Purpose of Review
To update the medical community on the new and old technologies use for the control and management of diabetes mellitus.
Diabetes technology is defined as the different technology including hardware, devices, and software that are used by diabetic patients in order to help to manage blood glucose levels. This technology can be used in patients with any type of diabetes mellitus and, when applied appropriately, it can have a significant impact on these patients’ health. They can be divided into different insulin delivery methods, blood glucose monitoring, and hybrid and implantable devices. Insulin delivery can be further subdivided into insulin pens, insulin syringes, or insulin delivery via a pump. New technology includes a bionic or “artificial” pancreas that has been introduced. This is an external device or system of devices that mimic the glucose regulating the function of a healthy pancreas.
It is essential to deeply understand the use of each of the devices so you can recommend the best one that fits your patient.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• American Diabetes Association. Diabetes technology: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Supplement 1):S71–80. https://doi.org/10.2337/dc19-S007. Most recent guidelines from the American Association of Diabetes on management and utilization of technology. The newest evidence is on this guideline.
Lasalvia P, Barahona-Correa JE, Romero-Alvernia DM, Gil-Tamayo S, Castañeda-Cardona C, Bayona JG, et al. Pen devices for insulin self-administration compared with needle and vial: systematic review of the literature and meta-analysis. J Diabetes Sci Technol. 2016;10:959–66.
Pfützner A, Schipper C, Niemeyer M, Qvist M, Löffler A, Forst T, et al. Comparison of patient preference for two insulin injection pen devices in relation to patient dexterity skills. J Diabetes Sci Technol. 2012;6:910–6.
Williams AS, Schnarrenberger PA. A comparison of dosing accuracy: visually impaired and sighted people using insulin pens. J Diabetes Sci Technol. 2010;4:514–21.
Reutrakul S, Wroblewski K, Brown R. Clinical use of U-500 regular insulin: review and meta-analysis. J Diabetes Sci Technol. 2012;6(2):412–20.
Hirsch LJ, Strauss KW. The injection technique factor: what you don’t know or teach can make a difference. Clin Diabetes. 2019;37(3):227–33.
Gildon BW. InPen smart insulin pen system: product review and user experience. Diabetes Spectr. 2018;31(4):354–8. https://doi.org/10.2337/ds18-0011.
Winter A, Lintner M, Knezevich E. V-Go insulin delivery system versus multiple daily insulin injections for patients with uncontrolled type 2 diabetes mellitus. J Diabetes Sci Technol. 2015;9:1111–6.
Sutton D, Higdon CD, Nikkel C, Hilsinger KA. Clinical benefits over time associated with use of V-Go wearable insulin delivery device in adult patients with diabetes: a retrospective analysis. Adv Ther. 2018;35(5):631–43.
David G, Gill M, Gunnarsson C, Shafiroff J, Edelman S. Switching from multiple daily injections to CSII pump therapy: insulin expenditures in type 2 diabetes. Am J Manag Care. 2014;20:e490–7.
McAdams BH, Rizvi AA. An overview of insulin pumps and glucose sensors for the generalist. J Clin Med. 2016;5(1):5. https://doi.org/10.3390/jcm5010005.
• Knebel T, Neumiller JJ. Medtronic MiniMed 670G hybrid closed-loop system. Clin Diabetes. 2019;37(1):94–5. Strongest evidence showed that hybrid closed-loop system due better control on glucose level compared with other systems.
Weaver KW, Hirsch IB. The hybrid closed-loop system: evolution and practical applications. Diabetes Technol Ther. 2018;20(Suppl. 2):S216–23.
Forlenza GP, Li Z, Buckingham BA, Pinsker JE, Cengiz E, Wadwa RP, et al. Predictive low-glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: results of the PROLOG trial. Diabetes Care. 2018;41(10):2155–61.
Müller L, Habif S, Leas S, Aronoff-Spencer E. Reducing hypoglycemia in the real world: a retrospective analysis of predictive low-glucose suspend technology in an ambulatory insulin-dependent cohort. Diabetes Technol Ther. 2019;21(9):478–84.
Zisser H. The OmniPod insulin management system: the latest innovation in insulin pump therapy. Diabetes Ther. 2010;1(1):10–24.
Wheeler BJ, Heels K, Donaghue KC, Reith DM, Ambler GR. Insulin pump-associated adverse events in children and adolescents—a prospective study. Diabetes Technol Ther. 2014;16:558–62.
Wood A, O’Neal D, Furler J, Ekinci E. Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Intern Med J. 2018;48(5):499–508. https://doi.org/10.1111/imj.13770.
Kovatchev BP, Patek SD, Ortiz EA, Breton MD. Assessing sensor accuracy for non-adjunct use of continuous glucose monitoring. Diabetes Technol Ther. 2015;17:177–86.
Fokkert MJ, van Dijk PR, Edens MA, et al. Performance of the FreeStyle Libre flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res Care. 2017;5:e000320.
Carlson AL, Mullen DB, Bergenstal RM. Clinical use of continuous glucose monitoring in adults with type 2 diabetes. Diabetes Technol Ther. 2017;19(Suppl 2):S-4–S-11.
Kropff J, Choudhary P, Neupane S, Barnard K, Bain SC, Kapitza C, et al. Accuracy and longevity of an implantable continuous glucose sensor in the PRECISE study: a 180-day, prospective, multicenter, pivotal trial. Diabetes Care. 2017;40:63–8.
• El-Khatib FH, Balliro C, Hillard MA, Magyar KL, et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet. 2017;389(10067):369–80. Study showed that relative to conventional and sensor-augmented insulin pump therapy, the bihormonal bionic pancreas was able to achieve superior glycemic regulation without the need for carbohydrate counting.
Brown S, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, et al. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. N Engl J Med. 2019;381:1707–17.
Akturk HK, Giordano D, Champakanath A, Brackett S, Garg S, Snell-Bergeon J. Long-term real-life glycemic outcomes with hybrid closed-loop system when compared with sensor-augmented pump therapy in patients with type 1 diabetes. Diabetes Obes Metab. 2019. https://doi.org/10.1111/dom.13933.
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The authors declare that they have conflict of interest.
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This article is part of the Topical Collection on Cardiovascular Care
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Elshimy, G., Ricardo Correa Updates on Technology for Diabetes Mellitus. Curr Emerg Hosp Med Rep 8, 35–39 (2020). https://doi.org/10.1007/s40138-020-00204-7
- Diabetes mellitus
- Insulin pump
- Continuous glucose monitoring