Wearable Tech to Manage Your Diabetes

Scientists and medical device manufacturers are exploring wearable devices to control the complexities of diabetes. The Food and Drug Administration (FDA) has recently approved several types of revolutionary wearable tech for people with diabetes—and newer technology may be on the horizon.

Types of Wearable Tech for Diabetes

There are several innovative wearable technology models that have been recently approved (since 2018) by the FDA.

Wearable tech for people with diabetes includes devices such as continuous glucose monitoring (CGM) systems and insulin pumps, which can make it easier and much more efficient for a person with diabetes to manage their blood sugar. Originally developed for people with type 1 diabetes, advancing technology has expanded their use among people with type 2 diabetes.

CGMs allow a person to track glucose levels on an ongoing basis. Insulin pumps deliver a precise amount of insulin at every dosage administration period. When the two systems are combined, the result is tighter blood sugar control than ever before.

A CGM is a compact monitoring and transmitting device with an implantable or a stick-on (affixed to the skin) sensor to detect blood sugar—which it does in real time, usually every five minutes. A sensor is either implanted in the skin (via a small cannula that is placed just under the skin by your doctor) or attached to the skin adhesively. The sensors must be replaced every 10 to 90 days, depending on the CGM model you use. A transmitter is connected to the sensor to transmit blood glucose readings either to a monitoring device or to your smartphone (depending on the CGM model).

Most CGM systems provide blood glucose readings along with additional data, such as alarms, for notification of pre-set high and low blood sugar levels, and more.

Why Continuous Glucose Monitoring?

Finger-sticks are limited in their ability to measure blood glucose levels—which fluctuate constantly—on an ongoing basis. When blood glucose monitoring is ineffective, this can translate to long-term complications of diabetes (such as damage to the nerves, circulatory system, vision problems, and more).

Continuous blood sugar monitoring means more accurate and effective adjustment of insulin and, subsequently, the maintenance of healthier blood sugar levels. Today, this is possible due to the innovative wearable tech for diabetes that is available.

Continuous monitoring can also offer immediate real-time protection against extremely high or low blood glucose levels that could result in dangerous adverse symptoms (such as disorientation or unconsciousness).

Continuous Glucose Monitoring Systems

There are several models currently available, and each differs in exactly how often and how long the glucose readings can be obtained (requiring that the sensor is changed at various intervals, from 10 to 90 days). The newest model names and features include the following.

Model: The Eversense CGM System

• Features an implantable fluorescence-based sensor and a smart transmitter and mobile app
• Provides real-time blood sugar monitoring every five minutes for 90 days
• Displays glucose levels and alerts on a compatible mobile device
• Provides 90-day continuous wear
• Allows for the transmitter to be removed without removing the sensor
• Features on-body vibration alarms (even when your phone is not in range)
• Requires that users visit their healthcare provider every 90 days for new sensor placement
• Provides accurate blood glucose monitoring (the Eversense was found to be as accurate, or more accurate than, other CGM models that are currently available)

If you currently have an Eversense implantable sensor and need help locating an available healthcare provider for a new sensor implant, contact the company at 844-SENSE4U or email HCPservices@senseonics.com.

Model: Dexcom CGM System
This model's features include:

• Can be used for children (aged 2 or older) and adults
• Transmits glucose levels every five minutes for 10 days
• Alarms for pre-set high and low blood sugar notification (as well as when glucose levels are rising or falling)
• High level of accuracy
• Integrated with insulin pumps (Animas Vibe and Tandem’s T:slim X2 models; the Anima Vibe is not available in the U.S.)
• Transmits information to a smartphone
• Alerts users when blood glucose levels are predicted to fall to 55 milligrams per deciliter (mg/dL) or below within the next 20 minutes
• Compatible with other medical devices and electronic interfaces (such as insulin pumps, automated insulin dosing systems, and other electronic devices used to manage diabetes)
• Comes pre-calibrated from the factory (no need to do a finger-prick to calibrate the monitor)

