Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

Abstract

Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. Moreover, the combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. Now a CIP is the expected future technology that does not need to be worn all day like insulin pumps and helps to calculate insulin doses with a built-in bolus calculator. Although only a few clinical trials have assessed the effectiveness of CIPs, they consistently show benefits in glycemic outcomes by reducing missed doses of insulin and improving problematic adherence. AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. Now fully automatic AID systems and tools for diabetes decisions based on artificial intelligence are in development. These advances in technology could reduce the burden associated with insulin treatment for diabetes.

Keywords: Artificial intelligence; Blood glucose self-monitoring; Diabetes mellitus, type 1; Technology.

Fig. 1.

Improving glycemic outcomes through continuous glucose monitoring (CGM) and its integration with connected insulin pens (CIPs), insulin pumps, automated insulin delivery (AID) algorithms, and virtual glucose monitoring platforms combined with artificial intelligence (AI)-based diabetes management systems. SAP, sensor augmented pump; HCLS, hybrid closed loop system; AHCLS, advanced hybrid closed-loop system; HCP, healthcare provider; ICR, insulin-carbohydrate ratio; CF, correction factor.