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Current and Emerging Technologies for the Diagnosis and Treatment of Diabetes Mellitus

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Abstract

Purpose of Review

This paper will review the published literature on technology used in the diagnosis and treatment of diabetes mellitus, with a special focus on those technologies used in the emergency department and acute care setting.

Recent Findings

Technology aimed at maintaining tight glycemic control in diabetics has advanced significantly in recent years, with the newest generation of hybrid closed-loop systems providing a new level of glycemic control for patients. Open-source closed-loop systems are gaining popularity among tech-savvy patients. Dual hormone closed-loop systems with glucagon are a promising future direction.

Summary

We provide an overview of the devices used in the diagnosis and treatment of diabetes mellitus. We focus on continuous glucose monitors and insulin pump therapy, including a discussion of technological definitions and what differentiates specific models of these devices. We discuss the up-and-coming technology of closed-loop insulin delivery, including the major systems available in the USA. We conclude by summarizing hopeful futures for the further advancement of diabetes mellitus technology.

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Fig. 1

© 2023 Dexcom, Inc. All rights reserved)

Fig. 2

© 2023 Abbott Pharmaceuticals. All rights reserved)

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sapra A, Bhandari P. Diabetes. [Updated 2023 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/

  2. Lal RA, Cuttriss N, Haller MJ, Yabut K, Anez-Zabala C, Hood KK, Sheehan E, Basina M, Bernier A, Baer LG, Filipp SL, Wang CJ, Town MA, Gurka MJ, Maahs DM, Walker AF. Primary care providers in California and Florida report low confidence in providing Type 1 diabetes care. Clin Diabetes. 2020;38(2):159–65. https://doi.org/10.2337/cd19-0060. PMID: 32327888; PMCID: PMC7164993.

  3. Eerdekens GJ, Rex S, Mesotten D. Accuracy of blood glucose measurement and blood glucose targets. J Diabetes Sci Technol. 2020;14(3):553–9. https://doi.org/10.1177/1932296820905581. Epub 2020 Feb 11. PMID: 32046520; PMCID: PMC7576954.

  4. Langendam M, Luijf YM, Hooft L, Devries JH, Mudde AH, Scholten RJ. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2012;1(1):CD008101. https://doi.org/10.1002/14651858.CD008101.pub2. PMID: 22258980; PMCID: PMC6486112.

  5. Galindo RJ, Aleppo G. Continuous glucose monitoring: the achievement of 100 years of innovation in diabetes technology. Diabetes Res Clin Pract. 2020;170:108502. https://doi.org/10.1016/j.diabres.2020.108502. Epub 2020 Oct 13. PMID: 33065179; PMCID: PMC7736459.

  6. • Teo E, Hassan N, Tam W, Koh S. Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: a systematic review of randomised controlled trials and meta-analysis. Diabetologia. 2022;65(4):604–19. https://doi.org/10.1007/s00125-021-05648-4. Systematic review of randomized control trials and meta-analysis on effectiveness of continuous glucose monitors in type 1 diabetes. Results found that continuous glucose monitors performed superior to self-monitored blood glucose in maintaining glycemic control.

  7. Duarte DB, Fonseca L, Santos T, Silva VB, Puga FM, Saraiva M, Silva IL, Teixeira S, Vilaverde J, Cardoso MH. Impact of intermittently scanned continuous glucose monitoring on quality of life and glycaemic control in persons with type 1 diabetes: a 12-month follow-up study in real life. Diabetes Metab Syndr. 2022;16(6):102509. https://doi.org/10.1016/j.dsx.2022.102509. Epub 2022 May 16. PMID: 35598543.

  8. Pratley RE, Kanapka LG, Rickels MR, Ahmann A, Aleppo G, Beck R, Bhargava A, Bode BW, Carlson A, Chaytor NS, Fox DS, Goland R, Hirsch IB, Kruger D, Kudva YC, Levy C, McGill JB, Peters A, Philipson L, Philis-Tsimikas A, Pop-Busui R, Shah VN, Thompson M, Vendrame F, Verdejo A, Weinstock RS, Young L, Miller KM; Wireless Innovation for Seniors With Diabetes Mellitus (WISDM) Study Group. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020;323(23):2397–406. https://doi.org/10.1001/jama.2020.6928. PMID: 32543682; PMCID: PMC7298607.

  9. Garg SK, Kipnes M, Castorino K, Bailey TS, Akturk HK, Welsh JB, Christiansen MP, Balo AK, Brown SA, Reid JL, Beck SE. Accuracy and safety of Dexcom G7 continuous glucose monitoring in adults with diabetes. Diab Technol Therap. 2022;24(6):373–80. https://doi.org/10.1089/dia.2022.0011.

