What’s New in Diabetes Technology?

continuous glucose monitoring sensor

Just as innovation has changed the way we shop, bank, and search for information, it’s transformed the way we manage chronic diseases like diabetes. These new technologies have made life easier for people with type 1 and type 2 diabetes.

Stick-Free Glucose Testing

Frequent needle sticks to test blood sugar are a crucial, but sometimes unpleasant part of the daily diabetes routine. Testing your blood sugar helps you make decisions about what you eat, exercise, and insulin dosing.

Continuous glucose monitoring, or CGM, helps you avoid the stick. It measures your blood sugar every few minutes via a tiny sensor inserted under the skin of your belly or arm, and sends the results wirelessly to a pump, smartphone, or other devices.

The FreeStyle Libre was the first CGM system to not require a finger stick. To get your blood sugar number, you simply wave a reader over the sensor. The original Abbott’s FreeStyle Libre was wearable for up to 10 days, but the newest version is designed for 14-day wear.

The Dexcom G6 is approved as both a standalone CGM and for integration with automated insulin dosing systems.

In January 2020, Tandem Diabetes Care launched its t:slim X2 insulin pump with Control-IQ technology, which combines the Dexcom G6 CGM with an insulin pump to regulate insulin levels with little user effort. It’s the first system that both adjusts basal (background) insulin levels and delivers automatic bolus (mealtime) doses to prevent blood sugar from getting too low or too high.

“With the advent of CGM, we’re looking at a new phrase: ‘time-in-range.’ That’s the percentage of the day a person spends with their blood sugar in the range their doctor wants them to be in,” explains Jason Ng, MD, clinical associate professor of medicine in the University of Pittsburgh Medical Center Division of Endocrinology and Metabolism. “The monitor can check blood sugar every 5 minutes throughout the day, and it can catch fluctuations in a patient’s blood sugar that a finger stick can’t.”

The t:slim-Dexcom combination doesn’t just react to blood sugar changes, it predicts them. “Because the CGM is gathering evidence and accumulating data, the decision treatments are based on calculations of what your blood sugar will be in 30 minutes,” Ng explains. “It’s almost like a weather forecast. It can make changes before a patient hits that level to keep their blood sugar more stable.”

The next-generation CGM, the Dexcom G7, should come out in late 2020. “The sensor is a bit thinner than the G6, and it hopefully will have a longer lifespan,” Ng says.

 

Noninvasive Glucose Monitoring

CGMs cut down on finger sticks, but they still require a small needle under your skin. The ultimate aim is to create a CGM device that monitors blood sugar continuously, without having to stick anything under your skin.

A couple of products are trying to achieve this goal, including the sugarBEAT CGM, which measures blood sugar through a sticky patch placed on the skin. It launched in 2019 but isn’t yet available in the United States. AerBetic is another wearable device that measures blood sugar through chemical changes in breath gases. It’s still in the testing phase.

Ng says he hasn’t seen any evidence that these noninvasive sensors are superior to the under-the-skin sensors currently available. “I’ve had hundreds of patients on the minimally invasive sensor and most people say they can’t feel it.”

Closed-Loop Systems

The future of insulin pumps is an automated, closed-loop system, also called an artificial pancreas because it acts more like your real organ. In this system, a CGM constantly checks your blood sugar level. The pump then uses an algorithm to determine whether you need insulin to lower your blood sugar or glucagon (a hormone that releases sugar from your liver) to raise it, and then automatically delivers the correct dose to keep your blood sugar steady day and night.

The Medtronic MiniMed 670G was the first hybrid closed-loop system. It continuously monitors blood sugar levels and automatically delivers insulin, but you still have to input the bolus insulin dose based on what you eat.

Actual closed-loop systems that deliver both insulin and glucagon are in development. The trouble has been finding a form of glucagon that’s stable enough to work in the pump.

Beta Bionics is developing the world’s first fully automated bionic pancreas, the iLet Bionic Pancreas System. It received the FDA’s Breakthrough Device designation in late 2019. “This would be the world’s first system that could do both,” Ng says. “I’m not sure we’re ever going to get to a true closed-loop system, but we’re getting close.”

Smart Pens offer the memory capability of a pump, without tethering you to your device. Products like InPen and Gocap connect via Bluetooth to a smartphone app that keeps track of your insulin dose and timing.

The new NovoPen Echo device offers the additional benefits of half-unit dosing increments. “That allows you to fine-tune the amount of insulin you need,” Ng says.

By the Numbers

30.3 Million. Number of people in the United States who have diabetes.

95%.  Percentage of people with type 2 diabetes (as opposed to other types of diabetes).

34%.  Percentage of adults who have prediabetes.

48%.  Percentage of adults ages 65 and older with prediabetes.

$ 7,900.  The average annual medical expenses for someone with diabetes. 

Ask Your Doctor

What are my blood sugar goals?

Your doctor may recommend that you keep your blood glucose in the 80–130 milligram/deciliter (mg/dL) range before meals, and less than 180 mg/dL 2 hours after meals.

How often do I need to test?

That depends on whether you have type 1 or type 2 diabetes, and what medicines you take to manage it. Typically, you’ll test several times a day, including before meals and bed.

If I have a CGM, do I still need to finger stick?

Many CGMs still require a finger stick to calibrate the machine, although you won’t need to stick as often as you did without it. Ask your doctor how often to do manual blood sugar checks.

What should I do if my levels are still too high?

