Insulin management is a nightmare. As a physician, even I have trouble sorting out how much short-acting and long-acting a patient needs through the day – what dose sliding scale to choose, how to adjust from Insulin Aspart to Lantus, how to pick the dose of insulin for the current blood sugar and anticipated meal. It’s tough. Fortunately, it’s my job and I have great support in the form of an EMR, endocrinologists, and others to help me whenever I need it. So for my patients, I can only imagine the daunting task they face on a day-to-day basis.
A study published in the New England Journal of Medicine is sign though that some relief may be on the way. Using a continuous blood glucose monitoring system – which basically uses a subcutaneous sensor connected to a wireless transmitter – a patient can check their blood glucose every five minutes without a finger prick. They can then use that data to manage their associated insulin pump.
In a one-year multicenter trial, patients with type 1 diabetes who were classified as poorly controlled – here that meant a baseline HbA1c of 8.3% – patients were either managed with this continuous monitoring/pump regimen or a more traditional long/short acting insulin. Both groups received teaching and regularly scheduled follow-up. Both groups also used Medtronic’s CareLink system, which basically tracks blood glucose measurements and allows for clinicians and patients to review data and make care decisions. By the end of the year, the pump group improved to a HbA1c of 7.5% compared to 8.1% for the injection group. The one obvious fact to be wary of here though is that this is a Medtronic sponsored trial for a Medtronic device.
What’s more exciting about this trial is the potential it hints at. One of the dreams of endocrinologists is to replace the function of pancreatic islet cells, even going so far as to explore the potential of pancreas transplant. Could this trial hint at the potential of an artificial pancreas (at least the beta islet cell part of it)? Even integrated management software which would help patient’s implement a sliding scale, perhaps even automatically suggesting adjustments to the sliding scale based on how the patient responds to the insulin, would be a huge step.
Much like the system Medtronic has tested for cardiac pacers, this mobile device could also provide emergency warnings to clinicians about hypo- or hyperglycemia in patients. Automated warnings through compatible EMR’s could prompt a simple phone call to a patient from their physician that could save their lives. It will be very exciting to watch this technology develop further.