NEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP

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1 NEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP

2 No commercial support or sponsorship was received for this project I have nothing to disclose

3 OBJECTIVES Identify at least two emerging technologies available for use in diabetes management. Verbalize at least two benefits associated with the use of these innovations.

4 GLUCOSE MONITORING

5 LIFESCAN VERIO FLEX Can log insulin, carbohydrates, and glucose levels Color coded glucose levels- blue, green, red Sync data with wireless app via Bluetooth technology Share data results in pdf format with family and/or provider Meter and app free

6 ROCHE ACCU-CHECK GUIDE Spill resistant test strip container Strip port light End fill test strip Sync data with wireless app via Bluetooth technology Share data results in pdf format with family and/or provider Allows remote monitoring on cloud Meter and app free Bolus calculator- requires prescription to activate

7 BOLUS CALCULATOR

8 BENEFITS Convenience Improved accuracy in dosing/recording Low to no cost Easy to see for visually impaired

9 INSULIN ADJUSTMENT SOFTWARE

10 SMART PEN TECHNOLOGY IPEN Via app- keeps log of time/amount of injections delivered Delivers up to 30 units of insulin in half-unit increments Can program dose reminders Compatible with Humalog and Novolog U-100 insulin cartridges Lasts for 1 year, no recharging needed Has dosing calculator Prescription available through mail order

11 ISAGE RX FDA cleared application to adjust basal insulin in T2D- provider picks adjustment algorithm Individual can program reminders for dosing, testing, health events Allows for remote monitoring- cloud access Has education videos, trivia, educational messages App/software free Requires prescription to activate from HCP

12 INSULIA Automated basal dosing adjustment for T2DM, FDA cleared Available via mobile app or web portal Blood glucose trend charts and log book Has education videos and coaching messages Requires prescription to activate using HCP Cloud based remote monitoring Free to commercially insured with savings care

13 BENEFITS Reduced delays in treatment Ongoing diabetes support On demand diabetes education

14 GLUCOSE SENSORS

15 CONTINUOUS GLUCOSE MONITORS (CGM) Small flexible disposable catheter inserted in subcutaneous fat Catheter has electrode that averages the interstitial glucose every 1-5 min Data can be downloaded for interpretation Professional and personal versions Does not replace blood glucose monitoring

16 GLUCOSE SENSOR Skin Fat / Interstitial Fluid Sensor Muscle

17 DEXCOM 5 Requires prescription, available through DME company or manufacture Can treat sensor glucose without finger-sticks Records every 10 mins for 10 days Requires calibration twice a day or every 12 hours Bluetooth compatible with multiple devices- receiver, phone and watches Predictive alarms, trend arrows, has 1,3,6,12, & 24 hour historical graphs Cloud based reporting up to 5 followers

18 ABBOTT FREESTYLE LIBRE Requires prescription Records every 15 mins for 10 day use Display- current glucose, directional arrows and 8 hour graph on display No finger-sticks required for calibration Inexpensive, available at local pharmacy Hand held reader stores glucose readings for 90 days Cloud based reporting ***Does NOT have alarms and only individual has to scan sensor with reader to get results ***Not covered by all health plans

19 MEDTRONIC GUARDIAN 3 COMING IN JULY 2018 Guardian Sensor 3 with attached transmitter Sends glucose data continuously via Bluetooth to the Guardian Connect app on a user's smartphone Provides predictive alerts about high or low blood sugar 60 minutes in advance of the event Trend arrows and 3,6,12, 24 hour graph options Requires prescription

20 BENEFITS Reduction in a1c- 1.3% from baseline Reduction in hypoglycemic events- up to 79% Reduction in overall glucose variability increased time spent in range mg/dl 1.3 additional hours Reduction in time spent in hyperglycemia up to 40% Benefits are independent of age & educational level (Diamond Study) Beck RW, et al. (2017). Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The diamond randomized clinical trial. JAMA, 317(4),

21 CLOSED LOOP INSULIN PUMP

22 MEDTRONIC 670G HYBRID INSULIN PUMP 1 st hybrid closed loop system Self adjusts basal insulin to target glucose levels Suspend before low feature Linked meter for quick & easy bolus calculations The only meter, sensor, pump integration on the market Waterproof

23 BENEFITS Reduced hypoglycemia Less variability A1c reduction Improved reported quality of life

24 BENEFITS Pivotal Trial Type 1 Diabetes greater 2 years, age 14-75, a1c <10% 10 sites, pump therapy >6 months 44% reduction in time spent with low blood glucose (under 70 mg/dl) 11% decline in time spent >180 mg/dl 8% improvement in time-in-range ( mg/dl) Bergepstal, R. et al. (2016). Safety of a Hybrid Closed-Loop Insulin Delivery System in Patients With Type 1 Diabetes Journal of American Medical Association, 316 (13),

25 PATCH PUMPS

26 V-GO INSULIN DELIVERY DEVICE Delivers basal insulin in pre-set basal rate Can administer meal bolus in 2 unit increments (up to 36 units/day) Filled daily/changed daily V-Go 20, 30, or 40 Available from local pharmacy with prescription

27 BENEFITS Convenience No tubing Simple to use- does not require programming or batteries Possible reduction in overall insulin needs with no change in a1c (VALIDATE study) Sustained reduction in a1c Grunberger G, et al. (2014). SIMPLE STUDY. American Association of Clinical Endocrinologists 23rd Annual Scientific and Clinical Congress; Abstract 224. Harrison HC, Everitt B, Nikkel C. (2017). The Impact of utilizing a novel insulin delivery device in patients with type 2 diabetes. Poster at ACCE.

28 APPLICATIONS- APPS

29 Allows kids & caregivers to log and share diabetes information Food, activity glucose trackers Carb counting app for kids, games included

30 ON THE HORIZON

31 IMPLANTABLE MEDICATIONS ITCA 650 Inserted in subcutaneous tissue for 3-9 months Releases exenatide continuously Matchstick size Inserted via office procedure Release postponed

32 IMPLANTABLE GLUCOSE SENSOR Sensor implanted and removed with in office procedure 90 day wear via transmitter to a mobile app Available in Europe, under review with the FDA

33 OTHER OPTIONS Basal-bolus calculator software and apps Basal/glp-1 combination dosing adjustment apps Closed loop Tandem pump with dexcom sensor Digital smart contact lens

34 QUESTIONS?

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