    Article  CAS  Google Scholar 

  10. Alva S, Brazg R, Castorino K, Kipnes M, Liljenquist DR, Liu H. Accuracy of the third generation of a 14-day continuous glucose monitoring system. Diabetes Ther. 2023;14(4):767–76. https://doi.org/10.1007/s13300-023-01385-6. Epub 2023 Mar 6. PMID: 36877403; PMCID: PMC10064376.

  11. Karinka SA, Brazg RL, Castorino KN, Liljenquist DR, Kipnes M, Liu H. 76-LB: Performance of FreeStyle Libre 3 system. Diabetes. 2022;71(Supplement_1):76-LB. https://doi.org/10.2337/db22-76-LB.

    Article  Google Scholar 

  12. Medtronic. GuardianTM Connect CGM System FAQS. 2019. Available at: https://www.medtronicdiabetes.com/customer-support/guardian-connect-faqs. Accessed 24 Jul 2019.

  13. Abraham SB, Arunachalam S, Zhong A, Agrawal P, Cohen O, McMahon CM. Improved real-world glycemic control with continuous glucose monitoring system predictive alerts. J Diabetes Sci Technol. 2021 Jan;15(1):91–7. https://doi.org/10.1177/1932296819859334. Epub 2019 Jul 4. PMID: 31272204; PMCID: PMC7783013.

  14. Medtronic. GuardianTM Sensor 3. 2023. Available at: https://www.medtronic.com/us-en/healthcare-professionals/products/diabetes/continuous-glucose-monitoring-systems/guardian-sensor-3.html#:~:text=%E2%80%A0-,GUARDIANTM%20SENSOR%203,a%20MARD%E2%80%A0%20of%208.7%25. Accessed 17 Oct 2023.

  15. Ng JKC, Ling J, Luk AOY, Lau ESH, Ma RCW, Li PKT, Szeto CC, Chan JCN, Chow E. Evaluation of a fourth-generation subcutaneous real-time continuous glucose monitor (CGM) in individuals with diabetes on peritoneal dialysis. Diabetes Care. 2023;46(6):1191–5. https://doi.org/10.2337/dc22-2348. PMID: 37043824; PMCID: PMC10234746.

  16. Valla V. Therapeutics of diabetes mellitus: focus on insulin analogues and insulin pumps. Exp Diabetes Res. 2010;2010:178372. https://doi.org/10.1155/2010/178372. Epub 2010 May 26. PMID: 20589066; PMCID: PMC2877202.

  17. Daly A, Hovorka R. Technology in the management of type 2 diabetes: present status and future prospects. Diabetes Obes Metab. 2021;23(8):1722–1732. https://doi.org/10.1111/dom.14418. Epub 2021 May 20. PMID: 33950566; PMCID: PMC7611289.

  18. Freckmann G, Buck S, Waldenmaier D, Kulzer B, Schnell O, Gelchsheimer U, Ziegler R, Heinemann L. Insulin pump therapy for patients with type 2 diabetes mellitus: evidence, current barriers, and new technologies. J Diabetes Sci Technol. 2021;15(4):901–15. https://doi.org/10.1177/1932296820928100. Epub 2020 Jun 1. Erratum in: J Diabetes Sci Technol. 2021 Jun 16;:19322968211027984. PMID: 32476471; PMCID: PMC825852

  19. Hartnell S, Fuchs J, Boughton CK, Hovorka R. Closed-loop technology: a practical guide. Pract Diab. 2021;2(38):33–9. https://doi.org/10.17863/CAM.72733.

    Article  Google Scholar 

  20. Ware J, Hovorka R. Closed-loop insulin delivery: update on the state of the field and emerging technologies. Expert Rev Med Devices. 2022;19(11):859–75. https://doi.org/10.1080/17434440.2022.2142556. Epub 2022 Nov 4. PMID: 36331211; PMCID: PMC9780196.

  21. Bekiari E, Kitsios K, Thabit H, Tauschmann M, Athanasiadou E, Karagiannis T, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis BMJ. 2018;361:k1310. https://doi.org/10.1136/bmj.k1310

  22. Weisman A, Bai JW, Cardinez M, Kramer CK, Perkins BA. Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(7):501–12. https://doi.org/10.1016/S2213-8587(17)30167-5. Epub 2017 May 19 PMID: 28533136.

  23. Fuchs J, Hovorka R. Benefits and challenges of current closed-loop technologies in children and young people with type 1 diabetes. Front Pediatr. 2021;30(9):679484. https://doi.org/10.3389/fped.2021.679484. PMID: 33996702; PMCID: PMC8119627.

