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Connected insulin pens are the latest technology to be introduced to the diabetes clinic. These pens use Bluetooth or Near Field Communication to transfer insulin dosing data from the pen to an app or online platform, allowing for the review of both glucose an insulin data in the clinic. This lecture will explore the concept of connected pens, unmet needs and expectations of both health care professionals and people living with diabetes. Just a decade ago, paper diaries were central to an effective diabetes consultation. They contained information on insulin doses, glucose levels and carbohydrate intake to enable informed shared decision making. Fast forward 10 years and the diabetes consultation has evolved with paper diaries largely replaced with uploaded or ‘in the cloud’ glucose data. For those on insulin pumps the ability to have the glucose, insulin and carbohydrate data available to review is an advantage. However, this data is not readily available for those on multiple daily injections. A data gap exists between multiple daily injection and insulin pump therapies. Connected pens bridge this gap by providing insulin data alongside glucose data, essential for optimisation. For those living with diabetes, connected pens may support therapy and behaviour change, for example, providing insight into the impact of mealtime insulin timing on postprandial glucose levels or the ability to identify missed insulin doses. This new technology is promising. Future feedback from both people living with diabetes and the health care professionals supporting them will determine their future role in diabetes services.

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Major milestones in non-automated insulin administration include plastic syringes, pre-filled insulin pens, and smart insulin pens. The InPen^TM smart insulin pen enables users to capture both the time and amount of insulin delivered and can provide missed bolus reminders to the person with diabetes. The need for such advance technology was found in observational data of over 1.1 million meals where on-time bolusing occurred in just over half of all boluses and that boluses were missed almost one-third of the time. The time-in-range (70-180 mg/dL) was strongly correlated with the frequency of on-time bolusing (r=0.59, p<0.001). When the InPen^TM is used with the accompanying smartphone app to calculate the meal dose or correction dose of insulin, the user can safely determine the dose because insulin-on-board is incorporated in the dose calculation. InPen^TM use is associated with almost 2% less time-below-range (TBR) in those who had TBR greater than 8% before initiating its use. In adolescents (13-17) and young adults (18-22) using MDI for management of their diabetes, those using InPen^TM (with CGM) had significantly lower GMI’s compared to those using traditional insulin pens (p<0.001). Combining the data provided by a smart insulin pen and CGM with sensors that capture the duration/intensity of exercise, sleep and meal gestures may allow MDI users to obtain real-time and/or retrospective decision support for their diabetes management.

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Development of effective technologies supporting patient self-care behaviors, real-time monitoring or optimization of treatment regimen is essential for people living with chronic health conditions, such as diabetes, where suboptimal adherence to medication and lifestyle modification can compromise patient outcomes. When people living with diabetes receive basal insulin, as part of their treatment regimen, it is assumed that basal insulin treatment is adapted and personalized. However, only ~25% of those on basal insulin achieve glycemic control, indicating that a significant gap remains. Since basal insulin is a foundational pilar for management of people with diabetes, we believe it is imperative to address the gaps in treatment regimen optimization and improve adherence to basal insulin using effective technologies.

The suggested strategies include the use of digital devices amongst which the connected insulin pen plays a key role. However, at Sanofi we believe that the game-changing determinant for adoption of next-generation pens is user experience. The question we asked ourselves is – what matters most to people with diabetes: Convenience of use? Live data? Device autonomy? Interoperability with digital companions? Fit into existing life and care routines? Or health outcomes?

In this context and as part of its commitment to help people with diabetes, Sanofi will present its connected solutions designed with the intention to support basal insulin management in fitting user expectations and guided by strict user safety standards. We believe such solutions could provide greater convenience for people with diabetes and support improved patient-healthcare provider interaction.