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Diabetes and technology: The future is now - continuous glucose monitoring and continuous subcutaneous insulin infusion therapy

Diabetes mellitus treatment is currently experiencing huge improvement due to technological progress. The future of diabetes treatment will greatly benefit from the new technologies mostly through innovation from glucose measurement to insulin dosing. Continuous glucose monitoring systems (CGM) uses an electrochemical enzymatic sensor measuring glucose in interstitial fluid at regular intervals. Self-monitoring of blood glucose (SMBG) has been shown to be helpful in many patients, however, with some limitations. In situations when there is a discrepancy between actual glycated hemoglobin (A1C) and SMBG, CGM should be used. A1C is valuable in management of many diabetic patients ; it is indicator of all over glycation risk for chronic complications. Though, it does not provide personalized diabetes management. CGM data should be used to assess hypoglycemia and glucose variability. A professional CGM is device owned and managed by medical professional. While wearing professional CGM patients do not receive any information about glucose excursions and do not change their everyday habits. Real-time CGM provides a continual display of interstitial glucose on the monitor of CGM device, insulin pump, mobile phone etc. It offers different alarms of hypo or hyperglycemia, but it must be calibrated to capillary blood glucose. Unlike real-time CGM, flash (intermittent) glucose monitoring requires the scanner to be moved over the sensor to displayed glucose values. It provides up to 8 hours of retrospective analysis ; it is used for 14 days and does not require calibration. Flash monitoring does not provide alarms and does not integrate with insulin pump devices. Insulin pump is a device that delivers insulin continuously into the body. In that way it imitates better physiological insulin secretion then standard insulin application in type 1 diabetes, especially in demanding cases with many hypoglycemias. Insulin pump consists of the pump itself (including controls, processing module and batteries), a reservoir for insulin inside the pump, a disposable infusion set with cannula placed under the skin and a tubing system that connects insulin reservoir. Insulin pump delivers insulin for 24 hours- physician predefines a basal rate, mostly after analysis of CGM data sheet. A bolus doses are set before the mealy by the patient. An insulin pump requires maximal co- operation of the patient and some technology skills. Artificial pancreas integrates CGM and insulin pump with a closed loop system. The data from CGM are providing blood glucose readings ; a sensor is connected wireless to the insulin pump that can automatically adjusts basal insulin based on CGM readings and keep glucose levels in target range. Artificial pancreas stops insulin at or before reaching preset low limits and automatically restarts insulin when glucose levels recover. Using artificial intelligence insulin pump combines a CGM and dynamic algorithm that continuously tracks and provides personalized insulin dosages every five minutes based on real- time glucose values.

diabetes ; technology ; continuous glucose monitoring ; continuous subcutaneous insulin infusion therapy

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