggles.
To get a sense of which are the most groundbreaking, Florence Health spoke with Kacie Doyle-Delgado, NP-C, a diabetes nurse practitioner who’s lived with T1D since she was 11. Because of their ease of use, these are some of her preferred d-tech items currently on the market and what she believes will be available to patients in the next few years.
1. Dexcom G6
The Dexcom G6 is a real-time continuous glucose monitor, which patients can wear for 10 days. It doesn’t require a fingerstick calibration before injecting insulin. Users can share the data from the monitor with up to 10 followers, and view the data and alerts on their receiver, smartphone and smartwatches.
2. Freestyle Libre
Freestyle Libre is a continuous glucose monitor that intermittently scans patients and can be worn for 14 days. It offers pain-free, glucose-level assessments by scanning a small sensor inserted under the skin instead of with fingersticks. This device can now use smartphones, in addition to the receiver, for scanning data using the LibreLink phone application.
3. Omnipod DASH
Omnipod DASH is a wearable insulin pump that provides continuous insulin and includes a Personal Diabetes Manager (PDM) in the form of a handheld device. The new Bluetooth PDM allows remote monitoring capabilities for up to 12 followers, a definite perk for parents and caregivers. The added Bluetooth and WiFi capabilities mean patients can use this system remotely.
The InPen consists of a reusable injector smart pen and phone app. It stores insulin settings and calculates the dose for the user. The smart pen also stores injection history so patients care share this info with their provider. The application also has a dose calculator, temperature alerts for insulin and optional dose reminders.
5. Sensor-Augmented Pumps
Examples of sensor-augmented pumps — which rely on CGMs to deliver the right amount of insulin at the right time — include the t:slim X2 from Tandem and Medtronic 670G. The t:slim X2 works with Basal IQ and Dexcom G6 technology, while the Medtronic 670G has a Guardian sensor. The t:slim X2 suspends insulin delivery when blood glucose levels are in the hypoglycemic range (<70 mg/dL) or when hypoglycemia is predicted. The Medtronic 670G system also suspends insulin delivery for actual or predicted hypoglycemia and automatically adjusts basal insulin rates to adjust for hyperglycemia.
6. Tidepool Loop
An example of exciting technology in progress is the Tidepool Loop. Tidepool, a diabetes data nonprofit, is working on an FDA-approved version of Loop, a popular, do-it-yourself, automated insulin delivery system. It will work with the Dexcom G6 CGM and future versions of Omnipod System and MiniMed pump. The original Loop was created as part of the #wearenotwaiting movement, which encourages diabetes patients to develop their own tech-based solutions to manage the condition.
“It is exciting to see the way that the type 1 community has driven this to push the commercial marketplace to improve their products and to tailor them to the needs of people living with type 1 diabetes,” Doyle-Delgado says. “Tidepool Loop will be an iOS application available in the app store.”
7. Tandem’s Control-IQ Hybrid Closed Loop Algorithm
With expected FDA-approval in late 2019 or early 2020, Tandem’s Control-IQ Hybrid Closed Loop Algorithm uses the t:slim X2 insulin pump, Dexcom G6 CGM and an algorithm to automate insulin delivery. The system gives correction microbolus doses to increase time-in-range and reduces hypoglycemia with a target glucose of approximately 110 mg/dL.
The system will be a free software update for current t:slim X2 with Basal IQ users through Dec. 31, 2020. They will be able to get the updates from the Tandem Device Uploader by using their home computer. This will be the first hybrid closed loop system that does not require fingerstick calibration due to the factory calibration of the Dexcom G6 continuous glucose monitor.
A New Standard of Diabetes Care
Doyle-Delgado explains that continuous glucose monitors have become the new standard of care for monitoring glucose levels in type 1 diabetes, so many of the recent tech developments focus on these products. These devices provide data that allow the user to see their average, variability, time-in-range and time spent above or below range. Access to this info can optimize care in ways that aren’t possible with glucometer fingersticks alone.
More importantly, diabetes technology allows users to customize the tools that work best for them to help them to achieve their personal goals for disease management. From pens to pods to pumps, these new innovations can be overwhelming for patients so be sure to understand what your patient needs assistance with before making any recommendations.