Technology is likely to play an increasing role in diabetes care in the next few years, with many expectations and some concerns. Three areas that are receiving particular attention are pumps and sensors, nanomedicine and computing.
A variety of closed-loop insulin delivery systems are being tested, including CGM-connected pumps with predictive low glucose insulin suspend, with or without insulin dosing for hyperglycaemia minimisation, hybrid closed-loop devices with patient-activated meal boluses, as well as fully-closed loop devices. The is increasing evidence for a role for insulin pump therapy in type 2 diabetes, and several new patch pumps are being developed that will be more suitable for this type of diabetes: smaller, less costly and with simpler infusion regimens.
Nanotechnology and nanomedicine applications are likely to include smart insulins with regulated delivery according to prevalent blood glucose levels (a ‘chemical artificial pancreas’), fluorescence-based glucose nanosensors that might be implanted subcutaneously and non-invasively interrogated from outside the body (‘smart tattoos’), and nanofilms for islet cell encapsulation, aimed at extending the survival of transplanted islet cells.
Amongst the many future applications for computers in diabetes care are smart phone or tablet-based apps, cloud-based expert systems for capture of data, management advice and for individual risk assessment – more personalised or precision diabetes medicine.