EASD 2019

At this year's EASD annual meeting, Dr Katarina Braune, Medical Doctor and BIH Junior Clinician Scientist, Charité University Medicine Berlin - a patient of type 1 diabetes (T1D) herself - gave a doctor and patient perspective of how digital apps and technology can help with the management of diabetes. She introduced the Open Consortium, a patient-led project comprising international researchers from academia and industry plus patient innovators, which focuses on artificial pancreas technology (funded by the EU Horizon 2020 Programme).

Living with diabetes

Mean HbA_1c levels peak during the teenage years, and for many patients, never reach the target range of <7.0%. It is estimated that there are over 100 factors that can influence blood glucose levels, many of which are hard to quantify, for example, both stress and hormone levels could cause an increase or a decrease in blood glucose. This constant volatility can affect the management of diabetes, and may impact medical complications, quality of life, cognitive impairment and gene expression. Patients with diabetes commonly feel distress, with approximately 40% developing anxiety or depression, and this can be particularly prevalent during teenage years.

Digital solutions to unmet needs in diabetes

• Products or prototypes exist, but are poorly integrated into clinical routine
• No standards exist for data logging or data interpretation
• No digital guidelines exist for healthcare professionals
• The digital divide: not all patients and doctors will accept and adhere to novel digital options (eg due to familiarity with digital technology)

An example of technology currently making an impact on the lives of patients with T1D is the do-it-yourself artificial pancreas systems (DIY APSs), which have been developed by people living with diabetes. An APS uses continuous glucose monitoring, an algorithm within a smartphone app to calculate insulin doses based on the input data, and an insulin pump. As such, the patient is no longer required to test glucose levels manually and determine and administer the appropriate insulin dose. The code is open-source and available globally at no cost. Such technologies are experimental and used at the patient's own risk, with no safety studies or regulation available.

Data from the Open project showed that for 1,058 patients who had used an APS (58% AndroidAPS, 29% Loop, 19% Open APS, 6% other), there had been a mean HbA_1c improvement of -0.83% from baseline (to a median value of 6.2%, within the target range; median usage time 10.1 months). In paediatric patients, the time in range (HbA_1c <7.0%) improved by 16% from baseline (from 64.2% to 80.7%; p<0.001). Collating patient opinion showed that improvement in sleep was one of the main benefits of the DIY APS, since the automated glucose monitoring-insulin delivery loop eliminates the necessity to monitor glucose levels manually at regular times throughout the night (by the patient themselves, or by a caregiver). One caregiver of a 10-year-old girl using a DIY APS was quoted as saying, "We were waking at 11pm, 2am, 5am, etc, to manually blood glucose check our daughter. We haven't done that in years… Now, we sleep all night".

Conclusions