See your doctor. You may need to adjust your medicine dose or make a few changes to your diet.

Find more articles, browse back issues, and read the current issue of WebMD Magazine .

RACISM IN THE CHURCH – TEAM SOTERIA MINISTRIES

Fred Price Triggers Debate Over Racism

Los Angeles pastor focuses his national television
program on racial tension in the church

Frederick K.C. Price, pastor of the 16,000-member Crenshaw Christian
Center in Los Angeles, believes racism is alive and well in charismatic
churches in the 1990s. That’s why he began televising a lengthy series of
sermons on “Race, Religion, and Racism” on his Ever Increasing Faith
the program, which is aired on Trinity Broadcasting Network affiliates and
other stations.

To illustrate that racism permeates churches today, Price has played
portions of an audiotaped sermon by a prominent Christian leader–whom
Price does not name. On the tape, the unnamed pastor says it’s OK for
Christian parents to teach their children that they shouldn’t date people of
other races.

Price says this position is not biblical–and he’s calling Christians to
reexamine the issue.

“I’m not angry at any individual, and I’m not angry at any group of people,”
Price announced on the air. “I’m really angry that the church hasn’t done
anything about this situation [of racism].”

Price contends that American churches remain segregated because whites
have believed since the days of slavery that they are the superior race. For
whites to believe that teaching against interracial marriage is acceptable is
a continuation of the “superiority” premise, Price believes.

“Now I know that doesn’t include everyone,” Price told his huge TV
audience recently. “But it includes too many of you. And too many of you
don’t say anything–which makes you accessories after the fact.”

In his sermon series, Price says God created only one race–“or one
blood”–as mentioned in Acts 17:26–and that skin color is determined
simply by the level of melanin.

“You can give (blood) transfusions to any racial group from any other
racial group with comparable blood type because there is only one human
race,” Price said. “There is no other race, so all the blood can intermix.”
Price also cites Romans 2:10-11 as proof that Christians cannot show
partiality toward one another.

Price says he is not promoting or encouraging interracial marriage, but he
is defending anyone’s right to marry someone of a different color. “God
doesn’t have a problem with it. Why do you?” he asked.

The series of sermons–and Price’s bold treatment of the subject–have
caused Christians in recent months to grapple with the subject of interracial
marriage.

Even though Price does not name the pastor heard on the tape, many
viewers have recognized the voice as that of Kenneth Hagin Jr., pastor of
the 5,000-member Rhema Bible Church in Tulsa, Okla. But neither Price
nor Hagin would grant for-the-record interviews to Charisma. Hagin holds
to an official policy of not responding publicly to the criticism.

On the audiotape–which was recorded more than five years ago–Hagin
describes a situation in which he found one of his children playing with a
black child.

“We just talked to [our child] and said, ‘Hey, look, we’re friends. We play.
We go together as a group. But we do not date one another.” In another
segment of the tape, he said: “I don’t think we ought to mix any of the
races. That’s my personal opinion, OK?”

On the audiotape, Hagin said he addressed the issue of interracial marriage
because parents at Rhema Bible Church were upset that their children
were dating interracially. Both black and white parents had come to him
for advice, he said.

A group of black ministers who were offended by Hagin’s remarks took
the tapes to Price in 1992. Because of Price’s long-standing partnership
with Kenneth Hagin Ministries, the ministers asked Price to confront
Hagin.

Price has been a staunch financial supporter of Rhema Bible College since
he founded Crenshaw Christian Center in 1973. The church sits on the
former 32-acre campus of Pepperdine University, where Price built the
10,000-seat Faith Dome. The former campus is also home to his television
ministry.

Price says he wrote a seven-page letter to Kenneth Hagin Sr. about his
son’s statements but did not get a satisfactory response. A further letter
seeking a retraction also failed to achieve results, so Price stands firm on
his decision to sever his relationship with the Hagins.

“I confronted this brother with it,” Price announced on television. “I was
forced to withdraw fellowship. I hated it! But principle means more to me
than friendship.”

Even though Hagin Jr. has made no official statement about this
controversy, he has answered Rhema supporters who inquired about it.

In one letter, he said he has tried to apologize to Price and has apologized
publicly and to his church. Hagin also points out that Rhema Church’s
policy is to marry mature couples after counseling, no matter what their
race. And he notes that key members of his pastoral staff are black.

“If people would just take a look at the fruit of this ministry and would talk
to people who know me…they would understand that I am definitely not a
racist, nor am I a bigot in any way,” Hagin said in the letter. “If I could take
the words back, I would…but I can’t. I can only apologize for having said
them and pray that the hurt and confusion will be healed.”

But Price says Hagin’s apologies fall short because he refuses to recant his
the view that it is acceptable for Christian parents to discourage interracially
marriage.

One of those who has gotten involved in the controversy is Carlton
Pearson, pastor of Higher Dimensions Ministries in Tulsa, Okla. Pearson,
an African American, is a close friend of Hagin’s.

“As an African American, I understand the hurt, disillusionment, and anger
Dr. Price is apparently experiencing in regard to the ugly and tenacious
persistence of racism within the church,” Pearson said. “It is my strong
feeling that Christians must learn to be confronted without being
combative,” Pearson said he believes disagreements between Christian
leaders should be handled privately.

But Price insists that his seeming combativeness on the issue of racism is
really righteous anger. “[Racism and slavery] never could have existed
without the consent of the church,” Price says. “That’s what makes me
angry.”

–Billy Bruce