Diabetes and Technology in the Covid-19 Pandemic Crisis

Prior to this pandemic situation, important advances in the diabetes/technology area were happening. In the ambulatory setting, the development of advanced continuous glucose monitoring (CGM) devices ¹ and hybrid closed-loop systems^2,3 led us to believe that a complete closed-loop system was closer than ever. In the inpatient setting, the wireless transmission of glucose values to a nursing station ⁴ and the hybrid closed-loop systems ⁵ were holding great promises that these developments could change the way that we manage hospitalized patients with diabetes.

And suddenly, the Covid-19 pandemic crisis happened, ⁶ which helped us to learn many important things. As access to the clinics has been restricted, patients and providers have been asked to quickly adapt to a new environment: Telehealth. Patients had to use a camera and microphones or software applications that had never been used before, with a goal to substitute typical office visits. Older patients are not only more vulnerable to Covid-19 but it is also more difficult for them to adapt to technological changes. As the majority of the staff in the diabetes clinics have been teleworking, many patients have been given instructions of how to use pumps/CGM devices remotely. Even renewing supplies has become challenging creating the potential for another healthcare crisis.

In the inpatient setting, providers have realized the importance of time management and healthcare utilization. Intensive care unit beds have become scarce and mild/moderate cases of hyperglycemia/diabetic ketoacidosis have been managed in the general wards. Occasionally, hospitalizations have been withheld or delayed and patients have been managed at home or at nursing homes due to concerns that an admission will lead to Covid-19 transmission. Additionally, CGM devices have been suddenly utilized to assist in this unprecedented health crisis, reducing or even replacing testing. As point of care is recommended to be performed four to six times per day, anecdotal reports suggest that wherever CGM was used, it has decreased or even eliminated the need to enter patients’ rooms. This reduced the risk of Covid-19 transmission, which led to important time saving and to a decreased use of the valuable personal protected equipment (PPE) as nurses did not have to change PPE every time that they entered patients’ rooms.

Based on the experience that we have obtained with the current crisis, I predict that several things may change in the near future, affecting drastically how we manage patients with diabetes. With so many telemedicine platforms available even now, the vast majority of the outpatient visits will be transformed to telehealth appointments. Telemedicine will help patients to have easier access to providers, medications, and supplies. As this healthcare crisis has revealed the many benefits that telemedicine has, important legislation needed will be obtained to also convince insurance companies to modify their plans and compensate for providers and facilities services. In the inpatient setting, the use of CGM devices will expand. In addition to reducing nursing or providers workload, which has been underscored during this healthcare crisis, CGM systems can have many other benefits: They can lead to intense glucose monitoring and therefore to early recognition and prevention of impending hypoglycemia. Glycemic trends could be identified easier leading to better insulin adjustments and improved glycemic control.

Finally, there is currently a lot of concern of what the future of clinical care and research in diabetes-technology area will be, as many believe that the majority of the funds will be dedicated to infectious diseases. In times like that, when people are feeling that “we are sailing into uncharted waters,” history may have the answers that we are all looking for: 100 years ago, another virus, the 1918 pandemic flu, was claiming the lives of millions of people globally. To make it even worse, the humanity was just exiting the horrifying effects of the First World War. But what about patients with diabetes? What was their situation? Well there were no dreams at those times, those were living the absolute nightmare. We have all read the stories and seen the pictures of parents sitting next to their ketotic children with diabetes, at their bedside, waiting for their imminent death. There was no hope there was no future, diabetes was a terminal illness, a death sentence. And in this truly apocalyptic environment, light came out of the absolute darkness. Scientists from University of Toronto announced on January 11, 1922 that a 14-year-old patient with type 1 diabetes was successfully treated with insulin.

And I am confident that this will also happen now. Technology in diabetes will progress.