PHILADELPHIA — Wearable technologies may soon play a larger role in prevention and management of diabetes and heart disease, according to a speaker here.
As cardiovascular disease is the leading cause of death among all adults with diabetes, devices currently available to monitor glucose level, vital signs, arrhythmias, ejection fraction, oxygen saturation, cardiac events and even potassium levels, as well as deliver insulin, may contribute to better disease management, according to George Grunberger, MD, FACP, FACE, chairman of the Grunberger Diabetes Institute, clinical professor of internal medicine and molecular medicine and genetics at Wayne State University School of Medicine, professor of internal medicine at Oakland University William Beaumont School of Medicine, and professor in the first faculty of medicine at Charles University in Prague.
“The main issue now is the device connectivity, data analysis and feedback by professionals back to patients,” Grunberger told Endocrine Today. “Value of all this technology progress to improved outcomes needs now to be established and means of remuneration to professionals codified.”
In the area of diabetes management devices, the primary goal is to prevent hypoglycemia, according to Grunberger. “The more frequently the patients look [at glucose levels], the better glycemic control and safer for hypoglycemia, so this obviously is very promising,” he said during the presentation.
Continuous glucose monitoring devices have improved accuracy with each new FDA approval, and some no longer require fingerstick calibration, including Abbott’s FreeStyle Libre Flash Glucose Monitoring System and the Dexcom G6 patch CGM. The Senseonics Eversense CGM is a fully implantable monitor approved for 90-day use.
Insulin delivery devices have also become smarter, according to Grunberger, with the t:slim X2 Insulin Pump with Basal-IQ — to be paired with the Dexcom G6 CGM — able to predict low glucose level up to 30 minutes before occurrence and suspend insulin delivery. The Omnipod DASH Insulin Management System (Insulet) is a tubeless insulin pump system that wirelessly connects to a bolus calculator and two smartphone apps. These systems are leading to fully closed-loop systems, Grunberger said. Not just a fantasy, he said, results of a study of such a system, published last month, greatly increased time spent in target glucose range without increasing hypoglycemia.
Finally, data sharing is a great benefit for patients, according to Grunberger. Currently, mySugr, Glooko, Livongo and others are able to receive and integrate data and send recommendations back to users, he said. In addition, data sent to the cloud for sharing with loved ones or health care providers can improve safety for users with hypoglycemia unawareness.
For monitoring data relevant to heart health, several devices are currently available to consumers. AliveCor Kardia is a fingertip ECG monitor that integrates with a tablet, smartphone or smart watch. “It apparently has a 97% specificity and 98% sensitivity for the detection of atrial fibrillation,” Grunberger said. The device can also detect hyperkalemia.
The Zio patch from iRhythm detected more arrhythmia events than traditional Holter monitoring in a 14-day study, according to Grunberger, and may eventually replace Holter monitoring in some patients. The Sypder wireless ECG monitoring system and Loop from SpryHealth allow monitoring of vital signs, BP, pulse and heart rate, among other parameters, and send user data to the cloud for access by the patient’s cardiologist.
“The idea is to detect problems before something bad happens to the patient,” Grunberger said. – by Jill Rollet
Grunberger G. Clinical impact of technology on prevention and management of heart disease in diabetes. Presented at: Presented at: Heart in Diabetes Clinical Education Conference; July 13-15, 2018; Philadelphia.
Grunberger reports no relevant financial disclosures.