An intriguing panel on new technologies at the EASD 2022 conference gives insight into where we are with AID and telemedicine, as well as what top diabetes experts predict will happen next in diabetes treatment.
Robots and artificial intelligence have advanced from science fiction to vital components of diabetes control, and they are now more important than ever. Researchers investigated this topic further during the EASD 2022 conference in Stockholm, Sweden, in a session titled “A New Hope or Strange New Worlds: Submerging Diabetes into Emerging Technologies.”
Clinical Decision Making
Dr. Moshe Phillip, director of the Institute of Endocrinology and Diabetes at Israel’s Schneider Children’s Medical Center, started by illustrating how continuous glucose monitors (CGMs) represent a paradigm leap in diabetes technology.
According to Philip, automated insulin administration technology has led to significant gains in time in range (TIR) and reduced A1C readings.
Phillip described how these technologies work together with artificial intelligence to form a Clinical Decision Support System (CDSS). He stated that diabetes treatment standards are “so intricate that they are impossible to follow.”
Data from technology such as CGMs, insulin pumps, smart linked pens, and even self-monitored blood glucose meters are included in the CDSS. Artificial intelligence algorithms recognize glucose trends and insulin dosage events in this data, ultimately offering an in-depth picture of an individual’s health data.
“Within a fraction of a second, clinicians receive information on how to adapt therapy to each particular patient,” Philip explained. The CDSS is designed to be used as a helpful tool, similar to knocking on a colleague’s door and asking for a second view.
With a more user-friendly visual depiction of health data, clinicians may spend less time trawling through pages of data and more time enabling discussions with their patients.
Telemedicine’s Benefits And Difficulties
Although telemedicine has been on the increase for some years, the COVID epidemic has hastened its acceptance. A study by Diabetes Life Solutions notes that any patients with Diabetes will begin doing 1-2 appointments per year virtually.
Diabetes patients liked telemedicine’s enhanced convenience and flexibility, while healthcare professionals profited from fewer missed visits and cancellations. Furthermore, not having to wait in the waiting area boosted people’s privacy and lowered the chance of infection transmission in the clinic.
However, Holt pointed out that the transition to telemedicine was fraught with difficulties. He highlighted research that claimed 60,000 instances of diabetes went untreated in the UK as a result of the COVID epidemic. During the epidemic, there were also considerably fewer A1C testing and foot inspections. “I don’t know how to inspect the foot over the phone or the internet,” Holt explained.
Some people preferred in-person visits because it was simpler for them to interact with their healthcare staff. Several people said that using telemedicine was more stressful, suggesting that we cannot expect that technology would be simple and comfortable for everyone. Holt stated that telemedicine is less appropriate for the extremely young and very elderly, those with complicated health requirements, and those who require a physical examination. Holt stated that, while telemedicine may be utilized to provide good diabetes treatment, it “cannot replace all in-person consultations.”
Dr. Steven Russell discussed the current status of automated insulin delivery and hinted at future smart insulin possibilities. Russell recognized at the outset of his discussion that the United States has a significant lack of endocrinologists and that most primary care doctors are uncomfortable managing persons with type 1 diabetes who use an insulin pump.
Closed-loop hybrid systems largely automate insulin dosage, needing only human mealtime boluses and correction boluses on occasion. He went into great depth on the Beta Bionics iLet Bionic Pancreas and how it enhanced range time and reduced A1C levels. The lower a person’s A1C readings, the better chance they qualify for life insurance for diabetics.
He also mentioned research that demonstrated how an AID system with automated glucagon microdosing might prevent or decrease severe hypoglycemia. Russell advocated for greater and longer-term research on this bi-hormonal (insulin and glucagon) systems.
He completed his presentation by briefly mentioning smart insulins, which are insulins that activate when blood glucose levels rise and deactivate when glucose levels fall below 50. This smart insulin would be “already there, simply waiting to be engaged or deleted.”
