What’s new in 2023? Part 2
Written by Carolien Koreneff, CDE-RN
In this article we list some new tools and technology that could be part of a person’s diabetes management in the future.
Lumen is the world’s first hand-held, portable device to accurately measure metabolism. Once available only to top athletes, in hospitals and in clinics, metabolic testing is now available to everyone.
Lumen measures the CO2 levels in the breath to interpret metabolism by understanding if the person’s body is using carbs or fats for fuel. Lumen will provide a daily personalised nutrition plan, as well as other actionable insights on sleep, workouts and meal timing. The makers of Lumen state that “by focusing on metabolism instead of restrictive or unsustainable diets, Lumen helps you to lose weight and keep it off for good with daily feedback”. That sounds promising (and perhaps a bit ‘too good to be true’?)
Apps can help a person with diabetes in various ways; with counting carbohydrates, monitoring of blood glucose levels, by tracking physical activity or by helping to manage stress. Apps are of course never meant to replace healthcare professional advice and when recommending apps to your clients you should always encourage them to pick apps that are created for use in Australia. The apps should use relevant units like mmol/L rather than mg/dL for glucose levels and kg or g for weight rather than lb or oz. For a food-related app, the data should be based on the Australian food supply, as overseas apps will have different labelling laws and may have different names of foods or ingredients which can lead to confusion.
Bolus insulin calculator apps (and other diabetes management technologies) have been around for some time and can be useful tools in improving diabetes management. According to our sources, a number of companies worldwide are working on apps that can help improve Time in Range, make life easier and help collect (and share) data. One example of such an App is OMNIA.
According to the developers, OMNIA is an artificial pancreas system which helps people with diabetes stay in a safe glucose range and avoid complications associated with diabetes. It’s an app built with a neural network powered algorithm, it apparently has an easy setup process and configuration. The developers state that “with OMNIA it’s very easy to achieve more than 70% Time in Range and make life with diabetes much easier”. OMNIA is currently available in Europe, parts of Asia, the Middle East, and the United States.
MySugr is another useful app. It offers glucose tracking, carbohydrate counting and a bolus dose calculator. Users can get weekly, monthly and even annual reports. This app can sync with many of the meters that are currently available in Australia, it can send reminders such as to check the blood glucose level after exercise and users can easily forward reports to their diabetes health professional. Best of all, it is available now, free of charge (in-app purchases are available).
A word of caution
When recommending apps for the management of diabetes, make sure the app is approved by the TGA. It is important to be selective, as some diabetes app manufacturers make claims that are not confirmed by appropriate scientific evidence. Also recommend to clients that they seek advice from their diabetes health professional when setting up their diabetes management apps.
Insulin pump technology
A lot is happening in the space of insulin pump technology. Following are a few new developments we found interesting and promising.
SigiTM patch pump
Sigi™ works with prefilled insulin cartridges (so filling reservoirs will become a thing of the past) and is controlled directly from a smartphone. Users should simply insert a new insulin cartridge into their patch pump and click it back on. SigiTM will connect with Continuous Glucose Monitors (CGM) and apparently SigiTM patch pumps are kinder to the planet as each user receives 2 rechargeable Sigi™ pumps, which last for years. SigiTM is not yet FDA approved or CE marked, so is not available on the market yet, but it looks pretty sleek and sounds promising.
The makers of the t:slim X2 insulin pump are developing a pump that is roughly half the size of the original pump and without any display screen. Initially they called it the t:sport, but the Tandem Mobi minipump as it is now called, has both a short 4-inch tubing and adhesive on the back, so it can also be stuck to the body (like a patch pump) or it can be used with the existing Tandem infusion sets. The Mobi will be operated through an iOS or Android phone, will be compatible with CGM (Dexcom) and allows for wireless charging.
Tandem are also developing the Mobi Tubeless. Mobi Tubeless will have a “disposable on-body kit.” Conceptual designs appear to show the Tandem Mobi Tubeless sticking directly onto the body, with a black rectangle shape and removable insulin cartridge. As it uses the same Mobi pump design, it will likely also hold 200 units.
Omnipod 5 tubeless system
The new Omnipod 5 tubeless insulin pump system, formerly known as Omnipod Horizon, is a closed loop system. It connects the Omnipod tubeless patch pump to a CGM via a smart algorithm, allowing for automatic insulin dosing adjustments.
The Omnipod 5 tubeless system is based on the Omnipod DASH (which is currently available with NDSS subsidy for some users) and uses the same insulin pods and mobile app. It will first be available to connect with the Dexcom CGM and later with Abbott’s FreeStyle Libre. It is not known when this system becomes available in Australia.
Medtronic extended-wear sets
Medtronic is developing an extended-wear infusion set, designed to last more than twice as long as existing infusion sets. That means it can be worn on the body for up to 7 days — compared to existing sets that must be changed out every 2 or 3 days.
This new extended infusion set will have changes to the tubing material and a different connector that will reduce the loss of preservatives, prevent tube occlusions (insulin blockages in the pump tubing) and keep the insulin chemically and physically stable over time. Less frequent set changes allow skin site locations to rest and heal, and would reduce insulin waste.
Continuous Glucose Monitoring (CGM)
Of course, there are also advances in CGM technology on the horizon.
The latest model of Dexcom CGM is expected to bring a combined sensor and transmitter design. The integrated G7 will be smaller, fully disposable, can be worn for up to 10 days (with a 12-hour grace period) and is expected to eventually support up to 15 days of sensor wear. The G7 will only need 30 minutes to warm up and will roll out with a completely new app, which is expected to have the Clarity software integrated into it. Dexcom also plans to update the Follow app at a later time. Dexcom G7 is available in the UK, Ireland, Germany, Austria and Hong Kong; it is not known when it will be available in Australia.
FreeStyle Libre 3
Freestyle Libre 3 no longer requires any sensor scanning to provide real-time glucose readings, meaning it has full CGM functionality. Freestyle Libre 3 displays a real-time glucose reading every minute on the compatible mobile app on iPhone or Android. It is 70 percent smaller, uses 41 percent less plastic and has customisable alarms. FSL-3 is currently available in the USA, it is not known when it will be available in Australia.
Eversense 180-day implantable
The Eversense implantable CGM is a first of its kind that has been available in the United States since 2018. The next-generation version currently under development would allow for the same tiny sensor to be implanted for 180 days (or 6 months rather than 3). According to the company, “this version will also reduce the number of fingerstick calibrations needed down from two to just one per day.” Eversense is not yet available in Australia.
There is a lot happening in the world of Research and Development, so this list is by no means a complete list. It is more a snapshot of some interesting new developments. We hope you enjoyed reading it.