Diabetes: Scope of Diabetes Management
Aug 17, 2022
15 min readAdd to Favourite
Aug 17, 2022
15 min readAdd to Favourite
Diabetic patients require daily blood glucose checks and insulin injections to maintain their blood glucose levels within the target range. Technology improvements have caused a substantial change in diabetes management in recent years.
Referring to diabetes cure technology, the doctor probably means technology that makes it easier for diabetic patients to take insulin or technology that measures their blood sugar levels. This technology for managing diabetes comes in many different forms, including insulin pumps and continuous glucose monitoring (CGM). CGM has taken the place of finger pricks, while insulin pumps have simplified the administration of insulin.
An advance directive for the treatment of diabetes should be adopted. Absolute insulin insufficiency results from type 1 diabetes, which is caused by autoimmune pancreatic beta-cell death. The treatment of type 1 diabetes has recently benefited from significant technical advancements. New insulin administration devices and interstitial glucose-based glucose testing devices are two examples of these. The quality of life and glucose management in this condition may be enhanced by these technologies. Type 2 diabetes, which is on the rise and accounts for 90% of all instances of diabetes worldwide, is a serious health concern. Insulin therapy is often necessary as the condition worsens due to the resulting insulin shortage and hyperglycemia. Although it is obvious that many type 2 diabetes patients need their treatment to be intensified, this does not always happen. This may be because of individual preference, limited health literacy, or fear of side effects. An increased risk of diabetes, particularly type 2 diabetes mellitus in females, is associated with gestational diabetes mellitus. Prenatal diagnoses of gestational diabetes mellitus are becoming more frequent and have a significant impact on mother and fetal morbidity. Recent technological developments offer useful ways to simplify glucose monitoring and increase the precision and safety of insulin administration. This has made diabetes detectable and controllable with comfort. There are many diabetes management systems as shown in Exhibit 1 which help diabetic patients achieve a better quality of life.
Diabetes requires a high burden of care making it associated with poor quality of life. To improve the condition of diabetic patients, there are technologies available for glucose monitoring.
Self-monitored blood glucose (SMBG)
Self-monitored blood glucose with finger stick glucose (FSG) concentrations is the rapid care for diabetic care. It is a method by which people with diabetes measure their blood sugar using a blood glucose meter. Based on the readings, people can adjust or check the effectiveness of their treatment. It has raised the capacity to find blood sugar measurements and support therapy accordingly. It helps to control blood glucose levels and cure hypoglycemia.
The enhanced speed of SMBG may raise glycemic control. There are a few more advanced new glucometers with blue tooth enabled that can be operated with smartphone applications for better detection and patterns. There is a restricted use for FSG as they provide the current glucose information but cannot detect glucose trends or the change associated. In the broader context of diabetes self-management, self-monitoring promotes maintaining blood glucose levels as close to target levels as possible.
Continuous glucose monitoring devices (CGM)
In recent years, insulin-treated patients have been increasingly using continuous glucose monitoring (CGM) systems as an alternative to self-monitoring blood glucose (SMBG) systems. The spot blood glucose measurements and the lack of information on trends or changes in blood glucose limit the clinical utility of SMBG devices and do not detect nocturnal or asymptomatic hypoglycemia. With the ability to overcome these limitations, instant blood glucose monitoring and continuous blood glucose monitoring (CGM) have become more popular. The data provided by CGM can help in finding insulin doses and the proceeded therapy selection. The handy CGM technology is convenient due to its automatic functioning and collection of data regarding glucose levels. Some of the features of CGM devices are:
Improvements in design and accuracy have accelerated the use of the CGM devices in people with type 1 diabetes and type 2 diabetes. In addition to the glycemic benefits of CGM, the ability to review continuous blood glucose data has been recognized to promote healthy lifestyle habits and motivation to exercise, reduce insulin resistance, and improve health, and cardiovascular disease in this high-risk group.
The technology association for the quick and accurate Insulin Administration can have:
Smart pens are next-generation insulin delivery systems that combine a reusable injector pen with a built-in smartphone application to enable diabetics better control the timing and amount of insulin delivered to their bodies. Additionally, the quality of the insulin is estimated by these devices, along with its shelf life and storage circumstances. They also communicate pertinent information to the doctor as necessary. An insulin pen is a reusable device as one can purchase them as an accessory for their existing insulin pen or in reusable form with cartridges that have been prefilled. With the smart pen calculation and tracking of doses becomes easy with the on-time reminders, reports, and alerts. This is the most popular way for type 2 diabetic patients to administer insulin with these insulin pens.
