Advances In Medical Technology
Improving Diabetes Care

In fact, Health and Human Services Secretary Mike Leavitt told the Associated Press shortly after Hurricane Katrina: “There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records…than Katrina.” At the time, Leavitt said the federal government’s goal was to have electronic medical records available for most citizens by 2015.

“The medical field is the most backward in terms of information technology,” says Dr. Hellman. “When that problem gets solved, it will have a huge impact on health care.”

Continuous glucose monitoring

But while Dr. Hellman is frustrated by his industry’s slowness to adopt information technology, he calls the burgeoning technology of continuous glucose monitoring “completely revolutionary” for its potential to change diabetes care.

Compared with relying on urine glucose test strips and a single blood glucose measurement at each visit to the doctor, home blood glucose monitoring and the HbA1c test (which provides information about the level of blood glucose control over the previous two to three months) have allowed a degree of blood glucose control that was unimaginable at their inception. Both, according to Dr. Hellman, “were revolutionary in their day. Continuous glucose monitoring is just another advancement…you can see what’s going on at all times. It’s changing the rules of what we use for control.”

Continuous glucose monitoring uses a sensor, inserted under the skin, to provide a glucose reading every one to five minutes (depending on the brand) that is displayed on a monitor. The monitor also shows whether the glucose level is rising or falling and can sound an alarm if it gets too high or too low. Numbers are stored and can be viewed as graphs, which lets the user see his glucose trends throughout the day or across several days.

Currently, there are several continuous glucose monitoring systems that have been approved by the U.S. Food and Drug Administration: the DexCom Seven, the DexCom Open Choice, Abbott’s Freestyle Navigator (the most recent to gain approval for marketing), and Medtronic’s REAL-Time System, which can be used alone or as an integrated part of the MiniMed Paradigm 522 or 722 insulin pump.

According to Dr. Hellman, being able to see if your blood glucose level is rising or falling “is extremely important,” and this may explain why a randomized controlled trial showed that using a continuous glucose monitor resulted in a lower HbA1c level among insulin pump users. “In its own way,” says Dr. Hellman, continuous glucose monitoring “will have a profound effect.”

Artificial pancreas

Creating a device that would regulate blood glucose levels on its own, in effect creating an artificial pancreas, has long been a goal of diabetes researchers. Now, however, such devices are actually being built and undergoing testing. The advent of continuous glucose monitoring has been crucial to this process, since an artificial pancreas is basically the marriage of an insulin pump, a continuous glucose monitor, and a computer program that calculates how much insulin the user needs at any moment based on his blood glucose level.

But, Dr. Hellman says, “There are things that you and I would know about ourselves,” such as how stress and activities affect blood glucose levels and insulin needs, that cannot be determined by a piece of mechanical equipment, no matter how sophisticated. Artificial pancreases, he believes, “will always be imperfect,” requiring the entry of some information by the people who use them.