Background and Aims

Many people with T2D will eventually need insulin treatment to achieve glycaemic control and to reduce complications from chronic hyperglycaemia. However, insulin treatment initiation is often delayed, and HbA_1c targets are frequently not achieved in insulin-treated patients; the latter is due, in part, to insufficient titration, inadequate dosing, or missed doses. We aim to highlight current challenges in managing insulin treatment and how new technologies may address these barriers.

Methods

We searched PubMed and materials from four national and international diabetes conferences in this focussed literature review. The term ‘diabetes’ was combined with the following: insulin titration, insulin AND digital, smart phone, digital health technology, smart pen, connected pen, connected device. More than 300 resulting publications were manually filtered.

Results

A number of publications reported technology-based interventions including software tools or devices to overcome barriers to effective treatment. Of the software-based technologies selected for discussion (Table), most were developed for smartphones and demonstrated equivalent or improved glycaemic outcomes and required less contact time with healthcare practitioners (HCPs) versus controls or previous care setting. The new devices chosen generally aimed to track doses and dose timing.

Conclusions

Key features that new technology should offer include efficacy at improving glycaemic control, ease of use, accurate data capture, accessibility of data to the HCP and insulin user, and data security. A solution that connects continuous glucose monitoring, dose recording, help with titration, and recording of lifestyle factors might reduce treatment complexity and burden and result in improved titration and higher treatment adherence.

Study funded by Sanofi