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Diabetes Management Technology Update - Summer 2019

Date Posted: Friday, July 19, 2019

New insulin pumps, other infusion devices, continuous glucose monitors (CGM) and smartphone apps continue to hit the market.  The latest technology offers a variety of options for people living with type 1 and type 2 diabetes, depending on needs and preferences.

THE LATEST INSULIN PUMPS

t:slim X2 insulin pump with Basal-IQ technology

This touchscreen pump integrates with the Dexcom G6® CGM (see below) to predict and help prevent low blood sugar (hypoglycemia) without finger-sticks.  Free upgrades are available to download (there may be a charge for some) using a personal computer.  Tandem Diabetes describes the Basal-IQ™ technology as a predictive low glucose suspend feature designed to help reduce the frequency and duration of low blood glucose. 

Coming soon: Control-IQ closed loop feature, which in addition to predicting and automatically adjusting basal rates, will also make hourly correction boluses to help prevent high blood sugar (hyperglycemia). Tandem hopes to receive FDA approval and launch it by the end of 2019.

MiniMed 670G Hybrid Closed Loop System

This device is approved for people 7 years or older who are living with type 1 diabetes.  The system delivers basal insulin every five minutes and constantly self-adjusts to help avoid highs and lows.  It features Medtronic’s SmartGuard™ technology and the Guardian Sensor 3, their most accurate CGM to date. 

Coming soon: Minimed 780G will include a more accurate and reliable algorithm.  I’ll provide automatic correction blousing and will automatically adjust for missed meals.  It will also offer free downloadable updates when new software becomes available. Clinical trials are expected to be completed by mid-2020.

OmniPod DASH™

This tubeless, waterproof wearable Pod provides up to 72 hours of non-stop insulin and works with a touch-screen Personal Diabetes Manager (PDM) that looks like a smartphone.  It’s now covered by pharmacy benefit with many insurance companies, including Medicare, as opposed to traditional Durable Medical Equipment (DME) coverage.

Coming soon: Insulet is working on downloadable upgrades for future versions of the OmniPod DASH.

OTHER INSULIN DELIVERY DEVICES

V-Go by Valeritas

This is a patch pump for people living with type 2 diabetes who require multiple daily injections (MDI).  Medicare now covers the V-Go under Part D, and such "disposable patch-like devices" were recently added to the American Diabetes Association’s Standards of Care for type 2 diabetes.

InPen by Companion Medical

This “smart insulin pen”, is a reusable injector pen that interacts with smartphones.  The ½ unit refillable pen helps to calculate doses and also keeps track of injection data.  It’s an option for people who take multiple daily injections, but do not want to wear a pump.  It can also be a backup for the pump or by those who want to take a pump break.

Ergonomic Pen Needles by BD

The BD Nano 4mm pen needle was the smallest, thinnest pen needle, designed for comfort.  Its improved insulin flow through the needle made it simple to use, even for people with hand-strength challenges. 

The Nano 2.0 concentrates and distributes force to allow better depth for insulin absorption and less pain.  BD says the 2nd generation redesign makes the device even easier to use and provides a more comfortable injection experience.

CONTINUOUS GLUCOSE MONITORS (CGM)  

“Continuous glucose monitoring continues to improve greatly.  People who once did not want a device attached to them, now find it indispensable.  A comment I often hear is that they feel like they had previously been ‘operating in the dark.’  The latest CGM’s are more accurate and easier to use.  They’re helping our most brittle patients finally get their diabetes under control.”   
- Dr. Michael Thompson, Chief, Adult Diabetes Clinical Research, Ambulatory Physician Leader at UMass Diabetes Center of Excellence    

Dexcom G6

This patch device is about the size of a quarter and gets applied to the skin of the abdomen.  It contains a small sensor which continuously measures blood sugars and transmits real-time data every five minutes to most smartphones or to a Dexcom receiver.  It does not require finger stick calibration, and sounds an alarm when readings go too high or low.  The sensor integrates with the t:slim X2 insulin pump (described above).  When integrated with an insulin pump, a drop in sensor glucose will automatically trigger the cessation of insulin from the pump. In the future, it will integrate to control insulin delivery from certain pumps.  The G6 device should be replaced every 10 days.  

FreeStyle Libre Flash

This 14-day wearable device allows for frequent blood sugar checks without finger sticks.  Instead, there’s a downloadable app available for most smartphones, or Libre also provides a reader device.  The phone or device is swiped/scanned over a small sensor worn on the arm.  People who use a pump but do not require reminders or alerts about high or low blood sugars may find this device suitable.

Coming soon: The Libre 2.0 will offer optional real-time alerts.  It will alarm if sensor connection is lost or if it predicts low or high sugars, and prompt the user to scan for a real-time reading.

Sugar.IQ Machine-Learning

This downloadable app is a “diabetes assistant” which works with Medtronic’s stand-alone Guardian Connect CGM, without a pump.  It recognizes patterns and provides individualized tips to help users keep blood sugars within target range.

Eversense Implantable CGM

This sensor is about the size of a piece of rice and gets implanted under the skin by a doctor, where it remains for 90 days.   The removable, rechargeable and water-resistant transmitter sends data to a smartphone or smart watch every 5 minutes.  It provides on-body alerts even when your phone is not nearby.  It does require two finger stick calibrations each day.

Coming soon: The 180 day version is currently available overseas but not yet approved in the United States.  

INJECTABLE GLUCAGON

Gvoke by Xeris Pharmaceuticals

Glucagon is the standard of care for treating severe hypoglycemia (low blood sugars).  The FDA plans to decide by September 10, 2019, whether to approve this EpiPen-style glucagon rescue pen.  Once approved, it will take emergency glucagon treatment to the next level, from the current mix kits which have been used for decades.

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