Diabetes: Device Therapy

Magdalena Pasarica
FP Essentials 2021, 504: 28-33
Insulin pumps, continuous glucose monitors (CGMs), and hybrid closed-loop insulin pumps with CGMs are available for the management of type 1 diabetes in patients of all ages and type 2 diabetes in patients treated with multiple daily injections of insulin. These devices have numerous benefits for patients, including improved diabetes control, fewer hypoglycemia and diabetic ketoacidosis events, and improved quality of life. Currently, there are seven insulin pumps on the US market, five CGMs, and four closed-loop systems. Insulin pumps can deliver insulin subcutaneously in a continuous manner. CGMs can measure and report the blood glucose level every 5 to 15 minutes. Hybrid closed-loop systems automatically discontinue basal insulin delivery if hypoglycemia is predicted, and provide alarms for hyper- or hypoglycemia and rapid changes in the blood glucose level. Some can administer correction bolus doses of insulin using a special algorithm without the input of the patient. These devices should be prescribed and managed by an interdisciplinary health care team led by a family physician or endocrinology subspecialist. Other devices include smart insulin pens and insulin inhalers. Mobile health technology for diabetes management uses mobile devices to increase patient capacity for self-management through delivery of medical information.

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