Can Smart Pens Help Improve Diabetes Management?

Abstract

Smart pen technology has evolved over the past decade with new features such as Bluetooth connectivity, bolus dose calculators, and integration with mobile apps and continuous glucose monitors. While similar in appearance to a traditional insulin pen, smart pens have the ability to record and store data of insulin injections. These devices have the potential to transform diabetes management for clinicians, and patients with type 1 and type 2 diabetes on insulin therapy by improving adherence, glycemic control, and addressing barriers to diabetes management. Smart pens can also highlight the relationship between insulin, food, and physical activity, and provide insight into optimizing insulin regimens. Education of clinicians and patients, and more clinical studies showing the benefits of smart pens and cost-effectiveness, are needed.

Keywords: diabetes management; insulin therapy; smart pens; technology; type 1 diabetes; type 2 diabetes.

Figure 1.

Smart pens plus CGM can reveal nonadherence to insulin regimens and may help healthcare providers create individualized treatment plans and provide targeted education. (a) A patient with T1D has inconsistent timing of bedtime long-acting (basal) insulin administration. The patient misses a dose of basal insulin in a 24-hour period and consequently experiences hyperglycemia (black rising arrow). (b) A patient with T1D administers multiple short-acting insulin doses within two hours in response to hyperglycemia. The patient subsequently experiences a prolonged episode of hypoglycemia (highlighted in red) due to insulin stacking. (c) A patient with T1D and history of fear of hypoglycemia skips mealtime short-acting insulin boluses despite steady glucose levels in the hyperglycemic range. The red diamond symbol indicates fingerstick glucose checks. The orange vertical lines indicate short-acting insulin administration and blue vertical lines indicate long-acting insulin administration. CGM, continuous glucose monitoring; T1D, type 1 diabetes.

Figure 2.

Smart pens plus CGM can highlight the relationship between insulin and food. A daily glucose report shows that a patient consumed four meals per day (apple symbol) and injected rapid acting insulin (Apidra) to cover meals and long-acting insulin at bedtime (Lantus). Data from the pen revealed that the patient was injecting rapid-acting insulin immediately before or shortly after eating, and consequently the patient experienced post-prandial hyperglycemia. There was one episode of a missed mealtime insulin dose at 8:00 PM (presence of apple symbol without Apidra administration). The patient had a consistent pattern of post-breakfast hyperglycemia and a review of dietary intake uncovered that the patient was eating a donut regularly at breakfast time. The red diamond symbol indicates fingerstick calibrations for the CGM and blue vertical lines indicate insulin administration.