Johnson Thomas, MD, FACE, Section Chair, Endocrinology, Mercy
Today, technology has become an essential part of diabetes practice. Our practice is virtually impossible without using basic technology like glucose monitors. Endocrinology as a specialty has embraced technology for a long time. We have come a long way from using urine test to monitor glucose levels. Type 1 diabetic patients were checking their blood sugars at least four times a day for reasonable control. With the availability of continuous glucose monitors (CGMS), a newly diagnosed diabetes patient does not have to check his blood glucose at this frequency. These and other wearable technologies are changing the way we practice endocrinology. Price, wearability and duration were the initial roadblocks. Now, the price of continuous glucose monitors has come down and majority of the insurance companies cover the cost. Also, latest CGMs last for 14 days to 3 months.
Online and desktop applications are also being used to analyze these blood glucoses, CGM outputs, food intake and activity level to make recommendation in medication dose. Data collected by these software is being used to create and validate artificial intelligence algorithms to better manage diabetes. Even the mechanical insulin pen got a technology upgrade. Newer insulin pens can track the amount of insulin administered and this information can be send wirelessly to an app or a cloud based applications. This in turn will help to avoid medication errors and hopefully increase medication adherence.
"Online and desktop applications are also being used to analyze these blood glucoses, CGM outputs, food intake and activity level to make recommendation in medication doset"
Previously, patients dependent on insulin had to take a minimum of 4 injections per day. But now, insulin pumps with inbuilt algorithms to manage blood sugar have decreased the burden on patients and providers. Pumps with improved algorithms are in the pipeline. To avoid large upfront costs, companies are also coming up with subscription based models for pumps. One of the major challenges when dealing with diabetes is the occurrence of low blood glucoses. Latest pumps can predict low blood glucoses before it happens and can shut off the insulin. There is an insulin pump in the pipeline with both insulin and glucagon, acting like a mechanical pancreas. Companies are also seeking FDA approval for open source algorithms for diabetes management. These algorithms can be deployed on the patient’s mobile phone. In the future, patients on any insulin pump will be able to utilize these open source apps to manage their diabetes effectively.
Insurance coverage and cost of diabetes medications pushed patients to invent their own solutions. Patients with type 1 diabetes, part of “we are not waiting” campaign have created open source hardware and software to control their diabetes. Stakeholders from different domains are now more receptive to these open source medical technologies including the FDA.
Ultimately, the impact of new technology will depend on its ease of use in daily lives, coverage by medical insurers and benefits to the patient.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine