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What new technologies are there for the management of diabetes?

Kelley-Ross Pharmacy GroupAsk The PharmacistWhat new technologies are there for the management of diabetes?
31
Jan
2021
31.01.2021

Make your diabetes management easier with technology!

Diabetes has been affecting millions of Americans and it has been an unpleasant battle. Risk of having diabetes can increase the risk of stroke by 2 to 4 times higher and decease the survival from first heart attack by half. However, the latest and greatest technologies are making future bright for the diabetes patients. And, here are information for some of these handful technologies.

Freestyle libre

The FreeStyle Libre was the first continuous glucose monitoring (CGM) system which relieved the unpleasant experience of frequent needle sticks to test blood glucose. Applying a 14-day use freestyle libre sensor through sensor applicator on back of your upper arm allows you get a review of your blood sugar by simply waving over the sensor with the reader.

For more information: https://www.freestylelibre.us/myfreestyle.html?gclid=EAIaIQobChMI1fK4svS_7gIVWxmtBh3V0gDYEAAYAiAAEgKHLfD_BwE

Advantages Disadvantages
The box comes with 2 sensors. Each sensor is 14 days supply which means each box is 1 month supply. Needs to be scanned at least once every 8 hours
The reader displays the current glucose reading, the latest 8 hours of continuous glucose data and a trend arrow showing if glucose levels are going up, down or changing slowly. The FreeStyle Libre 14-day system is accurate in the range between 40 to 500 mg/dL and only shows glucose values in this range. If “LO” appears on the reader, your reading is below 40 mg/dL
Reader stores up to 90 days of glucose data and has easy-to-understand graphs of your glucose history This device does not provide clinical decision support which means it could not decide how many units to inject next.
Does not need calibration, not like older continuous glucose monitors required fingersticks for calibration.
The reader has both sounds and vibration for confirmation, notification, and repeated reminder.

The newest Libre 2 device has sound and vibration for low/high blood glucose in addition.

 
Covered by insurance. Most privately insured patients pay between $10 and $75 per month for FreeStyle Libre 2 or FreeStyle Libre 14-day sensors.  

 

T:slim X2 insulin pump

T:slim X2 is also the first pump system that calculate insulin levels every 5 minutes. With Basal-IQ Technology, it can decide how many units of insulin to deliver next to prevent the sugar level getting too low or too high. This touchscreen pump has another unique feature in which this device can be updated its features by plugging into computer which allows the patients to experience the updates without new expensive hardware.

For more information:

https://www.tandemdiabetes.com/products/t-slim-x2-insulin-pump

Advantages Disadvantages
Water resistant device

Tested to 3 feet for 30 minutes

The pump is not indicated for use in patients less 6 years old.

It should also not be used in patients who require less than 10 units of insulin per day or who weigh less than 55 pounds.

Convenient with large color touchscreen, 40% smaller than other pumps, and rechargeable by micro-USB ports Should change infusion set which is a wire that connects pump and skin to deliver insulin to flow.
Bluetooth wireless technology Requires other devices to function more conveniently, such as control IQ technology or Basal-IQ technology which adjust insulin delivery.
Health insurance typically covers 80 percent of the cost of the pump. t:slim G4 users still need to pay $399 to receive a refurbished t:slim X2 or purchase a new t:slim X2 for $799 under coverage.
Medtronic MiniMed 670G

This was one of the first closed-loop system which acts like real organ. This device contains a continuous glucose monitor (CGM) which checks blood sugar level constantly, a pump which determines whether you need insulin, and delivery of correct dose to keep blood sugar steady all day long. So, this device has clinical decision support meaning it decides how many units to inject next.

For more information:

https://www.medtronicdiabetes.com/products/minimed-670g-insulin-pump-system

Advantages Disadvantages
Waterproof pump, protected against the effects of being underwater to a depth of up to 12 feet for up to 24 hours Needs wi-fi to send BG meter readings to pumps through compatible meter comes with MiniMed™ 670G system.
At any time, the user can review 90 days of pump history. Still have to input the bolus insulin dose based on what patient eat.
Can change the bolus speed:

Standard: 1.5 units/minute

Quick: 15 units/minute

Not deliver glucagon. The trouble has been finding a form of glucagon that is stable enough to work in the pump.
Cost starts at $50/month. This calculation is based off typical patient responsibility for 20% co-insurance. MedT notes it has coverage with 600+ plans nationwide 50$/month doesn’t include a separate receiver device like other CGMs so you’re only paying for the transmitter and Guardian 3 sensor.
Basal delivery also ranges from 0 to 35 units per hour  

 

Inpen

This device works like a pump by offering memory capability, but not tethering to the device which makes it more convenient for the patients. It connects via Bluetooth to smartphone app to determine insulin dose. Diabetes patients can keep track of exactly how many units you injected throughout the day, as well as the timing, and how many units of insulin you still have on board (IOB). The device can decide how many units to inject next when patient enter current blood sugar and number of carbs consumed on the InPen app.

For more information:

https://www.companionmedical.com/get-inpen/?utm_source=google-lg&utm_medium=cpc&utm_campaign=gads-lg&gclid=EAIaIQobChMI7cu79vS_7gIVXj6tBh0UgwenEAAYASAAEgJszfD_BwE

 
Lasts for a full year and comes in a variety of spiffy colors. Plus, covered under one-year warranty. Now available for ages 7 and up.

Under age 7 with adult supervision only

Compatible with Novolog, Humalog, and Fiasp cartridges. Can deliver half units Need to inject every time to update on blood glucose.
Monitors insulin temperature Cartridges are not included with InPen. You’ll need a separate prescription for cartridges and single-use disposable pan needles.
Creates shareable reports with time-based meal analysis Need to keep your phone within a few feet of the InPen when you are giving yourself a dose. Otherwise, the dose won’t immediately register in the app, which could throw off your data until the pen is back within range of your smart phone
Covered by most insurance companies in the US, with approximately 70% of users paying $50-$60 out-of-pocket copays for the one-year device. For those without any insurance coverage, the pen’s cash price is $549.
No need to tether to device.  

 

More to come…

These new technologies made diabetes patients’ lives easier and there are a lot more coming in the future as well. One device launched recently is a CGM called sugarBEAT CGM that monitors blood glucose without sticking anything under skin and just attach a sticky patch on skin. Another wearable device is AerBetic which measures blood glucose through chemical changes in breath gas. Furthermore, Beta Bionics has been developing a fully automated bionic pancreas which could be world’s first system that could control both insulin and glucagon in the future.

Prepared By Enkhchimeg Erdenee PharmD Candidate 2021

Kelley-Ross is an independently owned corporation operating 4 pharmacies in Seattle. Kelley-Ross provides a wide range of pharmacy services, including prescription dispensing, compounding, medi-set packaging, compliance packaging, long-term care facility services, consultant pharmacist services, immunizations and a variety of health screenings.

We provide Clinical Community Care. This means that our staff combines expert medication therapy management and clinical skills, with caring, patient centered pharmacy services. By using the triad approach – patient, provider and pharmacist – we can help patients maximize their healthcare resources while achieving optimal health outcomes.

Our high service level and commitment to problem solving has made Kelley-Ross the pharmacy of choice for patients and providers across the Northwest.