  24. Farrington C. Psychosocial impacts of hybrid closed-loop systems in the management of diabetes: a review. Diabet Med. 2018;35(4):436–49. https://doi.org/10.1111/dme.13567. Epub 2018 Feb 15 PMID: 29247547.

  25. •• Messer LH, Berget C, Forlenza GP. A clinical guide to advanced diabetes devices and closed-loop systems using the CARES paradigm. Diabetes Technol Ther. 2019;21(8):462–9. https://doi.org/10.1089/dia.2019.0105. Epub 2019 May 29. PMID: 31140878; PMCID: PMC6653788. Comprehensive clinical guide to diabetes devices including device algorithms, settings, critical education points, and key aspects of the sensor and sharing capabilities of the system.

  26. Barbara David Center for Diabetes. Device Comparison Chart. 2023. Available at: https://www.pantherprogram.org/device-comparison-chart. Accessed 17 Oct 2023.

  27. • Brown SA, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, Laffel LM, Levy CJ, Pinsker JE, Wadwa RP, Dassau E, Doyle FJ 3rd, Anderson SM, Church MM, Dadlani V, Ekhlaspour L, Forlenza GP, Isganaitis E, Lam DW, Kollman C, Beck RW, iDCL Trial Research Group. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. N Engl J Med. 2019;381(18):1707–17. https://doi.org/10.1056/NEJMoa1907863. Epub 2019 Oct 16. PMID: 31618560; PMCID: PMC7076915. Randomized multi-center trial of patients with type 1 diabetes demonstrated a greater percentage of time in target glycemic range with the use of closed loop therapy when compared to a sensor-augmented insulin pump.

  28. Breton MD, Kanapka LG, Beck RW, Ekhlaspour L, Forlenza GP, Cengiz E, Schoelwer M, Ruedy KJ, Jost E, Carria L, Emory E, Hsu LJ, Oliveri M, Kollman CC, Dokken BB, Weinzimer SA, DeBoer MD, Buckingham BA, Cherñavvsky D, Wadwa RP; iDCL Trial Research Group. A randomized trial of closed-loop control in children with type 1 diabetes. N Engl J Med. 2020;383(9):836–45. https://doi.org/10.1056/NEJMoa2004736. PMID: 32846062; PMCID: PMC7920146.

  29. Seget S, Tekielak A, Rusak E, Jarosz-Chobot P. Commercial hybrid closed-loop systems available for a patient with type 1 diabetes in 2022. Pediatr Endocrinol Diabetes Metab. 2023;29(1):30–6. https://doi.org/10.5114/pedm.2023.126359. PMID: 37218723; PMCID: PMC10226452.

  30. Carlson AL, Sherr JL, Shulman DI, Garg SK, Pop-Busui R, Bode BW, Lilenquist DR, Brazg RL, Kaiserman KB, Kipnes MS, Thrasher JR, Reed JHC, Slover RH, Philis-Tsimikas A, Christiansen M, Grosman B, Roy A, Vella M, Jonkers RAM, Chen X, Shin J, Cordero TL, Lee SW, Rhinehart AS, Vigersky RA. Safety and glycemic outcomes during the MiniMed™ advanced hybrid closed-loop system pivotal trial in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2022;24(3):178–89. https://doi.org/10.1089/dia.2021.0319. Epub 2021 Nov 16. PMID: 34694909; PMCID: PMC8971997.

  31. Silva JD, Lepore G, Battelino T, Arrieta A, Castañeda J, Grossman B, Shin J, Cohen O. Real-world performance of the MiniMed™ 780G system: first report of outcomes from 4120 users. Diabetes Technol Ther. 2022;24(2):113–9. https://doi.org/10.1089/dia.2021.0203. PMID: 34524003; PMCID: PMC8817690.

  32. Cobry EC, Berget C, Messer LH, Forlenza GP. Review of the Omnipod® 5 Automated glucose control system powered by Horizon™ for the treatment of type 1 diabetes. Ther Deliv. 2020;11(8):507–19. https://doi.org/10.4155/tde-2020-0055. Epub 2020 Jul 28. PMID: 32723002; PMCID: PMC8097502.

  33. Forlenza GP, Buckingham BA, Brown SA, Bode BW, Levy CJ, Criego AB, Wadwa RP, Cobry EC, Slover RJ, Messer LH, Berget C, McCoy S, Ekhlaspour L, Kingman RS, Voelmle MK, Boyd J, O'Malley G, Grieme A, Kivilaid K, Kleve K, Dumais B, Vienneau T, Huyett LM, Lee JB, O'Connor J, Benjamin E, Ly TT. First outpatient evaluation of a tubeless automated insulin delivery system with customizable glucose targets in children and adults with type 1 diabetes. Diabetes Technol Ther. 2021;23(6):410–424. https://doi.org/10.1089/dia.2020.0546. Epub 2021 Jan 18. PMID: 33325779; PMCID: PMC8215410.

