The 1993 Diabetes Complications and Control Trial (DCCT) showed that controlling blood glucose prevents and delays the progression of long term complications of diabetes. New diabetes technologies can make control of diabetes possible and safer. This paper reviews these technologies used to monitor blood glucose, administer insulin and evaluate effectiveness of therapy. Self-monitoring of blood glucose has been a standard of care for several decades. Today, patients and practitioners can gain great benefit from data that can be provided by using Continuous Glucose Monitoring (CGM). Current physiologic insulin therapy regimens have improved blood glucose control capabilities. Insulin therapy devices; including pens and pumps are reviewed. Advantages of insulin pump therapy and features of the latest 'smart' pumps are described. Children with diabetes, and their families, have many challenges as well as many opportunities to employ new technologies in diabetes management plans. The ability of school and care givers to support children can impact the overall success of any diabetes therapy regimen.
The control of diabetes and its effects on long-term morbidity are well known. Many new ideas and modalities have been explored that target improved methods to monitor blood glucose and deliver insulin to achieve better metabolic control. Over the years, technological advances in these areas have made it possible to improve blood glucose control. This review addresses these newer technologies such as:
* Blood glucose (BG) monitoring
* Real time continuous glucose monitoring (CGM)
* Insulin delivery with insulin pens and pumps
* The dosed loop system (artificial pancreas)
* Blood Glucose Monitoring
Blood glucose monitoring as a means of assessing diabetes control has been used since the 1970s and is an essential clinical tool in day-to-day diabetes management. The Diabetes Control and Complication Trial clearly has shown that good control of BG improves short- and long-term microvascular complications. (1) Because of technological advances, the devices that monitor blood glucose are more accurate and efficient than ever before.
BG monitoring is done using two methods: blood glucose meters for checking blood glucose levels at discrete times, most commonly used for day-to-day diabetes management; and continuous glucose monitoring.
Blood glucose meters. Self-monitoring of blood glucose (SMBG) is the essence of day-to-day diabetes control. SMBG enables patients and their health care providers to make medication adjustments that achieve and maintain optimal glycemia. Over the last decade, glucose meters have dramatically improved in their ease of use, in time required to perform the test and in volume of blood required.
Technology of the glucose meters. All glucose meters use enzymes that oxidize the glucose in the blood sample. Electrons released from the glucose by this reaction generate an electrochemical current that is measured as a digital value displayed on a screen. The amount of current released is proportional to the glucose concentration. Most of the meters use this method for glucose measurement. Though most of the meters contain sensors that adjust and correct to the outside temperature, glucose strips used for meters may give inaccurate readings in extreme hot or cold weather. It is advisable to wait before testing to assure that strips are at room temperature, to eliminate errors.
Accuracy and precision. All glucose meters in use today are reasonably accurate, with blood glucose values being within 5% (5mg/ dl < 100mg/dl) of the lab value if done with capillary blood from the finger. There is also good reproducibility, with blood glucose results from the same drop of blood on two separate occasions having little variability, differing by only 2% to 3%. (2) The …