Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Diabetes Technology: Vices and Virtues (#41)

John C Pickup 1
  1. Diabetes Research Group, King’s College London Faculty of Medicine, Guy’s Hospital, London , United Kingdom

Diabetes technologies like insulin pump therapy (continuous subcutaneous insulin infusion, CSII) and continuous glucose monitoring (CGM) are making important contributions to the improved care of people with diabetes, but there are still notable concerns about slow and variable uptake and the role of technology in routine clinical practice. To understand why this is, we might consider that many problems and have been due to ‘the seven deadly sins of diabetes technology’: testing in inappropriate patient groups (e.g. those that do not have any special clinical problem), poor reliability (insulin pumps and infusion sets still have some complications), poor affordability, a focus on short-term and not long-term performance and safety, poor attention to patient acceptability, lack of equitable availability and no clear guidelines for best use. Fortunately, there has been much recent research to solve these issues, including meta-analyses of efficacy in patients with clinical problems such as disabling hypoglycaemia, health economic analyses to identify patients that are most cost-effectively treated by CSII and CGM, studies of biochemical and clinical outcomes over many years (HbA1c, severe hypoglycaemia and cardiovascular disease), surveys of patient responses and attitudes to technology and national and international evidence-based guidelines for best use of devices in diabetes. More needs to be done to improve access to technology and understand the barriers to uptake; healthcare professional knowledge and attitudes and socioeconomic status of patients are just two factors that influence who gets technologies like CSII and CGM.