PHARMACY: DIABETES

Diabetes Goes Digital

Innovative technologies are revolutionizing diabetes care and monitoring By Debby Garbato

In January 1922, a Canadian doctor and two scientists successfully administered insulin to diabetics for the first time, halting progress of a disease that had been a sure death sentence. Since then, Type 1 diabetes treatment and monitoring have come a long way, thanks largely to better insulin formulations and blood glucose monitoring. But only in recent years has technology allowed diabetes patients to more closely and continuously track and compare glucose levels and other information, and to inject insulin more comfortably.

Bluetooth-enabled smart pens, for one, are experiencing widespread adoption. Connected to a smart phone app, they automatically upload insulin timing and dosage information. They can interface with continuous glucose monitors, or CGMs, which garner real time glucose level data. In addition, diabetes patients are benefitting from CGM devices implanted under the skin. These provide continuous glucose readings and send alarms if levels become unsafe. Needles have become more sophisticated as well, with shorter, thinner varieties affording more comfortable injections.

“People with diabetes are increasingly likely to use a growing number of connected devices,” said Janice MacLeod, head of clinical advocacy, global professional affairs and clinical education at Medtronic Diabetes. “Diabetes is a chronic, largely self-managed condition. Devices and apps collect patientgenerated data that can be shared with the care team. This opens the door to remote monitoring and more frequent, brief — but relevant — data-driven continuous care models.”

Technology has made products more palatable and easier to use, encouraging people to more closely follow treatment regimens. “It’s not that we don’t have a great group of medications and devices; it’s how do we get people to use them as prescribed?” said Francine Kaufman, chief medical officer at Senseonics. “Making innovations easier to use, less painful or with fewer side effects drives adherence, generating better outcomes.”

Convenient Alternative

This was the initial strategy behind insulin pens. They were introduced in 1986 as a more comfortable, discreet, accurate and convenient syringe alternative. Initially, they were not monitoring devices. Then in 2007, “smart” memory-enabled pens were introduced, followed by smart “connected” pens in 2017. In 2020, Medtronic launched the first integrated smart pen by combining its Bluetooth-enabled InPen with Guardian Connect CGM data.

(From left to right): Senseonic’s Eversense Continuous Glucose Monitoring System provides continuous glucose monitoring for 90 days and Medtronic’s integrated smart pen features Bluetooth-enabled InPen with Guardian Connect CGM data.

Medtronic’s system includes a small sensor worn under the skin for up to seven days and a discreet Bluetooth transmitter. It tracks data in real time, including glucose readings, past and current insulin doses and recent meals. It also provides dose recommendations and reminders. Information can be shared with medical professionals. “Automatic dose capture, missed dose alerts and individualized dosing decision support provided by devices are key in modernizing care,” MacLeod said.

Marketed by Ascensia, Senseonic’s Eversense Continuous Glucose Monitoring System provides continuous glucose monitoring for 90 days and is the only long-term implantable device available, Kaufman said. It consists of a fully implantable CGM sensor with a smart transmitter placed above it on the skin and a mobile app for displaying glucose values, trends and alerts. Glucose values are displayed every five minutes. Information can be shared with up to five people.

“The biggest evolution since the 1990s has been in the CGM space,” Kaufman said. “With the first CGMs, only physicians saw data. Now, there’s an implantable device where you don’t feel anything following the day it’s inserted. There’s nothing to insert or reorder. This drives innovation.”

From an evolutionary standpoint, more pharmaceuticals have been introduced in the last 10 years than in the past 50.

— Anu Rajora, director of medical affairs, HTL-Strefa

Smaller, Thinner Needles

Technology is impacting injection safety and comfort, too. HTL-Strefa’s Droplet Micron 34-gauge pen needle is 3.5 mm long, the “shortest, thinnest available,” said Anu Rajora, director of medical affairs. Droplet Micron is designed to minimize discomfort and pain by reducing penetration force by as much as 50%. Discomfort can prevent patients from properly following treatment regimens. “By removing barriers like pain and apprehension, patients can stay adherent and persistent on insulin therapies and outcomes can improve,” she said.

