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Diabetes requires many daily decisions, and quarterly medical visits are insufficient for a majority of individuals living with diabetes, particularly those using insulin. A growing number of connected devices including Bluetooth® or cellular enabled glucose monitoring devices, smart insulin pens, smart insulin pumps, fitness trackers, blood pressure, heart rate and weight monitors offer the possibility of remote patient monitoring and more frequent, brief but timely touchpoints as needed with the care team.
Insulin pumps and continuous glucose monitors have been connected for many years. But recently, two more devices are connected! People using the InPenTM smart* insulin pen are now able to sync Medtronic’s GuardianTM Connect Continuous Glucose Monitoring (CGM) data in real-time with their InPenTM app. The glucose data integrates with the dose and meal data in the Insights by InPenTM reports, that the patient shares with their health care team directly through the app. Future development will include integration of the InPenTM dose data into CareLinkTM software.
The ability to communicate regularly with people with diabetes and monitor their clinical and lifestyle data gives clinicians an opportunity to improve quality of care and health outcomes, creating a remote, continuous care model. Data-driven conversations allow for more objective, focused, collaborative and less interrogative discussion fostering shared decision making. As payment and practice approaches evolve there is growing interest from both patients and their health care teams in virtual data-driven care models.
According to a 2017 systematic review of studies evaluating technology-enabled Diabetes Self-Management Education and Support, there were improvements in A1c ranging from 0.1% to 0.8% in 18 of the 25 studies1. This review identified four key elements that were incorporated into the most effective interventions. They included two-way communication between patient and provider; analyses of patient-generated health data (PGHD), such as CareLinkTM software reports; tailored education; and individualized feedback. The authors referred to this as a Technology-Enabled Self-management feedback loop, which connects people with their health care team. Health care team members’ review of PGHD can lead to more immediate adaptions to the care plan by providing insights for shared decision making and proactive patient-team communication that engages patients in their care with members of the health care team. However, to be of value, technology tools and the resulting PGHD must be integrated into clinical practice, becoming a critical part of how clinical care happens.
The three hallmarks of a data-driven practice model for intensive insulin therapy include2:
Through automatic uploads from a Bluetooth®-enabled durable device, smart insulin pen or pump, insulin dosages are automatically recorded and can be uploaded for users. Individuals can check the app on their phone to see their dose history, their most recent glucose, as well as how much active insulin is currently on board. Additionally, users can share their integrated diabetes data with their health care team when needed.
In fact, the Association of Diabetes Care and Education Specialists (ADCES) has a new 6-hour continuing education certificate program, Connected Insulin Delivery Devices and Clinical Application of Data, available to ADCES members through DANA. This course is designed to help clinical teams led by diabetes care and education specialists to integrate the data from these tools into clinical practice to help optimize care for people with diabetes. The course is available here.
Readers are invited to tune into our ongoing webinar series regarding how smart insulin pens are helping to address these and other challenges of multiple daily insulin therapy. In February, endocrinologist, Anders Carlson, MD from the International Diabetes Center, will discuss The Health Burden of Hypoglycemia – Strategies For Addressing with Smart Insulin Pens. Click here to register.
Results of a national survey conducted online on behalf of the Association of Diabetes Care & Education Specialists (ADCES) in collaboration with Sanofi US3. Conducted in June and July of 2020 and included more than 700 American adults living with Type 1 or Type 2 diabetes who take insulin. All respondents were taking insulin that was administered with a vial/syringe or pen regularly for at least six months.
Smart insulin pens connect to a mobile app to provide dosing calculations, reminders and CGM system integration.
Greenwood D, Gee P, Fatkin K, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017;11(5):1015-1027.
Warshaw H, Isaacs D, MacLeod J. Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services. TDE Supplement, 2020;46(suppl 4):S3-S20
Technology Could Help with Diabetes Management. Survey sponsored by ADCES and Sanofi-Aventis. Conducted in June-July 2020, included more than 700 adults with type 1 or type 2 diabetes who take insulin via vial/syringe. https://www.diabeteseducator.org/docs/default-source/practice/educator-tools/sanofi-survey-2020/adces-national-diabetes-survey-results_infographic.pdf?sfvrsn=2
Important Safety Information: GuardianTM Connect CGM System
The Guardian™ Connect system requires a prescription and is indicated for continuous or periodic monitoring of glucose levels in the interstitial fluid under the skin, in patients (14 to 75 years of age) with diabetes mellitus. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional. The system requires a functioning mobile electronic device with correct settings. If the mobile device is not set up or used correctly, you may not receive sensor glucose information or alerts. For complete details of the system and its components, including warnings, contraindications, and precautions, please consult the user guide at http://www.medtronicdiabetes.com/support/download-library/user-guides and important safety information.
Important Safety Information: InPenTM Smart Insulin Pen
The InPen requires a prescription. It is a home-use reusable pen injector for single-patient use by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for the self-injection of a desired dose of insulin. The pen injector is compatible with Lilly Humalog® U-100 3.0 mL cartridges, Novo Nordisk Novolog® U-100 3.0 mL cartridges, and Novo Nordisk Fiasp® U-100 3.0 mL cartridges and single-use detachable and disposable pen needles (not included). The pen injector allows the user to dial the desired dose from 0.5 to 30 units in one-half (1/2) unit increments. The InPen dose calculator, a component of the InPen app, is indicated for the management of diabetes by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for calculating an insulin dose or carbohydrate intake based on user entered data. For an insulin dose based on amount of carbohydrates, a healthcare professional must provide patient-specific target blood glucose, insulin-to-carbohydrate ratio, and insulin sensitivity parameters to be programmed into the software prior to use. For an insulin dose based on fixed/variable meal sizes, a healthcare professional must provide patient-specific fixed doses/meal sizes to be programmed into the software prior to use. [*] For additional product and important safety considerations, see User Guide and http://bit.ly/InPenSafety.
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