When Technology Isn’t Enough to Prevent Lows

A researcher argues at the ADA Scientific Sessions that patients need more than just pumps and CGMs to control blood glucose levels.



The ADA Scientific Sessions is the kind of place where you hear a lot praise for technological advances in diabetes care. Diabetes researcher Dr. Simon Heller, however, provided a note of caution to our technological exuberance. In his presentation, Dr. Heller, the chair of the clinical diabetes department at the University of Sheffield (UK), presented data that showed pumps and CGMs haven’t cut rates of hypoglycemia.

“Despite all the (technological) advances, hypoglycemia is as common now as it was 25 years ago,” Dr. Heller said. “It’s quite depressing.”

He believes that some clinical trials on the effectiveness of technological interventions might be flawed. Researchers might be emphasizing trial data showing nighttime reductions in hypoglycemia rates or studying the wrong patients, he said, and that can create an optimistic picture that technology is a solution in itself. And, on a more fundamental level, he’s concerned that many researchers can’t even come to agreement on what hypoglycemia is.

“Almost everybody who runs trials uses a different definition,” he said.

man_180px
Dr. Simon Heller,
professor of clinical
diabetes at University
of Sheffield (U.K.).

Dr. Heller argued for a deeper intervention to help individuals with diabetes avoid hypoglycemia. He believes that focused and structured instruction and support is vital to help an individual manage daily blood glucose levels. He provided trial data to show that people with diabetes can use technology to achieve tight blood glucose control without risking more bouts of hypoglycemia. If this is true, he argued, then doctors must do more than just prescribe technological fixes.

“I think it’s unethical to promote intensive insulin therapy unless you combine it with structured….training,” he said.

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Craig Idlebrook is chief editor for Insulin Nation and Información Sobre Diabetes, and was founding editor for Type 2 Nation. You can reach him at cidlebrook@selfrx.com.