Diabetes mellitus is one of the top 10 causes of mortality and morbidity worldwide. Additionally, annual worldwide health care expenditure due to diabetes is $726 billion or more (Diabetes Res Clin Pract 2019;157:107843). Advancements in technologies that support diabetes management have greatly increased in recent years (Lancet Diabetes Endocrinol 2018;7:657). Hardware and software developments offer patients and physicians tools to better facilitate glycemic control, decrease hypoglycemia, and reduce the everyday burden of diabetes self-management in patients’ lives. Perioperative insulin management can now happen at the touch of a button! Innovations revamping the field include smart insulin pens, newer and smaller insulin pumps with wireless technology and closed loop systems, and even smartwatch apps. These technical advances make frequent pinpricks to check blood glucose levels redundant while providing a wealth of information that can be correlated in real time to stressors and therapeutic interventions. Better glycemic control can mean a smoother perioperative course, better overall diabetes management, and billions of health care dollars saved.
Smart insulin pens
Insulin pens as an alternative to syringes were first introduced in the late 1980s. Their latest avatar is the smart insulin pen, which is a reusable injector pen with an intuitive smartphone app that can help people with diabetes better manage insulin delivery (asamonitor.pub/3J1lWEy). This smart system calculates and tracks doses and provides helpful reminders, alerts, and reports, and can come in the form of an add-on to a current insulin pen or in a reusable form that uses prefilled cartridges instead of vials or disposable pens. These devices are programed to remember how much insulin someone has taken and when they took it last, notify them on insulin expiration, help prevent a missed or skipped dosage, and tell them if the insulin is too hot or too cold. What’s more, they can hold up to a year’s worth of insulin doses!
“Hardware and software developments offer patients and physicians tools to better facilitate glycemic control, decrease hypoglycemia, and reduce the everyday burden of diabetes self-management in patients’ lives. Perioperative insulin management can now happen at the touch of a button! Innovations revamping the field include smart insulin pens, newer and smaller insulin pumps with wireless technologyand closed loop systems, and even smartwatch apps.”
The Bluetooth interconnectivity with other smart devices such as phones and watches is a great tool to help track and share data through mobile apps and online platforms. Doctors can see patient data in real time, and individuals can store and manage the resulting data points to track and manage their diabetes. Smart insulin pens are designed to be simple to use even for the less computer literate and for those who are looking for other options of insulin delivery or for a backup to their insulin pump. The Medtronic InPen is the only U.S. Food and Drug Administration (FDA)-approved smart insulin pen currently on the market (asamonitor.pub/3J6SWve).
Apple entering the field
Apple stores now sell Bluetooth-enabled glucometers that link to the iPhone and Apple Watch, while Dexcom’s G6 continuous glucose monitoring (CGM) system’s software is being upgraded to work directly with Apple’s smartwatch. Soon, the Apple Watch may tell you if your blood sugar is too low and that it’s time for a Snickers bar!
No longer limited to diabetes?
A new CGM called Libre Sense Glucose Sport Biosensor is an over-the-counter product from Abbott and Supersapiens to advance glucose monitoring via a mobile app. Athletes aged 16 and older of various sports (swimming, running, cycling, and high-intensity training) can capture real-time data of their glucose levels during training and competition. This allows athletes to better understand the efficacy of their nutritional choices. Data tracking of this magnitude helps users learn when to fuel appropriately to avoid fatigue from low glucose and maintain peak performance (asamonitor.pub/3NFcB8Q).
While these advancements are good for both patient and provider, two factors persist in limiting wider distribution of such technology: accessibility and cybersecurity (J Diabetes Sci Technol 2015;9:1143-7). A lack of household internet access, visual/hearing impairments, and issues with cognitive ability are all roadblocks to a broader rollout of patient-controlled diabetes management technology. Additionally, concerns around data and control have slowed adoption of interconnected treatment technologies (J Diabetes Sci Technol 2019;13:817-20).
Overall, technology for diabetes management is becoming more informative, more portable, and more patient- and provider-friendly every year. It is up to the anesthesiologist to learn how to use these devices so perioperative and intensive care glucose management can be streamlined, easily recorded, patient friendly, and even painless!