What's in Your Diabetes Toolkit?
Use of diabetes technology and management techniques have expanded significantly in recent years, but diabetes outcomes are less optimal today than a decade ago. This article includes expert insights on the newest tools, and how people with diabetes can use these tools to create a more personal approach to their care.
Many experts say they remain baffled that over the past decade, fewer people with diabetes are attaining A1Cs below 7%. Frankly, it doesn’t make sense. Though there are serious challenges when it comes to access and affordability, with new insulin pumps, smart pens, medications, continuous glucose monitoring systems (CGM), and ever-growing support options through coaching apps, more people should be able to reach their glucose goals.
While there are many factors leading to this negative trend, the solutions could be right at our fingertips, according to the panel of experts on diabetes technology, coaching support, and clinical care who spoke at diaTribe’s most recent Musings event, “Personalizing Your Diabetes Toolkit: New Solutions to Persistent Problems.” They discussed CGM, insulin delivery, virtual coaching, and addressing social barriers to access. You can watch the full panel discussion here.
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To open up the panel, moderator and diaTribe’s Senior Director of the Time in Range Coalition, Julie Heverly, shared her view on the importance of each person finding the right management strategy that works for them. “For so many people, the fundamental experience of living with diabetes leaves us feeling like we are failing,” she said. “Each of the 463 million people with diabetes is unique, and I hope some of the tools we discuss today might be the missing pieces in building a better and more personalized diabetes toolkit for you.”
Each panelist had a perspective on why diabetes management has worsened. “Our healthcare system is designed to treat acute conditions and symptoms in emergency situations, not provide continuous care for chronic conditions like diabetes,” said Rachel Sánchez-Madhur, executive vice president of product, programs, and engineering at One Drop, a leader in precision health solutions for people with chronic conditions. “People like me, living with diabetes, need consistent support, something that fills the gaps between the healthcare team in the clinic and the daily lived experiences of diabetes management.”
Fellow panelist Ali Dianaty, vice president of research and development at Medtronic Diabetes, a medical device manufacturer that develops insulin pens, CGMs, and insulin pumps, added, “The technology we develop has to be easy for both the user and the clinician. Also, demonstrating that better outcomes are there is crucial. We have not seen this over the last 10 years based on the data. Making it easy and getting the positive outcomes without creating a burden will drive the numbers the way that we want.”
CGMs have become a revolutionary tool for diabetes management. Being able to view changing glucose values in real-time, 24 hours a day, is a vast improvement from the information provided through three to four daily fingersticks. Data suggests that for people who have either type 1 or type 2 diabetes and are on intensive insulin therapy, CGM significantly improves A1C levels and quality of life when compared to people without a CGM. However, for a variety of reasons, many people are unable, unwilling, or simply do not know how to get a CGM.
“Along with the established body of evidence, there is now evidence mounting in support of CGM for people who are not on insulin,” said Marc Taub, divisional vice president of Technical Operations, Diabetes Care at Abbott, a medical device and healthcare company that develops CGMs. “The question now shouldn’t be who can benefit from CGM, it should be who can’t benefit from a CGM. There was a time when patients essentially had to ‘earn the right’ to qualify for a CGM, and I’m glad we are finally starting to get rid of these restrictions.”
Panelists encouraged people with diabetes to continue seeking information about this technology and asking their healthcare providers about how to gain access. “To make CGM more appealing, especially for those with type 2 diabetes, people need to see others like them using the device,” said Dr. Michelle Litchman, a nurse practitioner at the Diabetes and Endocrinology Center at the University of Utah. “We have done this successfully through diabetes education classes, which can provide long-term peer support.”
The information provided by a CGM has also opened the door to simplify and optimize insulin delivery. “Taking CGM as a number and a trend can be enlightening, but it’s not enough,” said Dianaty. “We want to provide people with predictive insights about how their glucose levels will respond to something like eating breakfast, for example. Our intention is not just to provide CGM, it’s to provide value and insights through those predictions.”
