New Digital Health Technologies for Insulin Initiation and Optimization for People With Type 2 Diabetes

Kerr, David; Edelman, Steven V.; Vespasiani, G; Khunti, Kamlesh

doi:10.1016/j.eprac.2022.04.006

Cited by 15 publications

(11 citation statements)

References 69 publications

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“…In addition, digital health tools such as dosing guide apps may reduce barriers in insulin therapy and some such technologies available today have been shown to be associated with better glycemic control in people with T2D ( 157 , 158 ). In the ONWARDS 5 study with icodec in insulin-naive T2D patients, real-world elements of once-weekly insulin using a dosing guide app were assessed.…”

Section: Potential Benefits and Concerns With Once-weekly Basal Insulinmentioning

confidence: 99%

The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa

Rosenstock,

Juneja,

Beals

et al. 2024

Endocrine Reviews

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Basal insulin continues to be a vital part of therapy for many people with diabetes. First attempts to prolong the duration of insulin formulations were through the development of suspensions that required homogenization prior to injection. These insulins, which required once- or twice-daily injections, introduced wide variations in insulin exposure contributing to unpredictable effects on glycemia. Advances over the last 2 decades have resulted in long-acting, soluble basal insulin analogues with prolonged and less variable pharmacokinetic exposure, improving their efficacy and safety, notably by reducing nocturnal hypoglycemia. However, adherence and persistence with once-daily basal insulin treatment remains low for many reasons including hypoglycemia concerns and treatment burden. A soluble basal insulin with a longer and flatter exposure profile could reduce pharmacodynamic variability, potentially reducing hypoglycemia, have similar efficacy to once-daily basal insulins, simplify dosing regimens, and improve treatment adherence. Insulin icodec (Novo Nordisk) and insulin efsitora alfa (basal insulin Fc [BIF], Eli Lilly and Company) are 2 such insulins designed for once-weekly administration, which have the potential to provide a further advance in basal insulin replacement. Icodec and efsitora phase 2 clinical trials, as well as data from the phase 3 icodec program indicate that once-weekly insulins provide comparable glycemic control to once-daily analogues, with a similar risk of hypoglycemia. This manuscript details the technology used in the development of once-weekly basal insulins. It highlights the clinical rationale and potential benefits of these weekly insulins while also discussing the limitations and challenges these molecules could pose in clinical practice.

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Section: Potential Benefits and Concerns With Once-weekly Basal Insulinmentioning

confidence: 99%

The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa

Rosenstock,

Juneja,

Beals

et al. 2024

Endocrine Reviews

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“…However, use of mathematical models was not reported. Furthermore, Kerr et al, 2022 (69) found indications for improved glycemic control when using digital solutions to manage T2D treatment compared to standard of care. This is further supported by Hangaard et al, 2021 (70) , which found a significant improvement in HbA1c when using telemedicine among people with T2D.…”

Section: Table 2 Summary Of Critical Appraisal Assessed By Jbi Critic...mentioning

confidence: 99%

“…New technologies enabling improved data collection might ease some challenges in modeling insulin's effect on blood glucose levels for people with T2D using mathematical models. Kerr et al, 2022 (69) highlight that new technology that supports improved data capturing may facilitate better treatment support when combined with dose recommendation software. Furthermore, addition of automated data-driven dose guidance might help rectify the increased workload for HCP that, in some cases, has been reported when introducing new technology (77) .…”

Section: Implications For Future Researchmentioning

confidence: 99%

Time for Using Machine Learning for Dose Guidance in Titration of People With Type 2 Diabetes? A Systematic Review of Basal Insulin Dose Guidance