Beyond Medical Devices

Innovation is impacting more than CGMs and injection equipment, with special foods, beverages and foot care products becoming better tasting and more comfortable for diabetics. Over the past five years, The Simply Good Foods Company, marketer of the Atkins and Quest lines of low-carb, low-sugar products, has been using more natural, better-tasting cane sugar substitutes. “There’s more natural alternatives than before that don’t spike blood sugar,” said Colette Heimowitz, vice president of nutrition communication and education. Substitutes include monk fruit, stevia and, more recently, allulose, said Jonathan Clinthorne, director of nutrition. “They’re more widely accepted and taste profiles have improved. For a long time, sugar substitutes had an aftertaste or you could tell they were artificial.” Approved by the Food and Drug Administration in 2020 for food use, allulose is a rare sugar occurring in raisins and figs. Unlike xylitol or erythritol, it does not cause stomach upset. Not every sugar substitute works well with everything. For example, allulose caramelizes well and keeps food moist; stevia does not. “It’s a proposition of what you’re trying to do,” Clinthorne said. In foot care, Skineez is revolutionizing diabetic socks with a product impregnated with a 24-hour skin protectant containing shea butter, retinol, apricot, rose hip oils and vitamin E. The moisturizing socks help prevent blisters and skin breakdowns, which are problematic for diabetics. The domestically made, FDA-approved socks also wick moisture and resist odors. Every 10 washes, socks should be remoisturized with Skineez’s Garment Spray (sold separately for $19.99 at 50 sprays per bottle). Skineez also offers compression socks of varying firmness. “Average diabetic socks are scratchy and dry,” said Michelle Moran, founder and CEO. “You put these on and they start working. There are many copycat brands, but not much innovation.”

(Left) HTL-Strefa’s Droplet Micron 34-gauge pen needle is 3.5 mm long and designed to minimize discomfort and pain by reducing penetration force by as much as 50%. (Right) UltiGuard Safe Pack Sharps Container & Mailback Disposal Kit contains 100 pen needles or syringes, a sharps disposal container and a prepaid mailer for returning used needles to UltiMed for disposal. Owen Mumford’s Unifine Ultra pen needle uses a slide-lock action mechanism to secure the needle at both ends.

Owen Mumford, which makes needles for Medtronic’s pens, is emphasizing ergonomics and safety with its new Unifine Ultra. A flatter base provides a better grip while a slide lock action mechanism covers the needle after use and facilitates removal from the pen. Siliconization of needles improves skin penetration. Casey Pflieger, director of retail sales, said Unifine Ultra works well for people with nerve damage, which affects dexterity. “It can be hard to unscrew a tiny needle from a pen. Covering it prevents you from sticking yourself.”

UltiMed is addressing ease of use with its UltiGuard Safe Pack Sharps Container & Mailback Disposal Kit. Launched this month, the kit contains 100 pen needles or syringes, a sharps disposal container and a prepaid mailer for returning used needles to UltiMed for disposal. California spurred the Introduction of the product when the state passed SB 212, which requires consumers to send used needles back to suppliers for safe disposal. “It’s definitely easy to use,” said Holly Hartshorn, director of marketing. “People with diabetes already have many things to manage. And it’s an excellent way to ensure sharps stay out of waste streams.”

UltiMed also emphasizes injection comfort with pen needles measuring 4 mm by 32-gauge. “They’re super tiny,” Hartshorn added. “Needles continue getting smaller. We’ve also improved flow rate.”

Pharmacists: A Hub of Knowledge

Pharmacists are playing an increasingly fundamental role in diabetes care and management. Many

Making innovations easier to use, less painful or with fewer side effects drives adherence, generating better outcomes.

— Francine Kaufman, chief medical officer, Ascensia Diabetes Care have received additional certification through the have received additional certification through the Board for Diabetes Care and Education and other specialized groups on how to counsel diabetes patients and help them better understand care plans and technologies. Some retailers also employ dietitians and diabetes educators and conduct diabetes screenings and special consultations.

“The pharmacist’s role is growing and evolving,” Kaufman said. “They are no longer somebody behind the counter who you rarely see. They’re discussing use and contraindications of medications and use of technologies.”

Patients interact with pharmacists more frequently than with doctors. Pharmacists are also more accessible. “Pharmacists are one of the most trusted professionals,” Rajora said. “They advocate for the well-being of people with diabetes. Patients visit pharmacists seven times more annually than physicians, putting pharmacists in a unique position for impactful interventions to advance care and improved outcomes. As a pharmacist myself, I’m inspired by the community outreach and in-pharmacy consultations conducted by my peers.”

On both the pharmacy and product innovation ends, diabetes care is a far cry from what it was a few decades ago. “From an evolutionary standpoint, more pharmaceuticals have been introduced in the last 10 years than in the past 50,” Rajora said.

“I’ve been practicing 40-something years,” Kaufman said. “We’re a huge galaxy from where we were. It’s all so much more manageable.” dsn