Leveraging advances in diabetes technologies in primary care: a narrative review

Abstract

Primary care providers (PCPs) play an important role in providing medical care for patients with type 2 diabetes. Advancements in diabetes technologies can assist PCPs in providing personalised care that addresses each patient's individual needs. Diabetes technologies fall into two major categories: devices for glycaemic self-monitoring and insulin delivery systems. Monitoring technologies encompass self-measured blood glucose (SMBG), where blood glucose is intermittently measured by a finger prick blood sample, and continuous glucose monitoring (CGM) devices, which use an interstitial sensor and are capable of giving real-time information. Studies show people using real-time CGM have better glucose control compared to SMBG. CGM allows for new parameters including time in range (the time spent within the desired target glucose range), which is an increasingly relevant real-time metric of glycaemic control. Insulin pens have increased the ease of administration of insulin and connected pens that can calculate and capture data on dosing are becoming available. There are a number of websites, software programs, and applications that can help PCPs and patients to integrate diabetes technology into their diabetes management schedules. In this article, we summarise these technologies and provide practical information to inform PCPs about utility in their clinical practice. The guiding principle is that use of technology should be individualised based on a patient's needs, desires, and availability of devices. Diabetes technology can help patients improve their clinical outcomes and achieve the quality of life they desire by decreasing disease burden. KEY MESSAGESIt is important to understand the role that diabetes technologies can play in primary care to help deliver high-quality care, taking into account patient and community resources. Diabetes technologies fall into two major categories: devices for glycaemic self-monitoring and insulin delivery systems. Modern self-measured blood glucose devices are simple to use and can help guide decision making for self-management plans to improve clinical outcomes, but cannot provide "live" data and may under-or overestimate blood glucose; patients' monitoring technique and compliance should be reviewed regularly. Importantly, before a patient is provided with monitoring technology, they must receive suitably structured education in its use and interpretation. Continuous glucose monitoring (CGM) is now standard of care for people with type 1 diabetes and people with type 2 diabetes on meal-time (prandial) insulin. Real-time CGM can tell both the patient and the healthcare provider when glucose is in the normal range, and when they are experiencing hyper-or hypoglycaemia. Using CGM data, changes in lifestyle, eating habits, and medications, including insulin, can help the patient to stay in a normal glycaemic range (70-180 mg/dL). Real-time CGM allows for creation of an ambulatory glucose profile and monitoring of time in range (the time spent within target blood glucose of 70-1...

Efficacy of a Hybrid Closed-Loop Solution in Patients With Excessive Time in Hypoglycaemia: A Post Hoc Analysis of Trials With DBLG1 System

“…Time in a target range of 70 to 180 mg/dl has been proposed as a CGM metric that is linked to the quality of glycemic control. 9 The Glycemia Risk Index (GRI) is a new composite metric that has been demonstrated to correlate with opinions of clinicians as to the quality of glycaemia. Compared to TIR, the GRI has been shown to correlate more closely with the opinions of clinicians as to the quality of CGM control.…”

Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

“…As noted, diabetes technology utilization has been lower in vulnerable T1D populations. Recent registry data collected in specialty and primary care demonstrate similar disparities in primary care [40][41][42] for technology utilization. These data were further corroborated and used to develop interventions in diabetes-related ECHOs in Florida and California, which showed limited access to an endocrinologist and significant differences in pump use by SES and race/ ethnicity.…”

Patient Perspectives on the Benefits and Challenges of Diabetes and Digital Technology

“…BGM, in which blood glucose is intermittently measured by a fingerstick blood sample, was introduced in the early 1970s ( 15 , 22 ). Today, glucose meters are relatively compact and unobtrusive and provide results in a few seconds from a small blood volume ( 22 ).…”

“…They are important tools that, when coupled with education, can help to guide clinical and self-management plans that aim to improve outcomes ( 12 ). Although their accuracy depends on the instrument and the user, the training is straightforward ( 15 ).…”

“…Diabetes technology that gives clear and accurate information can improve patient and clinician engagement and self-management, and it can enhance the delivery of coordinated, team-based care ( 1 , 15 ). These are critical components of the Chronic Care Model advocated by the American Diabetes Association (ADA) for tailoring diabetes care to the needs of each person.…”