My name is Melissa Andrews Rearson. I am a pediatric nurse practitioner at the Children’s Hospital of Philadelphia (CHOP) in the Division of Diabetes and Endocrinology. Here at CHOP, we follow patients with type 1 diabetes, type 2 diabetes, and diabetes that is a result of other conditions, such as a pancreatectomy. We use developmental considerations as we help families and patients choose what types of technology might be appropriate for them.
As you know, over the past couple of years, technology in the diabetes field has advanced rapidly. Specifically, over the past year, there has been a huge increase in the number and types of devices that patients can use to manage diabetes.
Technology updates have allowed for improvements in all aspects of diabetes management, but the goal for overall control remains the same: a hemoglobin A1c of less than 7.5% for children and teens and less than 7% for adults. This goal is shared by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes.
The phone has become a very important tool in diabetes management and can be used in many different ways by both parents and patients who have type 1 and type 2 diabetes. Parents and kids can use apps on the phone to determine carbohydrate content of different foods they are going to eat. There are also apps that allow families to input recipes so that they can determine the carbohydrate content of homemade foods to be able to dose insulin more correctly.
In addition, apps support record-keeping, including allowing Bluetooth input from blood glucose monitors so that patients have a record of blood sugars that could be shared from their phones through the Cloud with parents and other caregivers.
One of the insulin pens now available relays insulin-dosing information to a phone, which then can be used in an app in conjunction with a continuous glucose monitor (CGM) so that patients can look at blood glucose trends resulting from insulin pen injections.
One of the biggest advances in connectivity is with the CGM, a small monitor device worn by a person with diabetes that continually monitors glucose levels. Data from these devices can be read in a variety of ways, including on a pump, in a reader or a receiver device, or even on a phone. Some of the devices still require fingerstick testing for calibration, but the newest CGM devices no longer require any blood sugar testing with fingersticks.
Those using a device that connects with the phone can be connected through the Cloud to other phones so that parents or other caregivers or friends have 24-hour access to the glucose data on their own phone. You might imagine that this could be helpful for parents who can check on sleeping children without pricking fingers. Data can also be used by caregivers who are caring for the child and need input from a parent. And parents can follow older children and teens, assuring their safety while still allowing independence.
In addition to technology improvements in blood glucose monitoring, there have been many strides made in insulin pump technology. One company has developed a hybrid closed-loop pump that communicates with a CGM to be able to adjust insulin doses to keep blood sugars close to a target range. This system requires input from the user regarding carbohydrates, and blood sugars must still be tested with fingersticks for calibration. Other companies are working in this direction, using data from the CGMs to adjust insulin using complicated algorithms that adjust for daily insulin need.
Many other pumps on the market at this point can connect, or are close to releasing versions that can connect, to the CGM for data display.
As the future unfolds, we will be seeing more and more technological advances in diabetes that assist patients and families in daily management. Still, there is nothing that takes the place of responsibility for carbohydrate counting and paying attention to the resulting blood sugars. The human brain, when well trained, can do an excellent job of managing diabetes and taking into account the myriad of variables that affect diabetes management on a daily basis.
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