Diabetes digital – smart support for diabetics

Monitoring blood sugar levels, counting carbohydrates, calculating insulin doses, and keeping accurate records in a journal – diabetes is a data-intensive disease that demands a lot of self-discipline and attention from those who are affected by it. Some concerns are patients neglecting to keep a food journal, "fudged" test results or calculation errors. Digital solutions help patients easily manage the large volumes of data.

The daily routine of many diabetic patients still looks like this: prick your finger before each meal, apply the blood droplet to the test strip and insert it into your meter and check your blood glucose level, estimate the amount of carbohydrates in your meal and calculate your insulin dose while taking all other influencing factors into account and keep a journal of it of course. Given all of these required calculations, there is an increased likelihood of making a mistake. Many diabetics are constantly worried about their blood sugar levels being either too high or too low. Diabetes profoundly affects their everyday lives.

Nowadays, computer-based options support patients in their constant calculation endeavors. Patients can now use a blood glucose monitor with memory capabilities for example. The physician subsequently imports the device data into an evaluation software on the computer via USB or Bluetooth. The software automatically analyzes the patient's measurement results since his/her last visit to the doctor and creates a graphic chart of the test results. The doctor can select different display options and have the measurements displayed as curves on a daily or weekly basis. This makes it easier to adjust the treatment – thus taking a big step towards individualized treatment.

Digital food journals in the shape of smartphone applications like mySugr App provide a better understanding of important therapy data such as insulin administration, blood sugar levels and carbohydrates. The data is displayed in clearly laid out assessments patients are able to check at any time – not just during physician office visits. Digital tools not only save time, they are also more accurate and don't allow patients to fib about their test results.

The interactive biolife logging system GlycoRec was developed by a research association and coordinated by the PFH Private University of Applied Sciences in Göttingen. This system automatically collects patient data by transferring blood glucose levels from the measuring device and insulin pen injections to the GlycoRec system. An extensive food and nutrient database allows users to easily enter the amount of carbohydrates. GlycoRec also tracks movements. Based on all this information, patients receive personalized recommendations, tips and alerts right on their smartphone or smart watch.

DiaDigital, the seal of distinction for diabetes apps helps sufferers choose the right app. Those who download a diabetes app that has been awarded this seal can rest assured their data is protected. Usability is likewise a criterion that is taken into account when it comes to certification. Diana Droßel of the DiaDigital initiative of the German Working Group for Diabetes Technology of the German Diabetes Society (DDG) explains, "It is actually the criterion we put the highest value on because it determines whether the app is relevant for daily use in the first place." Needless to say, patients with diabetes should know that expert-tested applications for data analysis for example, do not replace but merely complement an actual visit to the doctor's office.

Aside from data management, there are also devices and other digital tools that (in part) automatically perform glucose measurements and administer insulin.

The conventional way to measure blood glucose levels by finger prick only captures a snapshot in time. This method is gradually being replaced by continuous glucose monitoring (CGM). It tracks glucose levels throughout the day at regular shorter intervals. The readings are then combined and translated into an overall picture and allow continuous monitoring of the metabolism. Another advantage: CGM does not require daily fingerstick tests because a CGM sensor is attached to the abdomen. It transmits the measured levels via a transmitter to a receiver, which can be connected to a smartphone, depending on the device. Some sensors can also be inserted under the skin, making the measurements even more discrete.

Some insulin pump systems can be upgraded to become a CGM system, making the pump the receiver of the sensor's glucose readings without the need for patients to wear any additional equipment on the body. Medtronic's MiniMed 670G is a "hybrid closed loop system", an almost closed insulin delivery system, which is also referred to as an "artificial pancreas." It combines the functions of an insulin pump and a CGM system and measures glucose every five minutes and adjusts insulin delivery based on these readings. What makes it unique is that it automatically stops insulin administration when it reaches a preset low glucose limit, and restarts when levels recover and return to normal.

So-called patch pumps like those offered by OmniPod are simply attached to a body area where the pump administers insulin – without the need for cumbersome tubes. The pump is controlled by the so-called Personal Diabetes Manager (PDM), a small handheld device.

The internet offers endless opportunities – also when it comes to diabetes management. Patients with diabetes can find information about the disease, treatment options, and necessary products on countless websites. Diabetes blogs where those affected by the disease talk about their daily lives with diabetes hold a special place in this setting. Not only do bloggers offer suggestions based on their own encounters, but they also share their positive and negative experiences, thereby motivating people, who are in the same boat and creating a sense of belonging. Forums are an even more interactive platform, allowing users to compare notes and give advice on specific issues. That said, users should keep in mind that these are merely personal assessments and opinions and not recommended actions based on medical knowledge and expertise. That's why users should always consult with a physician if they experience serious health problems.

Considering this trend, future diabetic patients are – above all else – networked and well-connected. Today, there is a device, software or smartphone app to help manage diabetes at every stage. Needless to say, this might overwhelm some people and especially older adults. Ultimately, everyone must choose the method that is best suited for them. When diabetic patients select a treatment, they must consider the cost of treatment, data privacy concerns, their own tech-savviness and – most importantly – their personal preferences. The future of diabetes management is likely to involve an environment where analog and digital technologies coexist. Today's available digital solutions already offer support and make diabetes management much easier. Glucose monitoring, insulin delivery, data transmission - many processes are automated, seemingly making diabetes increasingly take a backseat to daily life. That said, diabetes is a chronic disease that needs to be carefully managed and requires continuing medical care.