Digital Diabetes Management: A Literature Review of Smart Insulin Pens

Heinemann, Lutz; Schnell, Oliver; Gehr, Bernhard; Schloot, Nanette C.; Görgens, Sven W.; Görgen, Christoph

doi:10.1177/1932296820983863

Cited by 47 publications

(41 citation statements)

References 37 publications

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“…Usage patterns can be expected to change with time, for example, in response to changing popularity of BGMs versus CGM, connected insulin pens, physical activity meters and sensors, and inputs describing dietary intake. 24,62 Additional data elements will likely need to be introduced.…”

Section: Discussionmentioning

confidence: 99%

Standardizing Reporting of Glucose and Insulin Data for Patients on Multiple Daily Injections Using Connected Insulin Pens and Continuous Glucose Monitoring

Rodbard

Garg

2021

Diabetes Technology & Therapeutics

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Background: Recent development and availability of several connected insulin pens with digital memory are likely to expand the availability of glucose and insulin metrics that previously had been available only for the much smaller number of people using insulin pumps. It would be highly desirable to standardize data presentations to avoid the chaotic emergence of multiple formats that might reduce the clinical utility of connected pens. Methods: We reviewed the literature and analyzed data displays from multiple blood glucose monitoring, continuous glucose monitoring (CGM), insulin pump, and automated insulin delivery systems, and methods for combination of glucose and insulin data. We examined multiple forms of presentation and now propose a prototype for a standardized method for data analysis and display, focusing on the content and format of a onepage dashboard summary for patients on multiple daily injection (MDI) insulin regimens. Results: We propose the following metrics to be included in the one-page report: (A) glucose metrics: simplified glucose distribution in the form of a stacked bar chart showing percentages of time below-, above-, or within-target ranges overall and (optionally) by date, by time of day, or day of the week; (B) insulin metrics: types and doses, and timing of basal and bolus insulin; (C) an enhanced ambulatory glucose profile or ''AGP+'' showing glucose data points and/or distributions (10th to 90th percentiles), dosages and timing of basal and bolus insulins and (optionally) graphical display of risk of hypoglycemia and hyperglycemia; and (D) user experience regarding technology usage, frequency of alerts for hypo-and hyperglycemia, and information regarding lifestyle, meals, exercise, and sleep, if available; and (E) clinical insights and interpretation. Conclusion:We propose a prototype for a dashboard summary report of glucose, insulin, meals, and activity data intended for providers and patients on MDI using connected pens and CGM. Our goal is to stimulate development of a standardized approach.

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Section: Discussionmentioning

confidence: 99%

Standardizing Reporting of Glucose and Insulin Data for Patients on Multiple Daily Injections Using Connected Insulin Pens and Continuous Glucose Monitoring

Rodbard

Garg

2021

Diabetes Technology & Therapeutics

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“…70 A recent review by Heinemann and colleagues of available publications investigating the use of insulin smartpens revealed a paucity of data for insulin pens with connectivity function for the management of diabetes. 71 Only two studies investigated HbA1c reduction with the use of insulin smartpens compared to conventional ones and did not show any significant change in glycemic control for patients with T1DM. 72,73 Most studies, however, did show that they improved patients' adherence and confidence.…”

Section: Insulin Titration and Deliverymentioning

confidence: 98%

Emerging technologies for the management of type 2 diabetes mellitus

Shah

Levy

2021

Journal of Diabetes

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Diabetes mellitus is a global health problem affecting 422 million people worldwide, of which 34.2 million live in the United States alone. Complications due to diabetes can lead to considerable morbidity and mortality related to both microvascular and macrovascular disease. While glycosylated hemoglobin testing is the standard test utilized to evaluate glycemic control, emerging targets like "time in range" and "glycemic variability" often provide more accurate assessments of glycemic fluctuations and have implications for diabetes complications and quality of life. Patients with diabetes face considerable burdens of self-care including frequent glucose monitoring, multiple insulin injections, dietary management, and the need to track daily activities, all of which lead to reduced adherence and psychological burnout. From the provider perspective, limited patient data and access to self-management tools lead to treatment inertia and a reduced ability to help patients achieve and maintain their glycemic goals. In the past few decades, there have been considerable advances in treatment-based technology and technological applications designed to help reduce patient burden and provide tools for better self-management. These advances make real-time clinical data available for clinicians to make necessary changes in treatment regimens. In this review, we discuss the latest emerging technologies available for the management of people with type 2 diabetes mellitus. K E Y W O R D S technology, type 2 diabetes mellitus HighlightsThe use of technology in diabetes self-management and education has expanded significantly over the past few decades and offers platforms for the rapid development of patient-centered interventions to achieve optimal glycemic control. Utilization of technology has the potential to lessen patient burden by seamlessly integrating real-time feedback into patients' daily lifestyle and provide an option for review of health data remotely by care teams. We

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“…Available studies that have assessed clinical outcomes related to connected smart insulin pens are limited; however, a recent systematic review summarized published data that confirm preference for this device among persons with diabetes and indicate this technology's potential for positive impact relative to diabetes self-management. 203 Q2.7 Who would benefit from the use of an insulin pump without continuous glucose monitoring?…”

Section: Evidence Basementioning

confidence: 99%

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

et al. 2021

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automated insulin dosing continuous glucose monitoring continuous subcutaneous insulin infusion diabetes diabetes technology glucose sensors hybrid closed loop insulin pumps sensor-augmented pump low-glucose suspend predictive low-glucose suspend a b s t r a c t Objective: To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. Methods: The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. Main Outcome Measures: Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. Results: This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base.Recommendations: Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. Conclusions: Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of Disclaimer: The American Association of Clinical Endocrinology medical guidelines for clinical practice are systematically developed statements to assist health care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on clinical evidence. In areas of uncertainty, or when clarification is required, expert opinion and professional judgment were applied.This guideline is a working document that reflects the state of the field at the time of publication. Because rapid changes are expected in this area, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made considering local resources and individual patient circumstances.

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Digital Diabetes Management: A Literature Review of Smart Insulin Pens

Cited by 47 publications

References 37 publications

Standardizing Reporting of Glucose and Insulin Data for Patients on Multiple Daily Injections Using Connected Insulin Pens and Continuous Glucose Monitoring

Standardizing Reporting of Glucose and Insulin Data for Patients on Multiple Daily Injections Using Connected Insulin Pens and Continuous Glucose Monitoring

Emerging technologies for the management of type 2 diabetes mellitus

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

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