Some features of the insulin pen:
An insulin pump complements diabetes control and reduces the threat of hypoglycemia. Insulin pumps are devices that deliver a series of putting insulin through the inserted cannula in the tissues as continuous subcutaneous insulin infusion (CSII). The insulin pumps are available with the infusion set having a tube to deliver insulin. However, there are some devices called patch pumps that directly get attached to with the skin without any tubing.
These pumps have well-set programmable bolus and basal but that can change as per the timings of the day. These pumps help to track insulin coverage for the meal with the bolus calculator. The calculator helps to maintain the correct level of glucose. The fluctuations of doses can be corrected with the tracking process and can be adjusted by the pump. It can use varied basal rates at different times of the day. It is a short-term basal rate basically to adjust the glucose trends. It helps to provide an extended duration of meal time bolus insulin. The process makes your insulin dose corrected as per the glucose trends.
Automated Insulin Delivery System (AID)
An automated insulin delivery system is an effective system that is safe and helpful in preventing glycemia situations in an individual who is suffering from type 1 diabetes. AID systems are also known as closed-loop, artificial pancreas, or bionic pancreas systems which are composed of a controller, an insulin delivery device such as an insulin pump, and a glucose sensing device such as a continuous glucose monitor (CGM). In this system, the real-time glucose measurements that are implemented into a control algorithm automatically adjust the rate of subcutaneous insulin delivery via an insulin pump. The clinical assessments and practices are advanced up to the level to have the AID system approved for children and adults. There is an area of concern related to the subpopulations like young children, pregnant women, etc. with the improvement of the AID system. The improvement of the AID system is still going on and taking the need of subpopulation as input for improvement.
Advancement in CGM Devices
For more than 40 years, the idea of implanted glucose sensors has been promoted. Continuous glucose monitoring (CGM) is now widely acknowledged to improve quality of life by enabling informed diabetes management decisions as a result of more effective glucose control.
Evolution of CGM Devices
A brief timeline, representing the development of CGM devices over the last 40 years has been shown in Exhibit 2.
Further, the release of some CGM products in the market is outlined in Exhibit 3, while the details are mentioned below:
There are a lot of companies providing CGM systems that require a sensor to be placed under the skin. Some of the special features of CGM devices offered by a few companies are compared in Exhibit 4.
More in the future is Abbott’s Freestyle Libre 3 which will have real-time CGM enabling a person to check at any time and see their readings. In Europe, Medtronic’s Guardian 4 sensor used with the most advanced MiniMed™ 780G insulin pump system demonstrated improved user experience and strong glycemic outcomes. Dexcom G7 will have a fully disposable transmitter sensor combination.
Future innovations in continuous glucose monitoring devices are moving towards integrated devices where players are integrating their CGM devices with an insulin delivery mechanism that is programmed to automatically deliver insulin upon detection of low glucose levels. Players are increasingly partnering with insulin pump companies to provide integrated/automated/closed loop solutions to end users.
Microneedles are increasingly being used as part of minimally invasive continuous glucose monitoring systems to reduce pain and provide comfort. Microneedles are relatively painless and can be implanted more easily when compared to older implantable sensors. Functionalized microneedles are mainly used for two purposes in CGM systems: as a sensor probe/electrode and as biological fluid collection materials.
Many companies are exploring the development and improvement of CGM devices for the non-invasive monitoring of diabetes. Despite the market’s abundance of biosensing platforms for glucose monitoring, there is still a critical need to improve the accuracy, reproducibility, wearability, and accessibility of these systems for end users. More and more research is being done on biosensing technologies, which use various biological fluids like perspiration, tear fluid, etc., that may be calibrated and used to assess correct blood glucose concentrations. Also, the use of exponential technologies like virtual reality, augmented reality technologies, etc. for glucose detection apart from the integration of non-invasive sensors into various wearable formats for non-invasive/ pain-free detection methods is being explored. Other than sensors, there is research going on using fluorescent gels for continuous glucose monitoring where the fluorescent gels are implanted into the living body which exhibits fluorescence response by bonding with glucose.
As per the research data, the future trends will be very exciting with the scope of diabetes management approach having the patient as the focal point. The technological support of the field made the prevention better with the high-tech devices. One can take care of their diabetes with tracking devices. The automated devices can track glucose levels and help patients take action on time towards diabetes control. Further in many patients, CSII-assisted insulin delivery is a well-respected therapy that has shown particularly effective in lowering hypoglycemia and enhancing glucose control.
The expectations are booming with the entrance of nanotechnology in the future of diabetes cure. The technology will be capable to detect diabetes before the symptoms appear to anyone as per the prediction. The technology will measure glucose and induce insulin into the bloodstream directly. Still, all are on the cloud but the future of inventions and research output will be excellent and can be the cure for diabetes for millions.
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