There have been tremendous advances in technology used for the management of diabetes over the past few years. Technologies most commonly reported are in the arena of needles and injections used in insulin delivery and devices that can manage blood glucose and prevent long-term complications.
Insulin Pens Have Become Better, More Accurate and Less Painful
Conventionally, insulin used to be given in syringes and a vial of insulin. In earlier days the needles were long and painful and the vial has to be kept in a refrigerator. All this changed when insulin pens were introduced. Insulin pens are more useful as they eliminate the need for drawing up a dose in a syringe. The ability to dial up the desired dose leads to greater accuracy and reliability, especially for low doses which are often needed in the elderly and in small children. The sensory and auditory feedback linked with the dial mechanism on many pens, also helps patients with visual impairment. Pen devices are also more compact, portable and easier to grip. Moreover as they are insulated, it is not necessary to keep the pen in a refrigerator. This makes life much easier especially for busy people who travel a lot. However, Insulin pens are more costly than insulin vials.
Advances in Insulin Delivery Devices
- a) Insulin pumps
All patients with type 1 diabetes and many with type 2 diabetes require insulin therapy to control their blood glucose levels. Notwithstanding the tremendous advances made in insulin therapeutics over the past three decades, glycemic control remains suboptimal in the majority of patients on insulin. A major reason for this paradox is that the currently used insulin regimens do not exactly mimic the physiological secretion of insulin from the beta-cells of the pancreas. The insulin pump represents an attempt to provide insulin in a more physiological manner to patients with diabetes, avoiding the peaks and troughs in insulin levels seen with multiple subcutaneous injections.
The insulin pump consists of a subcutaneous cannula inserted into the interstitial space (usually of the anterior abdominal wall), a connecting tubing and a small pager sized, battery operated pump which has the insulin reservoir as well as a microchip that controls insulin delivery according to pre-programmed rates.
- b) Artificial Pancreas
These are modern insulin pumps with built in glucose sensors. The ultimate Artificial Pancreas (under development now) would be able to automatically deliver the correct doses based on the blood sugars and switch off the delivery if the sugars are low!
Use of Technology in Monitoring Glucose Levels
- Blood glucose meters
Blood glucose meters have been used in clinical practice since the 1970’s. However their widespread use started only in the 1990s after technological improvements led to a reduction in the cost of the meters and reagent strips. The latest glucose meters provide results that are comparable in accuracy to the venous plasma glucose estimations, at comparable or even lower costs.
The advent of glucose meters and strips has made self-monitoring of blood glucose an integral part of diabetes care particularly in patients who are on insulin.
- Continuous Glucose Monitoring (CGM)
Today we have devices which can continuously monitor the glucose levels using sensors applied to the body. These are particularly useful for those who have fluctuating glucose levels.
- Ambulatory Glucose Profile (AGP)
The Ambulatory Glucose Profile device consists of a small sensor which is worn continuously by the patient for the duration of the profiling (up to 14 days). The glucose values recorded by the sensor are wirelessly transmitted to a reader (usually kept with the healthcare provider) and downloaded in the form of graphs using a proprietary software .The graphs provide glucose curves for each of the 14 days, as well as a “modal day” curve prepared by collapsing the readings from 14 days into a single curve.
The AGP is an improvement upon the original continuous glucose monitoring system in its longer duration of recording and in that, there is no need of calibrating with a capillary glucose meter. It is also far less expensive. The FGM is a useful educational and motivational tool for patients in addition to helping the clinician plan and titrate anti diabetic drug regimens more accurately.
Use of Mobile Phones (mHealth/mDiabetes)
Today it’s a mobile world. Smart phones are everywhere, giving more people instant access to information at their fingertips. This trend has led to growing popularity and use of mobile health technology. Mobile health technology is making health care more accessible and more flexible, places more power in the hands of patients, and is contributing to greater efficiency at medical practices. Various apps are now available to measure your diet, exercise and track your body weight glucose levels, blood pressure, cholesterol etc. You can also communicate the results to your doctor or health care provider making remote monitoring possible.
Use of Telemedicine
Telemedicine has now transformed into a complex integrated service used in hospitals, private physician offices, and other healthcare facilities. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities.
Electronic Medical Record (EMR) can transform the way healthcare is delivered. EMR is a patient centered record, which contains medical, and treatment history of the patient and this information can be made available online whenever it is needed to authorized users.
Precision Diabetes: Now in India
At Dr. Mohan’s Diabetes Specialities Centre, over the last several years we have developed algorithms by which a precise diagnosis of diabetes can be made. Applying the principles of ‘Precision Diabetes’, it will be possible in the near future to very accurately classify a patient and determine the type of diabetes he or she has, and then decide the type of treatment that this patient is likely to respond to. These are indeed exciting times in the field of diabetology.
This review sums up some of the technologies in practice for the management of diabetes. It ought to be remembered that any device or technology, is only as good as the person who uses it. The success of these technological advances will rely significantly on the willingness of patients and doctors to adopt them and to utilize them to the fullest.
Dr. V. Mohan is the Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre at Chennai in South India which is a WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care. He is also President and Director of the Madras Diabetes Research Foundation which is an ICMR Centre for Advanced Research on Diabetes.
Deeply interested in research from his undergraduate medical student days, Dr. Mohan has published over 1200 papers in peer reviewed journals including 750 original articles, 250 review articlesand invited editorials and 150 chapters to textbooks on Diabetes and Internal Medicine which is a world record by practicing doctor. His work has received over 59,000 citations and has a h index of 110 which is the highest by a medical doctor in India.
Dr. Mohan has trained over 12,000 physicians & 500 diabetologists in addition to Nurses, Educators and Technicians. Dr. Mohan has received over 170 awards including the prestigious Dr. B.C. Roy National Award by the Medical Council of India and the Dr. B. R. Ambedkar Centenary Award from the Indian Council of Medical Research, the highest award for Biomedical research in India. In 2018 he was conferred the prestigious Dr. Harold Rifkin Distinguished International Service in the Cause of Diabetes Award by the American Diabetes Association for his pioneering work in the field of diabetes and he is the first Indian to receive this award. For his extensive contribution in the field of diabetes, in 2012 Dr. Mohan was awarded the prestigious Padma Shri, one of the highest civilian awards given by the Govt. of India.
Dr. Mohan also provides lifelong free treatment to thousands of poor patients through the free diabetic clinics established by him and has conducted over 3000 free diabetes camps including several along with the Sri Sathya Sai Seva Organizations and Trusts.