Diabetes technology in Australia: What’s available, what works, and what’s coming?

#18ADC: Highlights from ADS/ADEA Joint Technology Symposium

By Dr Elizabeth Holmes-Truscott

A highlight from the 2018 Australasian Diabetes Congress was the ADS/ADEA Joint Technology Symposium. Six diverse presentations were delivered. Of particular interest, this session covered a range of technologies, such as diabetes management devices (e.g. insulin pumps, glucose monitors), apps, and online education programs, hospital-based digital diabetes dashboards, as well as emerging technologies on the horizon.

Diabetes Australia CEO Professor Greg Johnston began the symposium highlighting the important advocacy role Diabetes Australia plays in lobbying for government funding for the subsidy of diabetes management devices and supplies (e.g. CGM, blood glucose monitoring strips) for Australians with diabetes. Unlike medications and medical services, there are no national approval bodies or access pathways for diabetes technologies. Johnson argued for the need for reliable, timely, clear and transparent processes going forward. The technology market is growing and access to effective technologies for Australians with diabetes must be prioritised.

In a change of pace, our very own Prof Jane Speight presented of the psychosocial impact of diabetes technologies. Drawing on findings from the REPOSE and HypoCOMPaSS trials, Speight highlighted that while insulin administration modalities are equivalent in terms of their clinical effectiveness, those using pump therapy report higher levels of treatment satisfaction relative to those using insulin injection devices. No differences are typically observed in quality of life outcomes among people with diabetes using continuous glucose monitoring (CGM) and self-monitoring their blood glucose. Speight emphasised that there is no “one size fits all” or “fits forever” diabetes technology: enthusiasm to try technologies, and treatment satisfaction, can be different for each individual and also over time. Like their day-to-day management, the choice of diabetes technologies must be individualised and person driven.

Assoc/Prof Anthony Russell presented his research in developing and piloting a digital dashboard for use in hospital inpatient care. The potential benefits of the dashboard are identification of inpatients (people with diabetes) with suboptimal diabetes outcomes, and early intervention resulting in better glycaemia levels and shorter length of stay. It is also expected that the dashboard will help to train junior doctors, and those without specialist diabetes knowledge/experience.

Focusing on the use of technology in type 2 diabetes, Professor Sultan Linjawi provided an update on available health apps, wearable devices and technologies and provided a glimpse into what’s new in diabetes technology (including implantable long-lasting sensors). Linjawi reported that around 500,000 health apps are available today and the market continues to grow at a rate of 20-505 per year. However, abundance doesn’t necessarily equate to clinically accurate and effective apps that people with diabetes find helpful and user-friendly. We need to take stock of what health apps are currently available, advocate for the clinical and user testing of apps, and develop recommendations for people with diabetes and health professionals.

Finally, Sue Wyatt presented her experience as a clinical research nurse on the Australian Adult Hybrid Closed Loop trial. Wyatt discussed participants’ experiences of commencing and using the closed loop system (i.e. wearing linked pump and CGM devices) and drew links with some of the data reported by Speight in her earlier presentation. The ‘closed loop’ system automatically adjusts for basal insulin rates in responses to glucose levels. However, the wearer still needs to adjust for bolus (mealtime) insulin. The greatest benefits have been observed overnight with the prevention of nocturnal hypoglycaemia. Limitations include sensor issues and skin irritations. The ACBRD is involved in the Hybrid Closed Loop trial, which you can read more about here.

We thank Natalie Wischer (CEO of National Association of Diabetes Centres) and Assoc/Prof Sof Andrikopoulos (CEO of the Australia Diabetes Society) for chairing yet another thought-provoking symposium on technology. Check out our summary of the 2017 joint ADS/ADEA technology symposium here.

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