Dr Alistair Lumb
Consultant in Diabetes at Oxford University Hospitals NHS Foundation Trust, Vice Chair Diabetes Technology Network UK
People with all types of diabetes, but particularly type 1 diabetes, need to make potentially life-changing decisions about their treatment throughout each and every day. This places a significant unseen burden on people living with diabetes.
Recent developments in diabetes technology have enhanced the lives of people with diabetes, by reducing this burden and improving other health outcomes.
Continuous glucose monitors can connect to your phone
Continuous glucose monitoring (CGM) systems show people with diabetes their glucose level, and how it is changing, at any given time.
In these systems, a sensor measures glucose under the skin, and is used to give an accurate estimate of blood glucose.
Sensors can last under the skin for up to two weeks, and readings can be transmitted to a smart mobile phone or reader where they can be viewed and even shared with somebody like a parent or partner.
Some systems can alert users to falling or rising glucose levels, allowing them to make treatment adjustments before their glucose goes out of range.
Insulin pumps can give a more tailored dosage than frequent injections
Insulin pumps deliver insulin via a continuous infusion under the skin, allowing finer and more physiological adjustments to insulin treatment than are possible with repeated injections.
The background level of insulin can be adjusted for situations such as exercise where requirements are different, and finer adjustments can be made to the insulin doses taken with food.
Some of the pumps, which are about the size of an old-fashioned pager, deliver insulin via a small tube called a ‘cannula’, which passes through the skin. For others the cannula is part of a pump that sits on the skin and is controlled remotely by a handset.
A relief from finger-pricking to monitor glucose levels
Compared with fingerprick glucose monitoring (which can also be painful and inconvenient), CGM has been shown to help people reduce their blood glucose overall, while also reducing the risk of dangerously low glucose levels.
This reduces the risk of both short- and long-term diabetes-related problems. Insulin pumps offer the same benefits through the flexibility they offer in insulin delivery.
Dosage decided by a mathematical algorithm and glucose data
CGM and insulin pumps can also be combined in closed-loop or ‘artificial pancreas’ systems.
In these systems, a mathematical algorithm, stored either in the insulin pump or a mobile phone, uses the data from a CGM to make insulin dosing decisions via a pump.
This reduces the burden on the person with diabetes and results in a high proportion of readings falling into the target range.
These technological advances are making a huge difference now to diabetes management. Others, such as ways to deliver transplants without the need for drugs to suppress the immune system, are being studied now with a view to providing a cure for diabetes in the future.