4 New High-Tech Tools to Help Control Diabetes

By: Katherine Kam

Reviewed by: John A. Seibel, MD

Diabetes can make huge demands on you. For many patients, the daily routine involves painful finger sticks, glucose tests, and insulin injections -- all in an effort to keep blood sugar and diabetes under control.

But new devices, such as continuous glucose monitors, may make it easier for many of the nation’s 21 million people with diabetes to control the disease, according to Aaron Kowalski, PhD. Director of strategic research projects at the Juvenile Diabetes Research Foundation.  Kowalski is himself a type 1 diabetes patient. “We think there are some new technologies that hold tremendous promise,” he says. “It’s an exciting time.” 

Not all new devices make it, though. Some have fizzled after the fanfare. In 2001, the GlucoWatch debuted. It was a wristwatch-like device that measured glucose from fluid through the skin. Many hoped it would replace the difficult finger stick. “The expectations were extremely high,” says Kowalski. “But it was disappointing on many levels.”

Among the problems? Skin irritation and inaccurate readings.

But Kowalski and other experts predict that newer technologies that aim to help people control their diabetes may fare much better.  And controlling diabetes is very important. Over time, long-term, high blood sugar can lead to eye, heart, kidney, and nerve disease and other complications. Low blood sugar can also quickly trigger immediate emergencies, such as seizures, coma, and death.

Here’s WebMD’s roundup of some of the latest breakthroughs in diabetes control tools.

New Diabetes Control Tools: Continuous Glucose Monitors

Many people with diabetes lance their fingers 2 or more times a day to check glucose levels. But even with as many as 9 finger sticks a day, patients still spend less than 30 percent of the day in a normal range, Kowalski says. “It’s often a teeter-totter that a person with diabetes stands on.”

Now, imagine getting a glucose reading every 5 minutes. That’s 288 readings in 24 hours -- or almost 100 times what one would get with 3 finger sticks a day.

It is now happening, thanks to continuous glucose monitors (CGMs) that have come on the market in the past 2 years. With a CGM, the user inserts a disposable, needle-like sensor under abdominal skin. The sensor measures glucose in interstitial fluid, not blood. This is fluid found between the body’s cells. The sensor then transmits the data every 5 minutes to a monitor.

“It shows graphically what the patient’s glucose level is doing in real time 24 hours a day,” says Steve Sabicer, spokesman for Medtronic. (This is the company that introduced the first CGM in 2005.) 

When people can see glucose trends continuously, they can make “real-time” decisions, says David Klonoff MD, FACP, Medical Director of the Diabetes Research Institute at Mills-Peninsula Health Services in San Mateo, California. For example, it helps them know when to inject insulin or to eat. “They can take action right now. They spend less time with high blood sugar and less time with low blood sugar.”

There is some debate about the accuracy of CGMs compared to regular blood glucose meters. “Right now, scientists are creating standards to measure the new devices’ accuracy,” says Klonoff, who also edits the Journal of Diabetes Science and Technology.

But some research already shows encouraging results. The journal Diabetes Care recently published a study of 91 diabetes patients. Subjects using CGMs spent 26 percent more time in normal glucose range than a control group without the devices.

Does this mean that people can toss out their dreaded lancets? Not yet, says Sabicer. Currently, all CGMs instruct users to do a “confirmatory” finger stick test before taking action, such as injecting insulin. Also, CGMs aren’t approved for those under 18, and insurance doesn’t routinely cover the devices. 

But Kowalski, who has used a CGM for 6 months, says that many people -- including him -- are already beginning to free themselves from finger sticks. He’s down to 2 finger sticks per day and he does this only to calibrate the device. The rest of the time, he relies on the CGM readings.

“It is life-changing,” he says, adding that he believes continuous sensing will soon completely change diabetes.

“Certainly, we’re moving toward a finger stick replacement with improving the accuracy of these devices,” says Sabicer. But for now, Medtronic urges patients to keep double-checking readings.

