An effortless way to monitor blood glucose levels for diabetics
There is growing and concerning data that diabetes among younger people in Malaysia is on the rise.

According to the latest Malaysian Diabetes in Children and Adolescents Registry (DiCARE) 2006-2008 report, 71.8% of children under the age of 20 years with diabetes mellitus had type 1 diabetes (T1D).

Over the past decade, there has been an increase in not only T1D cases among the paediatric age group (below 18 years of age), but also type 2 diabetes (T2D).

Diabetes mellitus is a chronic disease associated with multiple other medical conditions and long-term complications.

Uncontrolled diabetes is one of the most common causes of heart disease, kidney failure, stroke, blindness and limb amputation in the adult population.

This is why it is so important to address and control diabetes from an early age.

Good diabetes control early in the disease can result in a lower number of diabetes-related complications.

In order to reduce long-term healthcare costs and maintain a good quality of life, diabetes should be tightly controlled even in the paediatric population.

Unfortunately, DiCARE reported that the mean HbA1c among children and adolescents had been very poor at 10.8%.

HbA1c, which is short for glycated haemoglobin, measures the average blood glucose levels in a person over the two to three months prior to the test.

Only one quarter of these children and adolescents had good diabetes control, achieving a HbA1c of less than 7.5%.

The mainstay of treatment for T1D is intensive insulin replacement, either as multiple daily injections of insulin or continuous subcutaneous insulin infusion via a pump (CSII).

The goal of intensive insulin therapy is to mimic the body’s normal insulin secretion by the pancreas in a basal-bolus fashion to achieve tight glucose control, and thereby reduce the risk of chronic complications of hyperglycaemia (high glucose levels).

However, optimal diabetes control in many T1D people is limited by hypoglycaemia (low glucose levels), the burden of frequent blood glucose monitoring and insulin dosing self-adjustment.

As a result, the majority are not able to achieve the recommended glycaemic target.

Wearable smart devices offer an advanced and effective management option for those who are insulin dependent to regulate their blood glucose.

For this age group of people living with diabetes, tapping into technology is almost second nature, and therefore, an ideal approach to help them address their condition.

Types of technology

Children are naturally active, but some parents of children with T1D stop them from being active for fear they will become hypoglycaemic. — Freepik

The introduction of the following new technologies have advanced the management of diabetes over the past decade:

> Continuous glucose monitoring system (CGM)

This consists of a small device inserted under the skin, which measures the interstitial glucose (i.e. in the space between cells) every five minutes.

This will take away the burden of having to perform multiple finger pricks daily.

It is an advantage, especially in children who have needle phobia.

The patient can access their glucose level at any time, as well as monitor the trend of their glucose levels, so that appropriate action can be taken to keep glucose levels always within the desired range.

> Insulin pump (open loop system)

This is a small device inserted in the body (usually the abdomen, buttock, thigh or upper arm).

It delivers customised doses of insulin subcutaneously (under the skin) continuously, i.e. CSII.

At any given mealtime, the patient calculates the amount of carbohydrates to be consumed.

She then enters this amount into the pump, the pump calculates the required dose of insulin, and with a simple push of a button on the pump, the insulin is delivered into the body.

It is very simple and takes away the burden of multiple injections of insulin everyday.

Studies have shown that CSII improves glycaemic control, quality of life and reduces the frequency of hypoglycaemic events.

> Automated insulin delivery (AID)

This closed loop system connects the above two types of devices, i.e. CGM and insulin pump, with an elegant artificial intelligence (AI) algorithm that facilitates automatic insulin delivery.

This is also referred to as the artificial pancreas, as the system is constantly adapting to minor fluctuations in blood glucose. just like our own pancreas would.

ALSO READ: This artificial pancreas could automate insulin delivery for diabetics

More evidence is emerging on the benefits of these technologies for better diabetes management, whether in terms of clinical, psychological or behavioural outcomes.

AID systems, in particular, have made insulin therapy so much easier and safer.

The patient can track his own diabetes control on a daily basis or over a period of time, by checking the Time In Range (TIR, percentage of time spent in the desired glucose range of 3.9-10.0 mmol/L), Time Below Range (TBR, percentage of time spent below the desired glucose range) and Time Above Range (TAR, percentage of time spent above the desired glucose range).

With the use of AID systems, many people living with diabetes are able to achieve the target TIR more than 70% of the time.

This can be an encouragement and motivation for them to do even better.

It’s important to note though, that in order to maximise the benefits of pump therapy, people living with diabetes need ongoing education on how to use the device correctly, how to utilise the glucose data, and ways they can be more proactive in the management of their diabetes.

For the kids

With wearable smart devices, the need for multiple fingerpricks a day to measure blood glucose levels can be done away with. — Positive Parenting

Children are naturally active.

Their daily activities and meal patterns can also be unpredictable.

Parents are often concerned that their children’s glucose levels may drop to dangerously low levels, especially when unaccompanied (e.g. in school).

Hence, some parents tend to overfeed their children or stop them from being active.

Both these situations are not ideal.

Hence, these smart wearable devices can be very useful in effectively managing their diabetes, i.e. to keep their glucose levels within the desired range of 3.9-10.0 mmol/L, even in the midst of their variable lifestyle.

This would allow children with diabetes to exercise safely, do everything their peers do, and enjoy their childhood, while keeping their blood glucose levels under control.

It is life-transforming.

Parents and caregivers can consult their healthcare providers about these options to help their children lead a normal life.

Indeed, in the future, we can look forward to a completely closed loop system where there is no more patient interaction.

The pump completely takes over control, assuming the role of the pancreas.

Possibly soon to appear on the market is the bi-hormonal closed loop system, which contains insulin and glucagon.

Insulin suppresses glucose, while glucagon does the opposite.

With the incorporation of an AI algorithm, the risk of hypoglycaemia can be minimised to nil.

According to the American Diabetes Association (ADA) Standards of Medical Care 2022 guidelines, AID systems “should be offered to youth and adults with type 1 diabetes and other types of insulin-deficient diabetes who are capable of using the device safely”.

The data on safety and efficacy speak well to how much these systems have improved the lives of many people with T1D.

Dr Wu Loo Ling is a consultant paediatrician and endocrinologist. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Wellness,Diabetes,child health,continuous glucose monitoring,insulin pump
Wearable smart devices are a boon in helping people with diabetes keep an eye on their blood glucose levels.