Abstract Body

Since the first clinical use of insulin, more than one hundred years ago, the face of diabetes has dramatically changed. Diabetes turns out to be a ‘hydra’ with many faces, with many pathophysiological routes, with many diagnostic paths and more importantly with many therapeutic opportunities. The last 20-30 years have seen an explosion in our knowledge and in our therapeutic approach of people living with diabetes, ranging from the introduction of novel insulins and novel technologies for measuring glucose and administering insulin, to the availability of direct organ protecting agents and disease modifying therapeutics, in particular in type 2 diabetes, but more recently also in type 1 diabetes. Research is moving on rapidly, with the promise of precision medicine for all just around the corner. In the whirlwind of progress, it will remain important to stay focused on what really matters: the quality of life of the person living with diabetes. For people to live longer and healthier lives, not only tools and techniques are important, but even more so education, motivation, accompaniment of the person living with diabetes. Making the person with diabetes a member of the multidisciplinary team will ultimately determine success. The way we communicate all the novelties and make them matter, really matter for those with diabetes, is crucial and we should never forget that there are as many faces to diabetes as there are people living with this disease. Importantly, we need to strive for an all-inclusive strategy in diabetes care: access to care should be there for all… independent on age, gender, where you are born in the world, your socio-economic status…. And probably that is the greatest challenge to be faced in the next years. A challenge however this community can and WILL overcome.

Abstract Body

When it comes to monitoring glucose, the last 50 years have seen a revolution, in particular when it comes to allowing people living with diabetes to measure their glucose levels themselves. It was only in the 1980’s that self-monitoring of blood glucose became available broadly with the home blood glucose meters. These have seen increasing accuracy, but most importantly increasing user friendliness, with reduction of the size of the capillary blood volume needed, with the improved lancets for sampling, and with greater affordability, increasing thus the accessibility of the technology and allowing people with diabetes around the world to perform capillary blood glucose measurements. This is of the utmost importance those using insulin, as they need the guidance of blood glucose levels in their day to day decisions on insulin doses, but also for those not on insulin, having the data on blood glucose levels is important for guidance and motivation, provided the data are part of educational programs.

The field was revolutionized with the arrival of systems allowing continuous glucose measurements, measuring glucose levels in subcutaneous tissue and recalculating them to blood glucose values. But it was only when the Abbott system Libre^TM became available that this technology truly revolutionized the way glucose is measured in those living with diabetes. This system with intermittent scanning allowed a 14day sensor use, with great accuracy and most importantly greater affordability compared to the previous continuous glucose monitoring systems was a key moment in diabetes care. Democratization of sensor use lead to worldwide uptake and importantly pushed the field forward on thinking about new ways to express overall glucose control. The availability of 24h glucose curves, with many more data, drove to new concepts: times in ranges, coefficients of variability etc.. These turn out to be important additional inputs on top of the traditional concepts like HbA1c and are even overtaking HbA1c in daily practice and clinical trials. It will hopefully not be long before also regulators will embrace these new parameters.

The good news is that the field does not stand still! For a revolution to become a persisting reality, evolution is needed: linking sensor and pen data, linking sensors to pumps with artificial intelligence, creating (hybrid) closed loop systems, apps assisting those using sensors for glucose measures in decision making on insulin doses, food intake, exercise etc. and most importantly, increase affordability and user friendliness.

But new revolutions are on the horizon: not only glucose monitoring is being targeted, but also other metabolites come into the picture: lactate, ketones and others. And integration of all these values together with information on exercise, heart rate, food intake and even geography (person in the kitchen versus the bathroom…) will lead to completely different sets of information allowing artificial intelligence systems to assist those living with diabetes even better in therapeutic decision making, but particularly guiding them how to integrate diabetes better in their life, with less disruption and improved quality of life.