  34. Brown SA, Forlenza GP, Bode BW, Pinsker JE, Levy CJ, Criego AB, Hansen DW, Hirsch IB, Carlson AL, Bergenstal RM, Sherr JL, Mehta SN, Laffel LM, Shah VN, Bhargava A, Weinstock RS, MacLeish SA, DeSalvo DJ, Jones TC, Aleppo G, Buckingham BA, Ly TT; Omnipod 5 Research Group. Multicenter trial of a tubeless, on-body automated insulin delivery system with customizable glycemic targets in pediatric and adult participants with type 1 diabetes. Diabetes Care. 2021;44(7):1630–40. https://doi.org/10.2337/dc21-0172. Epub 2021 Jun 7. PMID: 34099518; PMCID: PMC8323171.

  35. Braune K, Lal RA, Petruželková L, Scheiner G, Winterdijk P, Schmidt S, Raimond L, Hood KK, Riddell MC, Skinner TC, Raile K, Hussain S; OPEN International Healthcare Professional Network and OPEN Legal Advisory Group. Open-source automated insulin delivery: international consensus statement and practical guidance for health-care professionals. Lancet Diabetes Endocrinol. 2022;10(1):58–74. https://doi.org/10.1016/S2213-8587(21)00267-9. Epub 2021 Nov 13. Erratum in: Lancet Diabetes Endocrinol. 2022 Jan;10(1):e1. PMID: 34785000; PMCID: PMC8720075.

  36. Lambadiari V, Ozdemir Saltik AZ, de Portu S, Buompensiere MI, Kountouri A, Korakas E, Sharland H, Cohen O. Cost-effectiveness analysis of an advanced hybrid closed-loop insulin delivery system in people with type 1 diabetes in Greece. Diabetes Technol Ther. 2022;24(5):316–23. https://doi.org/10.1089/dia.2021.0443. PMID: 34962140.

  37. Serné EH, Roze S, Buompensiere MI, Valentine WJ, De Portu S, de Valk HW. Cost-effectiveness of hybrid closed loop insulin pumps versus multiple daily injections plus intermittently scanned glucose monitoring in people with type 1 diabetes in the Netherlands. Adv Ther. 2022;39(4):1844–56. https://doi.org/10.1007/s12325-022-02058-9. Epub 2022 Feb 28 PMID: 35226346.

  38. Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, Hood KK. Optimal use of diabetes devices: clinician perspectives on barriers and adherence to device use. J Diabetes Sci Technol. 2017;11(3):484–92. https://doi.org/10.1177/1932296816688010. Epub 2017 Jan 10. PMID: 28745093; PMCID: PMC5505431.

  39. Pauley ME, Berget C, Messer LH, Forlenza GP. Barriers to uptake of insulin technologies and novel solutions. Med Devices (Auckl). 2021;12(14):339–54. https://doi.org/10.2147/MDER.S312858. PMID: 34803408; PMCID: PMC8594891.

  40. El-Khatib FH, Balliro C, Hillard MA, Magyar KL, Ekhlaspour L, Sinha M, Mondesir D, Esmaeili A, Hartigan C, Thompson MJ, Malkani S, Lock JP, Harlan DM, Clinton P, Frank E, Wilson DM, DeSalvo D, Norlander L, Ly T, Buckingham BA, Diner J, Dezube M, Young LA, Goley A, Kirkman MS, Buse JB, Zheng H, Selagamsetty RR, Damiano ER, Russell SJ. 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. https://doi.org/10.1016/S0140-6736(16)32567-3. Epub 2016 Dec 20. Erratum in: Lancet. 2017 Jan 28;389(10067):368. Erratum in: Lancet. 2017 Feb 4;389(10068):e2. PMID: 28007348; PMCID: PMC5358809.

  41. Castellanos LE, Balliro CA, Sherwood JS, Jafri R, Hillard MA, Greaux E, Selagamsetty R, Zheng H, El-Khatib FH, Damiano ER, Russell SJ. Performance of the insulin-only iLet bionic pancreas and the bihormonal iLet using dasiglucagon in adults with type 1 diabetes in a home-use setting. Diabetes Care. 2021;44(6):e118–20. https://doi.org/10.2337/dc20-10.

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  1. Wayne State University School of Medicine, Detroit, MI, USA

    Patrick Kollman & Emma Burke

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Kollman, P., Burke, E. Current and Emerging Technologies for the Diagnosis and Treatment of Diabetes Mellitus. Curr Emerg Hosp Med Rep 12, 1–12 (2024). https://doi.org/10.1007/s40138-024-00281-y

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