Insulin pumps and hybrid artificial pancreas are now the most advanced treatments for glycaemic control, but they are expensive, complex systems that do not suit all patients with diabetes on insulin treatment. Currently, the majority of patients still follow basal bolus insulin treatment in multiple daily doses with insulin pens.
Continuous glucose monitoring systems are already the standard of control for most people with type 1 diabetes and glucose levels are automatically transmitted to a receiver or smartphone that records all that data. However, insulin data administered with insulin pens, required to calculate IOB (Insulin-on-board or active insulin) and insulin doses to be administered, should be entered manually into the various diabetes management software. If the dose and type of insulin administered, as well as the time of administration, could be automatically transmitted from pens or insulin injection devices to CGM receptors or smartphones, would greatly facilitate the operation and use of diabetes management software.
The ultimate goal is an ecosystem in which all the results of capillary blood glucose, CGM, insulin administered, food intake and activities as well as insulin sensitivity and carbohydrate ratios are integrated into a timeframe , along with a software with predictive capacity able to recommend adequate insulin doses at all times.
For this reason, devices have emerged that coupled to the insulin pens are able to record insulin injection data and transmit them by bluetooth to the control devices. Insulclock® is an electronic device that attached to the insulin pen tracks the date, time of day, dose, insulin type, temperature and duration of insulin injections. The information is stored in the device’s memory and is available for analysis by patients and health care providers. The Insulclock device also has a reminder system with visual and acoustic alerts to reduce insulin omissions and timing error.
This spanish system has demonstrated its capabilities in controlled studies such as Dr Gómez Peralta published last year in Diabetes Technology and Thereapeutics,which observed its accuracy in recording injected doses, injection time and temperature. A recent pilot study has also shown its ability to improve glycaemic control and quality of life in patients with poorly controlled DM1.
However, I see that Insulclock® falls back into the same problem as many other companies. It does not market the device so that we can use it with the diabetes management program we consider best. What people with diabetes need is interoperable technology, not closed technologies. The needs, preferences and resources of each person can be different and professionals should have available all the technologies to adapt them to each specific case.
Novonordisk has developed smart or digital or connected pens (Novopen 6 ® and Novopen Echo Plus ®) being shown more than 1 year ago, and has reached agreements with CGM companies like Abbott or Medtronic to make them compatible, however there are no official announcements about their commercialization so far.
There are other reusable pens with connection capability such as INPEN,the only one approved by the FDA and for sale in the USA. Connects only with your own application.