Chances are that one in ten people who crossed your path today has diabetes. The CDC’s 2017 National Diabetes Statistics Report estimates that 30.3 million people in the United States (9.4% of the population, and 12.2% of adults) have diabetes, of whom only 23.1 million are diagnosed. Attaining glycemic control so that the macrovascular and microvascular complications of this disease can be avoided involves changes to diet and physical activity as well as drug therapy.
Today there are more tools than ever available to help patients adhere to their medication regimens and manage their diabetes, but education is still key to maximizing the benefits.
The Role of Diabetes Technology
In light of the increasingly important role that technology plays in diabetes management, the 2019 edition of the American Diabetes Association’s (ADA’s) annual Standards of Medical Care for Diabetes has consolidated information that had been spread throughout the standards. It is now in one dedicated section on diabetes technology, says Joshua J. Neumiller, PharmD, CDE, FASCP, chair of the professional practice committee of the ADA, which develops these standards. The section now focuses on use of insulin syringes versus pens, continuous glucose monitors (CGMs), and insulin pumps, but Neumiller anticipates it will evolve to include other things like apps and other technologies.
According to Jennifer Trujillo, PharmD, CDE, BC-ADM, ambulatory care pharmacist at the University of Colorado Center for Adult Diabetes Care and Research, CGMs, which measure glucose taken from interstitial fluid at five-minute intervals, have been a huge game changer for patients, particularly those with type 1 diabetes (5% of people with diabetes, according to the CDC), helping them with their decision-making about bolus insulin doses.
Real-time CGMs show glucose trends over the last eight hours, display trend arrows that show patients how quickly glucose levels are increasing or decreasing, and alert patients when their blood glucose is falling, which can be a lifesaving feature, says Trujillo.
The Dexcom G6 is a big advancement over older devices, as it can be worn for 10 days, does not require calibration using glucometers, and can interface with smart devices, sharing data with up to five devices, she says. “Parents can look at their phone and know what their child’s blood sugar is and how it’s trending.”
Intermittently scanning or flash CGMs such as the Freestyle Libre, which are less costly than real-time CGMs, require a device to be waved over them to display data from the last eight hours, Trujillo says. Because they do not provide alerts about dropping blood glucose, Trujillo says, flash CGMs may be more appropriate for patients with type 2 diabetes. “Data is power,” she explains. The CGMs “can tell patients what their glucose level is doing all the time, instead of just a couple of independent moments throughout the day.” This enables patients to see how their glucose is impacted by food, exercise, or skipping an insulin dose, she says.
Regardless of which device is used to monitor blood glucose, it is crucial that patients be taught how to use the information they get, says Candis M. Morello, PharmD, CDE, FASHP, director of the Diabetes Intense Medical Management Clinic at the Veterans Affairs San Diego Health System. “We teach them how to use them appropriately so they can learn what their numbers mean and then what to do about them,” she says, “and that always helps adherence.”
Another huge area where technology can aid diabetes management is the plethora of apps that help with carb counting, insulin dosing calculation, healthy eating, setting and meeting fitness goals, maintaining glucose logs, tracking lab data, and more, reports Trujillo. The challenging part is keeping track of new apps since this changes so fast, Neumiller says.
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