Mimicking the insulin delivery of a working pancreas has been at the forefront of development in diabetes technology for years. Thanks to the many pumps, smart pens, smart algorithms and types of insulin now available, the field is progressing toward this goal for those who can access this tech.
For example, One Drop can accurately forecast glucose levels up to eight hours in advance for people with type 2 diabetes, prediabetes, or gestational diabetes on orals or basal insulin. “Every time you dose insulin or record new health data (e.g., food, exercise), that information is used to deliver a more accurate forecast of your blood sugar [glucose level] over time,” said Sánchez-Madhur. This type of predictive technology based on real-world data can simplify diabetes management and help people take proactive action to counteract oncoming highs and lows.
CGM has made predictive glucose modeling possible, whereas new insulin pens and pumps have been able to put these models into practice. “People with diabetes have lots of options for insulin delivery. Many do not even know that an inhalable insulin actually exists,” said Litchman. “Also, smart insulin pens can assist with carb counting, dosing calculations, and reminders. Smart pumps are also on the market, either with or without tubes, some of which have closed-loop options that can adjust insulin titration automatically.”
Still, automated insulin delivery (AID) and other technologies improve glucose outcomes for some and not for others. “Closed-loop pumps can do a lot, but they still come with intricacies. For those who do not want to be connected to a medical device, the smart pen is the way to go,” said Dianaty. “They can help with corrections, boluses, general titration, produce great health outcomes for users, and overall optimize insulin usage.”
For a chronic condition like diabetes, which requires people to make a host of decisions each day regarding their glucose management, people often need sustained guidance and support. “Providers cannot meet all our needs from within the clinic in periodic, 15-minute increments,” Sánchez-Madhur said. Mobile coaching services have increasingly become an avenue for people with diabetes to receive support between traditional doctor’s visits.
“The goal of virtual coaching apps is to give people with diabetes the same level of support as in the clinic, but in the context of everyday life,” she said. “These apps empower people to get real-time advice on what to do next if they are uncertain. Coaches range from diabetes education specialists to nurses, to registered dieticians, all of whom come together to provide guidance, much more effectively than ‘Dr. Google.’”
The goal of using the online space to enhance diabetes care is not to take away from the support given by an endocrinologist or primary care provider, the panelists agreed. Rather, it can supplement clinical care and help your doctor help you.
“When your CGM data is recorded and you have the app on a smart device, your data goes directly into the cloud, which allows your healthcare provider to look at your data and check in between visits,” said Taub. “Thanks to our apps and data sharing capabilities, our glucose data can be located easily, whenever the doctor, parent, or user needs it.”
Among all the goals for the future of diabetes technology and care, experts continue to mention increased accessibility as one of the best ways to combat the worrisome trend in glucose management. Panelists mentioned some of their visions for how to increase technology use in the diabetes world going forward.
“We need to make sure primary care providers know about these different tools,” said Litchman. “Also, we can better access diverse communities by providing our devices in multiple languages.”
Expanding on this, Sánchez-Madhur noted, “Many people don’t realize that it’s OK to reach out and ask for help through diabetes coaching. There can be stigma around diabetes and asking for help, so encouraging people to use these resources and fighting this stigma will go a long way.”
Adding how technology and CGM could potentially play a role in diabetes prevention, rather than just treatment, Taub said, “We are rapidly approaching a time where sensors can be part of the first-line treatment for diabetes, where they can even be prescribed for people with prediabetes to help prevent disease progression and empower patients with an understanding of how their decisions impact their glucose levels.”
The growing diversity of diabetes tools and technologies for management is encouraging, the panelists agreed. All people with diabetes are different and need personal care and an array of choices to achieve the best results. Dianaty said: “We want to build technologies that make things easy, so easy that people with diabetes can forget they even have diabetes in the first place.”
To learn more about some of the topics discussed during the panel, check out our resources: