Innovation in Diabetes Management
A variety of innovations in diabetes management have improved healthcare and outcomes.
A. Diabetes Medications113, 114
When insulin was first used 100 years ago, it transformed diabetes from a fatal illness into a chronic one. Since that time, the lives of people living with diabetes have been transformed by many treatment innovations.
Insulin has evolved from animal insulin, taken from the pancreases of pigs or cows, to human-made, or human insulin. Additional innovations have made insulin treatment more flexible with varying durations of action or more flexibility in injection timing. For example, there are longer-acting insulins that lasts close to two days and ultra-rapid insulins that start acting within minutes of injection.
Advances in diabetes treatments have created a broader range of treatment options to meet peoples’ diverse needs, simplify treatment regimens, improve adherence and reduce the risk of hypoglycemia. Some new treatments address comorbidities or complications, including reducing the risk of major cardiac events such as stroke or death.
In the past, reducing glucose levels was the sole priority when choosing diabetes medications, says Tanner, “however, diabetes management is no longer glucocentric.” In addition to lowering glucose levels, the management of diabetes takes a holistic approach that also prioritizes reducing the risk of complications, lowering the risk of hypoglycemia and taking into consideration the effect on weight. For example, says Tanner, an older medication may work well to lower glucose but may carry the risk of hypoglycemia and cause the person to gain weight. “Imagine having diabetes, receiving counselling to lose weight and being prescribed a medication that makes you gain weight!”
In contrast to the older agents, says Tanner, “some of the newer medications lower the risk for those with or at high risk of heart disease, kidney disease and heart failure.” In addition, some of the newer medications can help with weight loss, a recommended diabetes management strategy.
Newer oral medicines that combine different classes of diabetes medications can reduce pill burden and barriers to treatment adherence. Research shows that people who use these combination medicines use fewer healthcare resources and have an increased life expectancy.
B. Hybrid Closed-Loop Insulin Delivery Systems115, 116, 117, 118, 119
Hybrid closed-loop insulin delivery systems (HCL)120 are an emerging technology for the management of type 1 diabetes. HCLs integrate a real-time continuous glucose monitoring (rtCGM) with an insulin pump and a computer program with a control algorithm that automatically determines insulin needs and keeps the user within their pre-determined blood glucose range. It is called a hybrid system because users must manually occasionally account for insulin needs (e.g., meals or snacks). HCLs can alleviate the mental and emotional burden of around-the-clock diabetes management, and evidence shows that users are likely to experience lower average glucose levels, less hypoglycemia and more time in range.
“I wear a CGM that I rely on a lot,” says Pelcz, “because it will sound an alarm if my glucose levels are rising or falling. My insulin pump and CGM are interconnected, and my CGM sends my glucose readings right to my pump and my phone. Not only will I receive alarms, if necessary, but the system can also suspend my pump from giving me insulin, or if my levels are going higher, give me more insulin.”
C. Digital Diabetes Care
Digital diabetes care combines virtual healthcare with digital health tools and remote connectivity to allow healthcare providers to assist people with diabetes in managing their condition. Although the tools have been available for some time, they demonstrated their real value when COVID-19 hit.121
Digital diabetes care technology integrates medical devices, such as glucose monitors and insulin pumps, with physician clinical decision support software. Digital connectivity provides an overview of peoples’ progress, allows healthcare providers to monitor their patients health status, recommend medication adjustments and provide remote coaching.122
Virtual care allows a person to meet where they are at, says Tanner. “With the rates of diabetes increasing, virtual care is seen as a feasible way of improving the ability of healthcare providers to see a large number of people.”
Research shows that digital diabetes care can result in a significant improvement in A1C levels and reduced diabetes complications and healthcare costs. It has been shown to be just as effective as diabetes care received in-person, with no difference in A1C, blood pressure or cholesterol levels.123, 124
“With the emergence of virtual health as a growing employee benefit,” says Adams, “digital diabetes programs are an ideal vehicle to deliver employer-sponsored chronic disease management and health coaching programs.”
120 Hybrid closed-loop insulin delivery systems (HCL) are sometimes referred to as an artificial pancreas; however, the current umbrella
term is automated insulin delivery, or AID, and HCL is a type of AID.
121 https://www.diabetes.ca/about-diabetes/stories/virtual-care-isintegral- to-the-future-of-diabetes-management