Do tech improvements lead to better diabetes outcomes?
An important question is whether improvements in technology can make better control accessible to patients who are not currently good candidates for insulin pumps.
The approval of new continuous glucose monitoring equipment, new insulin pumps, and the enabling software has created a lot of excitement in diabetes healthcare. Although a true artificial pancreas (closed loop self-contained insulin delivery device) has not yet been launched, several technological improvements have been made and some new more advanced devices are obtaining approval in the U.S. and other countries.
Improvements in the technology are most apparent in the software, which is advancing from making decisions on current glucose levels and the use of high and low thresholds to sophisticated algorithms for predicting future glucose levels from current trends. This allows for adjustment of insulin delivery before critical glucose levels are reached.
A predictive approach based on trends is much more physiologic and may prove to be more effective and safer than threshold based algorithms.
Integrated systems are gaining approvals and becoming more available to patients. In August the U.K.’s National Institute for Health and Care Excellence (NICE) issued a
The system consists of an insulin pump, a continuous glucose sensor and a transmitter. The transmitter wirelessly sends glucose readings to the pump where the software makes adjustments to the amount of glucose being delivered.
NICE has cited a safety feature, “low-glucose-suspend,” as a key reason for its recommendation. The low-glucose-suspend feature is not available on the other devices considered by NICE. The safety feature automatically stops insulin delivery for two hours when a preset low glucose level is reached. The user can reprogram the device if they respond to an alarm alerting them to the low glucose level.
The MiniMed system has been available in the U.K. for several years and has recently been approved in Australia and other countries. The MiniMed 640G system is available in the U.S. and Medtronic is currently conducting a clinical trial of the predictive low glucose management system.
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