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Diabetes mellitus - new technologies

Diabetes mellitus technology is increasingly used for routine management of the disease so the future of diabetes treatment will greatly benefit from the new technologies. Technology is used mostly through innovation of glucose measurement and insulin dosing, or the combination. Continuous glucose monitoring systems (CGM) uses an electrochemical enzymatic sensor measuring glucose in interstitial fluid at regular intervals. CGM have increasingly become more available and affordable providing personalized diabetes management. CGM data are used to assess hypo and hyperglycemia as well as glucose variability through standardized ambulatory glucose profile. Using CGM new markers of glucose regulation are revealed, on the most important one is time in range. 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 and does not require calibration. Since the commercial availability in late 1970s of continuous subcutaneous insulin infusion, commonly known as insulin pumps, such technology continues to evolve. 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 hypoglycemc events. 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. A bolus doses are set before the mealy by the patient. 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. A smart insulin pen is a reusable injector pen with connection to a phone app that calculates and tracks doses providing reminders, alerts, and reports.

Diabetes mellitus ; technology ; insulin pump ; CGM

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