12th Feb 2020

Technology in diabetes: Paving the way to automated insulin delivery


Abigail Holland, BSc, MSc, PhD
Medical Writer

In 2019, there were an estimated 54 million individuals aged between 20-79 years living with diabetes in the Middle East and North Africa (MENA) region.1 Approximately 419,000 deaths were attributed to diabetes in this same age group in the MENA region in 2019.1 The self-management of diabetes involves an on-going routine of blood glucose monitoring, adhering to antidiabetic medication regimens, physical exercise and diet.2

Modern technologies are now able to assist diabetic patients in their self-management activities to lessen the burden and distress that can be associated with self-care. The aims of such technologies are to help individuals suffering from diabetes to manage their blood glucose levels, prevent or reduce any complications associated with the disease, reduce the burden of diabetes as well as improve the quality of life of those suffering from the condition.3 The two main areas of healthcare technology development within this field are in the administration of insulin and in the monitoring of blood glucose levels.

Insulin administration: Insulin pumps are portable electronic devices which deliver small amounts of insulin continuously throughout the day as well as delivering variable amounts of insulin at mealtimes. Such devices deliver insulin into the fatty layer underneath the skin (most commonly around the stomach area) via a cannula and tube attached to the device. Such pumps can be connected wirelessly to glucose meters, to ensure that the required levels of insulin are delivered based on blood glucose levels.4

Blood glucose monitoring: Self-monitoring of blood glucose (SMBG) can be undertaken using portable glucose meters and is especially important for type 1 diabetics or those taking insulin.5 SMBG enables patients to assess their own response to treatment and ensures that glycaemic control is being reached.3 Continuous blood glucose monitoring (CGM) measures glucose in interstitial fluids at regular time intervals (up to every 15 minutes). CGM enables diabetic patients to adjust their insulin levels more precisely and therefore reduces the potential for severe episodes of low blood glucose (hypoglycaemia) or high blood glucose (hyperglycaemia).6  Flash, or intermittently scanned, CGM measures glucose in interstitial fluids via a thin filament placed under the skin and provides the individual with their glucose levels upon scanning a reader over a sensor.3Automated insulin delivery (AID) systems, also known as an artificial pancreas, have now been developed and incorporate the use of CGM with an insulin pump and a computer algorithm to calculate insulin requirements based on blood glucose levels.6

Whilst the healthcare technologies discussed above offer diabetics greater control of their condition, education and training are essential to reduce human error and the incidence of adverse events.7 In addition to the technologies to assist in insulin delivery and blood glucose monitoring, other technologies, such as smartphone applications and web-based programs, can assist diabetes patients in managing their physical exercise and nutritional intake as part of diabetes self-management.8

 

  1. International Diabetes Federation. Middle East and North Africa Diabetes Report 2010 — 2045, 2019 [Last update 25 November 2019. 9th Edition]. Available from: https://diabetesatlas.org/data/en/region/4/mena.html
  2. Danesi G, et al. 2020. Soc Stud Sci; 306312720903493.
  3. American Diabetes Association, 2019. Diabetes Care; 42(S1):S71-S80
  4. Endocrineweb, 2019. Insulin Pump Overview. Available at: https://www.endocrineweb.com/guides/insulin/insulin-pump-overview [last accessed 06 February 2020]
  5. Montagnana M, et al. 2009. Clinica Chimica Acta; 402:7–13
  6. Umpierrez GE & Klonoff DC, 2018. Diabetes Care; 41:1579–1589
  7. Heinemann L, et al. 2015. Diabetes Care; 38(4):716-22
  8. Rollo ME, et al. 2016. Diabetes Metab Syndr Obes;9:381-390