Another advantage of continuous monitoring: It alerts a patient when glucose is too high or low. Although some users have complained of being awakened too much, an alarm will sound if glucose levels fall dangerously low during sleep. “It’s a great tool that’s never been available before,” Sabicer says of CGMs. “Patients have a security blanket or insurance policy that’s always looking out for them.”

New Diabetes Control Tools: Combination Continuous Glucose Monitor and Insulin Pump

Patients who use insulin now have another option besides stand-alone CGMs. In April 2006, the Food and Drug Administration (FDA) approved Medtronic’s MiniMed Paradigm REAL-Time, the first combination CGM and insulin pump. [5]

“It’s the only combination product on the market,” Sabicer says. “Patients can both monitor their blood glucose and administer insulin therapy through the insulin pump.”

It’s not an automated system; patients must still make decisions about insulin dosing. But the Juvenile Diabetes Research Foundation has hailed it as a “significant step” toward one of its major research priorities: That is development of an external, artificial pancreas that could someday automatically measure glucose and deliver insulin -- much like the real thing.

New Diabetes Control Tools: Diabetes Information Management Software

Increasingly sophisticated software programs allow patients who use regular blood glucose meters to track and analyze trends, Klonoff says. Patients can download stored data from their meters onto a computer. Then, for example, they can view charts that show what percentage of time their glucose levels were within normal ranges, as well as above or below normal.

Bayer HealthCare’s latest software can even identify rapid swings in blood glucose, which signal that patients have over-treated themselves with insulin or food, says Paul Inman, director of research and development.

“There’s some evidence that people who use these types of software have better outcomes than people who don’t,” Klonoff says. “They have more information and it’s analyzed for them.” Patients can also share the information with their doctor to guide treatment.

What’s next? One company, HealthPia America, hopes to soon introduce a combination cell phone and glucose tester, a “telemedicine” device that allows the user to transmit the stored data to a doctor’s office, according to HealthPia President Steven Kim.

New Diabetes Control Tools: Smaller, Hidden Insulin Pumps

When the Omnipod Insulin Management System came on the market in 2005, it signaled a new generation of pumps. These were small, disposable, worn directly on the skin, and concealed under clothing. [7]

“It’s a completely different animal. It’s the size of a small half-kiwi or a small Matchbox car,” says Elizabeth Vivaldi, director of marketing at Insulet Corp., maker of the Omnipod. The pump, a compact “pod,” weighs only 1.2 ounces when its insulin reservoir is full.

“You can hide it. People don’t need to know,” says Kowalski, who wears an Omnipod. He says that many people resist conventional insulin pumps. They’re typically worn on one’s belt like a small cell phone, with short tubing to deliver insulin through a needle inserted under abdominal skin. Many people dislike hooking up the pump and they try to conceal the tubing. 

In contrast, the Omnipod adheres to the abdomen, lower back, arm or other site. It also gets rid of the tubing. Instead, it delivers insulin through a small cannula inserted under the skin. When it’s time for an insulin dose, the patient uses a wireless, handheld device to control delivery. Omnipods are worn for up to 3 days and then replaced.

While the Omnipod is a “pod pump,” Klonoff says, “there are many scientists working on even smaller pumps.” Every component has to be miniaturized, he adds, perhaps to the point of creating a “patch pump” about the size of a wallet.

Kowalski says that the future of pump therapy may be disposable, patch-like pumps, maybe something a little bigger than a Band-Aid.

“Absolutely a huge deal,” he says.

SOURCES:

Aaron Kowalski, PhD, director of strategic research projects, Juvenile Diabetes Research Foundation. Steve Sabicer, Medtronic spokesman. David Klonoff MD, FACP, medical director, Mills-Peninsula Health Services Diabetes Research Institute. Steven Kim, president, Healthpia. Elizabeth Vivaldi, director of marketing, Insulet Corp. American Diabetes Association web site, “All About Diabetes.” Joan Lee Parkes, PhD, CCRA, Jane Wallace and Paul Inman, Bayer HealthCare spokespersons. Garg, Satish. Diabetes Care, January 2006; 29(1): 44-50