Model: Medtronic’s Guardian Connect System
This model's features include:

• Continuously monitors and reports glucose levels every five minutes for seven days
• Sends data directly to a compatible mobile device (there is no option for a separate receiver)
• Sensor as well as the system itself require charging
• Reports blood sugar level trends and patterns

Model: Medtronic MiniMed 670G System
This model's features include:

• Monitors glucose levels
• Automatically adjusts the delivery of long-acting or basal insulin according to glucose readings

Model: Abbott’s Freestyle Libre 14-Day System
This model's features include:

• Continuously reports readings
• Alarms for high and low blood sugar states
• No finger-pricks are required
• Approved by the U.S. FDA in June 2020

Automatic Insulin Pumps

Before advanced medical technology became available, insulin was given by self-injection for those with type 1 diabetes. Today, there are other choices, including the insulin pump. The insulin pump is about the size of a deck of cards; it is worn outside of the body (around the waist, attached to a belt or armband).

How Insulin Pumps Work

The insulin pump delivers insulin via a thin tube (catheter) that is placed under the skin (into a layer of fat tissue). The pump works via a computerized mechanism that administers small doses of short-acting insulin continuously (called the basal rate), followed by a variable dose of insulin when a large meal is ingested (called a bolus).

Most insulin pumps are equipped with bolus calculators to help you figure out how much the bolus insulin dosage should be (based on your blood sugar level and your food intake at each meal). The way the insulin pump administers insulin is much like how the human pancreas works.

Automatic Insulin Pump Models

Model: Tandem t:slim X2
The features include:

• Compatible for integration with the Dexcom G6 CGM system
• Rechargeable battery
• Basal-IQ algorithm (uses the sensor values from an integrated Dexcom G6 sensor to help reduce the frequency and duration of adverse blood sugar events)
• Watertight (up to 3 feet for 30 minutes)
• Control-IQ algorithm (adjusts basal insulin delivery and provides automatic correction boluses, in an automated closed loop that prevents both highs and lows)

Model: Insulet Omnipod DASH
The features include:

• Tubeless pump
• Insulin delivery via pod that needs to be changed every 2-3 days
• Communicates using Bluetooth technology
• Works with an app on smartphones
• Waterproof, ideal for active lifestyles
• The Omnipod Horizon will be released in 2021 and will include an automated closed-loop system that will connect to the Dexcom sensor

Model: Roche Accu-Chek Spirit Combo
The features of this model include:

• Remote connection with Accu-Chek Aviva combo meter
• Pump holds 315 units of insulin
• Utilizes Bluetooth technology connection to communicate with the Aviva Combo meter
• No longer sold in the U.S.

Is Wearable Tech Effective?

Many people can benefit from wearable technology for diabetes, including those who are elderly. It's common that older adults have difficulty performing their own blood sugar checks, particularly those who have dementia. Nearly 20% of elderly people with dementia also have diabetes. These people are usually more prone to low blood sugar because of the medication they take for dementia. They may also have trouble recognizing the warning signs of hypoglycemia due to their dementia.

According to a 2019 study published in The BMJ, older people with diabetes could benefit from the use of wearable technology, namely, wearable glucose monitors.

According to lead study author Dr. Katharina Mattishent, from the University of East Anglia Norwich Medical School: "Older people with memory problems can find it more difficult to keep an eye on their blood sugars.”

Mattishent stated, "Devices which continuously monitor people with dementia could help keep them out of hospital, preventing unnecessary distress, and saving the NHS money."'

The study discovered that the CGM device provided greater ease in monitoring glucose levels for the people with diabetes in the study as well as their caregivers. The study also found that real-time wearable tech—devices with automated data transfer—for diabetes may be more suitable for older people with diabetes.

CGM is also helpful for parents, since they're able to not only monitor but control their child's glucose levels with greater ease.

Other Studies

In a randomized control study published in 2016, in those with type 1 (insulin-dependent) diabetes who injected insulin several times each day, the use of the CGM system (compared to the standard finger-prick method) resulted in a greater decrease in HbA1c levels during a 24-hour time span.

