Treating Type 2 Diabetes: Looking Ahead - Episode 10
A description of hybrid artificial insulin pump systems for type 2 diabetes and a discussion highlighting potential integration with continuous glucose monitoring systems.
Davida Kruger, NP: We’ve decided that every person who has diabetes should be given a CGM [continuous glucose monitor]. We’ve got that taken care of, now we have to just get the insurance companies to agree with us. Check. The other new technology, and again, I have to remind you one more time that I have been in diabetes for 40 years and you can’t believe what we did not have when I started in the world of diabetes. Now I came right in to work in the diabetes control and complication trial. That’s what I was hired to do. Insulin pumps for that study, this is not an exaggeration, they were this big. They were this thick. We had to plug them in at night and you had to dilute out the insulin and only metal needles were available, and we had to take those down and tape them down. I had to teach people to stop peeing on the blood glucose strip because they were so used to urine strips and now I was asking them to do blood glucose strips for the DCCT [Diabetes Control and Complications Trial] and other things in clinical practice. It’s been huge for me to watch the changes that have occurred. Now, we have itty bitty insulin pumps and I always laugh when a patient goes, “Oh my God, that pump is so big.” I’m like, “Oh, let me show you.”
Margo B. Minissian, PhD, ACNP: You have no idea.
Davida Kruger, NP: You have no idea. But we also now have insulin pumps that will integrate with CGM, which is totally geeky. I just finished a study with Beta Bionics and that is an actual integrated pump that does everything for the patient. We use hybrids. We have a couple of hybrids that we use. But to me it’s just amazing what these pumps could do. They get the data from the continuous glucose monitoring and they adjust the insulin. If the blood sugar goes high, it gives more insulin. If the blood sugar goes low, it turns it off during sleep mode. There are all kinds of things that these pumps use and they’re kind of mind-blowing in terms of thinking about that. We’re giving more and more use for those individuals who have type 2 diabetes and they’re on insulin. They really want to move that out to that population as well and discuss how do we get these patients on insulin pumps.
Margo B. Minissian, PhD, ACNP: And can I say, it’s about time? Think about having a discussion with someone about a new pair of shoes or a purse that you were looking at. You go and hop online, and you get on your computer, and you go to search something and that purse that you were talking about pops up in the side window. They have been using AI [artificial intelligence] in marketing forever. To the point where we’re constantly having data gathered on us and almost everything that we’re doing. It would make perfect sense that they would be able to fine tune this pump to be able to utilize AI to inform the dosing of the insulin. So, bravo for getting all this put together and for helping to lead this because this is going to be life changing, especially for our juveniles. It’s vitally important that we’re able to help people to have a better quality of life, which is what it’s all about at the end of the day.
Davida Kruger, NP: Yes, and I see mostly 15 and above. But I must tell you that we probably have 2000 people on insulin pumps in our clinical practice, in our group. It is mind-blowing the changes and how much these impact and how much quicker we can get to patients to treatment goal when we have the assistance of the insulin pump doing its job. Because if the patient misses an injection or a bolus of insulin for a meal and the pump says, “Wait a minute something is wrong here.” Your blood sugar is going high after you eat and the pump says, “Oh, let me fix this. Let me fix this for you.” It really is mind-blowing how many more people can get to an A1c [glycated hemoglobin] treatment goal by doing that. Just a quick sidestep, I just want to remind people again that if your patients move to insulin there’s no reason that you must take them off of the GLP-1 [glucagon-like peptide 1] or the SGLT2 [sodium-glucose cotransporter-2] inhibitor. We just get to use less insulin if, in fact, we’re using both.
Margo B. Minissian, PhD, ACNP: And remember, we’re not just treating numbers. We’re treating risk. We have to think less about people as numbers and think more about people as an entity, as a whole self. That risk reduction comprehensively is the most important piece beyond whether it’s their blood sugar number, their hemoglobin A1c, or their lipid LDL for that matter.
Davida Kruger, NP: I want to thank our audience for watching HCPLive® Peers and Perspectives. If you enjoyed the content, please subscribe for our new e-newsletter to receive upcoming Peers and Perspectives and other great content right in your inbox. I receive it and I really love it when I see it in there. Take some time to enjoy it. Thank you again for joining us.
Transcript edited for clarity.