Next-generation technology empowers better diabetes management
Posted on 10 November 2020
For those living with Type 1 diabetes, hybrid closed-loop systems combine the benefits of an insulin pump and continuous glucose monitoring. They use an algorithm to vary the delivery of insulin into the body, automatically and as needed – making managing the condition easier and more efficient.
Insulin plays a crucial role in the body. It’s secreted by the pancreas in order to allow sugar to enter your cells. This lowers the amount of sugar in your bloodstream, and as your blood sugar level drops, so does the secretion of insulin from your pancreas, which regulates blood sugar levels.
People with Type 1 diabetes, however, produce no insulin, with potentially disastrous results. ‘This is a disease you can’t ignore. It presents suddenly, develops rapidly and if poorly managed, can be fatal,’ says Professor David Segal, a specialist paediatric endocrinologist at Wits Donald Gordon Medical Centre.
Once someone is diagnosed with Type 1 diabetes, it can change their whole life, he says. ‘This disease is primarily managed by the patient, and in many cases, by the patient’s parents. So, they need to understand the physiology of diabetes, in other words, what it means when we say your body does not produce insulin – and health education plays a big role.’
Patients with Type 1 diabetes will be prescribed an insulin dose regime, based on regular testing. There are two amounts to calculate: background or basal insulin, a dose designed to replace insulin overnight, when fasting and between meals, and bolus, to cover carbohydrate intake and correct high blood sugar.
‘This means you need to know your blood sugar levels before meals and snacks, before and after exercise, before bed, even during the night – which requires pricking your finger to get a drop of blood, and running the numbers,’ Professor Segal says. ‘This is a lot of work for a young patient and can be confusing and stressful for the whole family.’
Hybrid closed-loop (HCL) systems are changing all of that. HCL systems bring together the many benefits of an insulin pump, continuous glucose monitoring and computer algorithms to vary the automatic delivery of insulin into the body when needed.
Continuous glucose monitors (CGMs) offer a richer source of data, Professor Segal explains. ‘You won’t know, when you prick your finger before breakfast, whether your blood sugar is heading up or down, or how quickly it’s moving. A monitor, which tests your blood sugar every 15 minutes, gives eight hours’ worth of readings, so you can see the rate of change. This empowers you to make better decisions about managing your blood sugar.’
It also helps engage the patient, he says. ‘CGMs make the whole process more visual, more real. You now have a scoreboard and can see if you’re winning or losing. This encourages patients to learn more about their disease: they’re able to see day by day how certain foods affect their physiology, in real time. The improvement in how they manage their condition is significant.’
These have now been integrated with insulin pumps, which deliver insulin through a tube implanted under your skin. These pumps have been in use for decades, but when integrated with the data provided by CGMs, they close the ‘loop’ of effective insulin management. ‘When you combine constant measurement with rich data and the ability to replace insulin automatically, you take the patient – the need for calculations, and the guesswork, and the pain – out of the equation. In that way, these systems allow for much more detailed, accurate care.’
HCLs also empower doctors to provide continuous care. Professor Segal is one of only a handful of specialist paediatric endocrinologists in the country, and the continuous data monitoring and management of these systems allow him to conduct remote consultations much more accurately and effectively.
While there’s no data available on the prevalence of Type 1 diabetes in SA, the International Diabetes Federation (IDF) estimates that globally, half-a-million people live with this disease. “A great deal of our population does not have in-person access to the kind of expertise needed to manage this condition,’ he says. ‘This technology, and the richness of the data it provides, lets us work much more closely with these patients and their doctors. It has broken through that barrier and allows thousands of people across South Africa to receive expert care.’