The HbA1c test indicates the average blood glucose levels over the past two to three months. The use of CGM allows you and your doctor to focus not only on the HbA1c, but on the glucose management indicator, or GMI. GMI reflects how well controlled glucose has been over a specific period of time. The advantage of the GMI measurement over the HBA1c is that GMI is based on the percentage of time that glucose has been within normal range, while the HBA1c test doesn't reflect how well glucose has been controlled over the same period. The GMI is also independent of hemoglobin, so it doesn't change if you have other conditions such as anemia or kidney disease.

Tips for Selecting Wearable Tech for Diabetes

Before deciding on the right type of wearable technology for you, it’s vital to have a discussion with your healthcare provider to get a list of features and elements that are the most important for your diabetes management. Not all features will apply to each person with diabetes.

Selecting an insulin pump can be a complicated process. Here are some factors to consider from Diabetes Education Online:

• Insurance coverage (check the durable medical equipment portion of your healthcare insurance policy)
• Cost (which can fluctuate greatly)
• Ease of use (some systems can be complicated to set up and use)
• Online or local education (video tutorials or classes on how to use the technology)
• Healthcare provider/diabetic team familiarity (to help educate you on the use of the monitor)
• Maintenance
• Intermittent or continuous transmission of blood glucose levels
• How often does the sensor need to be replaced?
• Features (such as illuminated screens, audio, and more)
• Warm-up period (some models take up to 12 hours from the time the sensor is replaced to start producing readings)
• Alarms and notifications (for high and low blood sugar and trends and patterns)
• Information storage and retrieval (tracking time and date of each test result, keeping track of trends, sharing information with the physician, etc.)
• Type of transmission (is an external transmitter needed, or is information automatically sent to a smartphone?)
• Does the system come pre-calibrated, or does it need to be manually calibrated?
• Compatibility with other technology (such as insulin pumps)
• Customer service and technical support (24-hour support for technical problems?)

Considerations for insulin pumps include:

• Insurance coverage (insulin pumps can cost over $6,000)
• The weight and size of the pump
• Ease of use of the system (depending on your level of technical savvy)
• Lowest basal rate delivery (the hourly insulin basal rate is calculated by dividing the total basal dose by 24, but always check with your diabetes team to get help, particularly when initially calculating your basal dose)
• Background patterns available (such as weekday, weekend, night shift, exercise day, etc.)
• Waterproof or water-resistant feature
• Insulin-to-carbohydrate ratio program feature (helps to estimate the size of bolus when eating carbohydrates)
• Customizable bolus programs (including automatic settings for specific foods, such as pizza, and more)
• Various types of alarms and alerts
• Compatibility with other technology (such as CGM systems)
• Local insulin pump education availability
• Familiarity of your healthcare team with the model/technology
• Customer service availability (and 24-hour technical support?)
• Upgrades (costs, future features that will be available?)
• Infusion set (the parts that connect the insulin pump to your body) compatibility—brand-specific (proprietary) or universal?

The Future of Wearable Tech and Diabetes

The future of wearable tech and diabetes looks promising. Big medical equipment manufacturers and other well-known technology corporations are looking into the development of new technology. Soon, new diabetes management technology may emerge incorporated into smartwatches, smart shoes and socks, and perhaps even contact lenses.

A Word From Verywell

To say that the new wearable technology for diabetes may transform the way diabetes is managed in the future is not an exaggeration. Compared to traditional methods of blood sugar monitoring (daily finger-pricks), providing blood sugar levels several times per day, the modern CGM systems transmit blood sugar level reports over 280 times a day. A person with diabetes (as well as healthcare providers) can be informed every five minutes regarding the fluctuation of blood sugar. Combine those facts with the ability to automatically dispense insulin whenever the blood glucose begins to rise—keeping it within normal limits on a continuous basis—and you can get a clear picture of just how impactful this new technology really is.