Learning From COVID-19 and Looking to Technology Ahead

I have learned a great many things in the last month—not least that diabetes technology is about far more than simply improving in-clinic efficiencies and health outcomes day-to-day. It can also be an invaluable tool during—and even before—times of crisis. As the COVID-19 pandemic continues, it is challenging our healthcare systems in a manner that few, if any of us, have seen before. Yet while the majority of attention is being paid to many cases of acute respiratory distress syndrome, nobody had expected that people living with diabetes would face such an elevated threat. Indeed, as a recent US CDC report ¹ showed, roughly a third of people in the country admitted to ICU with COVID-19 have diabetes. In addition, an early Chinese report found that if a person’s diabetes is well-managed, the risk of them getting severely sick from COVID-19 is about the same as for the general population. This in turn could indicate that poor glycemic control is associated with a higher risk of poor outcomes if contracting COVID-19—which should not be a surprise as glycemic control is considered a marker for how well diabetes is managed.

As a former clinician, I know that, for many people, diabetes can be difficult to manage outside times of crisis. But the arrival of COVID-19 has seen two fresh problems emerge. The first is the need to avoid contact with clinics for fear of contracting COVID-19, reducing access to regular consultations and treatments. The second is that healthcare workers have no means by which to triage people with diabetes remotely, making it nearly impossible to identify and adjust treatment for those at highest risk of complications. Together, the early reports and learnings underline the need for technology to keep patients in good glycemic control and to manage them by distance during a crisis of this nature.

In the future, I predict we will see more widespread leverage of data collected on the patient side. Patients will only to a limited extent be willing to actively collect data, so passive collection of data at the patient side, most importantly insulin dosing and blood glucose data via smart pens, connected blood glucose meters (BGMs), and continuous glucose monitors (CGMs), will be key. Allied to simple, clear analytics and data visualizations, these insights could help healthcare professionals guide treatment and thereby improve health outcomes. Insulin dosing and blood glucose data from smart insulin pens, BGMs, and CGMs should also be leveraged between consultations to conduct automated risk stratification to identify the patients who are at the highest risk of developing diabetes complications. This passively collected data could also be used to create regulated algorithms that provide automated dose guidance and help titrate a person with diabetes to their preset blood-glucose target.

Similarly, virtual consultations must be made more commonplace to compensate for the “touch and feel” of having a face-to-face consultation. In example, during this crisis, a tenfold increase in virtual consultations has been observed in France. And to optimize the virtual consultation, we need the virtual clinic to be in place. An important part of the virtual clinic comprises reliable real-time—preferentially passively collected—data readily available, especially when it comes to insulin dosing and blood glucose values.

There is no escaping the fact that the COVID-19 pandemic is an extraordinary worldwide event and a harrowing reminder of the healthcare challenges that come with living in a truly global society. We must not forget that the immediate needs of every person impacted by this virus should continue to be our primary focus.

But as a medical community, we must also use this moment to figure out how we can better utilize digital technologies and innovations in future—not only to make diabetes care and consultations more effective during normal times but to ensure we are better equipped to save lives during periods of crisis. Amidst the unprecedented challenges of today, we have an opportunity to create a better tomorrow. We owe it to people everywhere to take it.