Thomsen

Hangaard

Kronborg

et al. 2022

J Diabetes Sci Technol

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Background: Real-world studies of people with type 2 diabetes (T2D) have shown insufficient dose adjustment during basal insulin titration in clinical practice leading to suboptimal treatment. Thus, 60% of people with T2D treated with insulin do not reach glycemic targets. This emphasizes a need for methods supporting efficient and individualized basal insulin titration of people with T2D. However, no systematic review of basal insulin dose guidance for people with T2D has been found. Objective: To provide an overview of basal insulin dose guidance methods that support titration of people with T2D and categorize these methods by characteristics, effect, and user experience. Methods: The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies about basal insulin dose guidance, including adults with T2D on basal insulin analogs published before September 7, 2022, were included. Joanna Briggs Institute critical appraisal checklists were applied to assess risk of bias. Results: In total, 35 studies were included, and three categories of dose guidance were identified: paper-based titration algorithms, telehealth solutions, and mathematical models. Heterogeneous reporting of glycemic outcomes challenged comparison of effect between the three categories. Few studies assessed user experience. Conclusions: Studies mainly used titration algorithms to titrate basal insulin as telehealth or in paper format, except for studies using mathematical models. A numerically larger proportion of participants seemed to reach target using telehealth solutions compared to paper-based titration algorithms. Exploring capabilities of machine learning may provide insights that could pioneer future research while focusing on holistic development.

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“…The International Diabetes Federation (IDF) Atlas reported that in 2021, 537 million people had diabetes globally; of these, type 2 diabetes is estimated to account for over 90% of cases [ 1 , 2 ]. This number is predicted to increase by 46% to 783 million by 2045, with 94% of the rise expected to occur in low- and middle-income countries [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Digital health technology and monitoring systems that document the quality of diabetes care can help people with diabetes to manage BI titration, improving glycemic control and clinical outcomes [ 2 , 15 ]. Health technologies may help reduce the barriers to optimal insulin therapy with connected systems simplifying dose recording and glucose monitoring, which may empower patients in clinical conversations and help to make the connection between insulin use and blood glucose levels [ 2 , 16 ]. Health2Sync (H2S) is a digital platform that provides diabetes management/self-management functionality, including coaching and titration advice from physicians for patients to follow [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Real-World Effectiveness of the Gla-300 + Cap + App Program in Adult Users Living with Type 2 Diabetes in Taiwan

Wang,

Zhou,

Gandhi

et al. 2024

Diabetes Ther

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Introduction Health2Sync (H2S) is a digital health technology platform that provides coaching and titration support to patients with diabetes. The Mallya cap converts a conventional insulin pen into a smart connected device that can automatically synchronize dose values and associated timestamps (upon injection) to the H2S platform. This single-arm real-world study evaluated the effectiveness of insulin glargine 300 U/mL (Gla-300) combined with H2S and Mallya cap (Gla-300 + Cap + App program) on clinical outcomes among users with type 2 diabetes (T2D) in Taiwan. Methods Adults (aged ≥ 20 years) with T2D who were registered H2S users and initiated Mallya cap for a new/existing Gla-300 regimen (identification period May 1, 2021–May 31, 2022) were included in this retrospective cohort study. Follow-up data from H2S were collected for 90 days. Glycated hemoglobin (HbA 1c ) change (baseline to follow-up) and HbA 1c goal attainment were primary outcomes. Hypoglycemia incidence and usage metrics of Mallya cap were secondary outcomes. Results Of 83 participants, 38.6% were new Gla-300 users. HbA 1c was reduced in both new (− 2.4 [2.7] %, − 26.2 [29.5] mmol/mol) and previous Gla-300 users (− 0.5 [1.6] %, − 5.5 [17.5] mmol/mol). Reduction in HbA 1c was significant ( p < 0.05) in both groups. At follow-up, 43.4% of users had a reduction of > 0.5%. Mean HbA 1c reductions increased numerically with higher baseline HbA 1c and with longer duration of Mallya cap usage. Conclusions Use of digital technology within a connected ecosystem such as Gla-300 + Cap + App program could help people with type 2 diabetes to improve their glycemic condition. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01570-1.

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New Digital Health Technologies for Insulin Initiation and Optimization for People With Type 2 Diabetes

Cited by 15 publications

References 69 publications

The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa

The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa

Time for Using Machine Learning for Dose Guidance in Titration of People With Type 2 Diabetes? A Systematic Review of Basal Insulin Dose Guidance

Real-World Effectiveness of the Gla-300 + Cap + App Program in Adult Users Living with Type 2 Diabetes in Taiwan

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