Cleveland Clinic Journal of MedicineDiabetes Technology: A Primer for Clinicians

Emerging diabetes technologies are enhancing patient management through continuous glucose monitors, smart insulin pens, and advanced insulin pumps, indicating broader implications for integrating technology in chronic disease management.

Diabetes management is undergoing significant advancements with the advent of new technologies such as continuous glucose monitors (CGMs), smart insulin pens, and advanced insulin pumps. These devices, increasingly approved by the FDA and covered by insurance, are reshaping the way patients and clinicians approach diabetes care. This article provides a comprehensive overview of the current diabetes management devices available, emphasizing their functionality, benefits, and practical implications for clinical practice.

Key Points:

• Continuous Glucose Monitors (CGMs):
  • Measure interstitial glucose and transmit data wirelessly.
  • Widely used in insulin therapy and high-risk hypoglycemia patients.
  • Examples include Freestyle Libre 2, Freestyle Libre 3, Dexcom G6, and Dexcom G7.
  • Professional CGMs are temporary; personal CGMs are for long-term use.
  • CGMs can be intermittently scanned or real-time, with newer models requiring minimal calibration.
• CGM Models:
  • Freestyle Libre 2: Intermittently scanned, 14-day sensor, no calibration needed.
  • Freestyle Libre 3: Real-time, Bluetooth-enabled, improved accuracy.
  • Dexcom G6: 10-day sensor, requires a separate transmitter, 2-hour warm-up.
  • Dexcom G7: Integrated sensor and transmitter, shorter warm-up, improved accuracy.
  • Eversense E3: Implanted sensor, 6-month use, requires professional insertion.
  • Guardian Connect: 7-day sensor, requires twice-daily calibration, smartphone compatible.
• Smart Insulin Pens, Caps, and Buttons:
  • Aid in dose calculation and monitoring insulin administration.
  • Examples include InPen, Bigfoot Unity, and Tempo Smart Button.
  • Smart pens connect with CGMs to provide real-time insulin dosing recommendations.
  • Smart caps and buttons attach to insulin pens, recording and transmitting dosage data.
• Insulin Pumps:
  • Deliver continuous subcutaneous insulin infusion.
  • Categories include manual/open-loop and automated insulin delivery systems.
  • Examples include tX2, MiniMed series, Omnipod DASH, and Omnipod 5.
  • Hybrid closed-loop systems adjust basal insulin based on CGM readings.
  • Patch pumps like V-Go and Simplicity offer discreet insulin delivery.
• Patient Considerations:
  • Device suitability depends on patient adherence, technology comfort, and insurance coverage.
  • CGMs and insulin pumps offer advantages in reducing severe hypoglycemic and hyperglycemic episodes.
  • Smart devices provide missed-dose alerts and dose calculations, aiding patient compliance.
• Clinical Implications:
  • Primary care providers need familiarity with diabetes technology to support patient management.
  • Collaborative care with endocrinologists enhances device utilization and patient outcomes.
  • Increased device accessibility and simplified models enable broader use in primary care settings.

“Devices measure glucose levels continuously, make it easier for patients to calculate insulin doses, and deliver insulin based on an algorithm, helping patients manage their diabetes in a manner consistent with their goals and lifestyle.”

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