Connected Health Ecosystems: Integrating Diabetes Devices for Seamless Care

For decades, the standard care for people with diabetes (PwD) relied heavily on face-to-face appointments with healthcare professionals (HCPs). 

Most of the glucose data upon which treatment was prescribed passed through a heavy filter of human error, lack of connectivity, and delayed response to patient health fluctuations.

After the COVID-19 pandemic, it became evident that the healthcare system was deeply flawed because it didn’t allow PwD to receive the needed care. 

From the objective shortage of diabetes specialists to medical personnel struggling to meet the increasing number of PwD demands, it was time to think of a new method to manage diabetes.

That’s where connected health ecosystems prove to be the future of diabetes care. Aside from facilitating the work of HCPs, they’ve been linked to improved population health outcomes. 

So, what does integrating diabetes devices look like, and how do PwDs and HCPs benefit from it? Here’s all you need to know.

To understand connected health ecosystems, it’s important to be familiar with buzzwords like the Internet of Things (IoT) that get thrown around. IoT refers to a device that does its function while being connected to the internet. 

This allows it to collect data about user behaviour, like patterns of use, struggles, and most-used integrated functions. Then, it creates logs of this data that the user, and sometimes the manufacturing company, can later access.

Digital health tools are IoT devices and systems that utilize technology to improve the user’s health, wellness, and lifestyle choices. They usually collect data, store it, and transmit it to a database where it can be used to improve future devices and systems.

A connected health ecosystem uses digital health products to comprehensively examine a patient’s health parameters. Genetic, biological, and psychological information can improve both the treatment choices made by the patient’s healthcare team and the patient’s subsequent diabetes care outcomes.

When someone asks you to name digital solutions that improve insulin therapy, most people would go right to the insulin pump. While insulin pumps are of immense clinical relevance, diabetes management for most patients relies heavily on conventional injection methods using a vial and syringe or an insulin pen.

This usually is the case due to the limitations imposed by the patient’s insurance provider or socioeconomic factors. Also, many patients diagnosed later in life are more hesitant about embracing digital tools to manage their diabetes.

Since only about 1% of PwD in the US use insulin pumps, while close to 8% use continuous glucose monitoring devices (CGM), it’s becoming clear the most revolutionary change in diabetes technology is the CGM.

Aside from providing access to instant glycemic data, it’s also paving the way to a connected digital diabetes ecosystem. A CGM can connect to insulin pumps and smart insulin pens through a smartphone app, many of which have insulin dose calculators. This allows patients to have real-time decision-making support for their insulin therapy, even without an HCP nearby.

A connected diabetes ecosystem relies on integrating digital health products and tools to provide patients, physicians, and caregivers with the tools necessary to improve the patient’s health.

There was a positive step forward in this direction with the Integration of Continuous Glucose Monitoring Data into the Electronic Health Record (iCoDE) Project. It’s a consortium whose purpose is to facilitate data integration efforts of CGM data into Electronic Health Records (EHR).

So let’s break down the components of a connected diabetes management system with an emphasis on digital health tools:

The biggest component of a connected diabetes ecosystem is continuous glucose monitoring. It provides the basis for any other glycemic control technology and boosts both the patient's and HCPs’ understanding of the patient’s condition.

A continuous glucose monitor (CGM) is a device that consists of a sensor, a receiver, and a transmitter to connect the two. The sensor is placed under the patient’s skin to read plasma glucose levels, while the receiver parses this data and makes it readable.

CGMs come in different types. Some of them have disposable sensors that are intermittently scanned using a specialized display device, while others have implantable sensors that send data to a smartphone app continuously.

While the former type is cheaper and more accessible, the latter is better suited for a connected diabetes ecosystem. Thanks to the lack of human intervention, an automatically updated CGM is more capable of providing necessary information to patients, caregivers, and HCPs in real-time. 

This can be invaluable in cases of emergency and generally to keep complete records of the patient’s blood glucose range.

Insulin therapy, especially for type 1 diabetes patients, was revolutionized by the insulin pump’s introduction in the late 1970s. What started as a means to control insulin administration ended up being the most tech-forward option for patients seeking treatment.

By design, insulin pumps were the favorable choice to support diabetes self-management. That’s because they can be programmed in advance to release basal and bolus doses of insulin as the day wears on. They also received multiple upgrades over the years that allowed them to connect to other diabetes technology with ease.

Nowadays, insulin pumps that are connected with CGMs are labeled “artificial pancreas.” That’s because they form a closed-loop system that reads blood glucose levels and releases insulin based on the reading, directly controlling the amount released down to 0.01 units at a time.

The artificial pancreas is considered a marvel of modern technology, but that’s not where the innovation stops. Since most PwDs who need insulin therapy prefer to control their condition using an insulin pen, integrating the insulin pen into the digital ecosystem became a priority.

Creating a smart insulin pen capable of directly connecting to a CGM was a huge step in the right direction. It allows the patient to make informed decisions when it comes to their insulin dosing, which makes a marked difference in improving therapeutic outcomes.

Smart insulin pens connect to the same smartphone app the patient would use to track their CGM data. It usually contains a dose tracker to avoid insulin stacking, as well as a dose calculator that determines the dose based on glucose levels in the blood and expected carb intake.

This allows the patient to have their insulin doses tracked and visualized alongside their glycemic data, which gives their physician and diabetes care team a better idea of how to proceed with their treatment based on the available information.

Wearable digital health products are also becoming part of the digital ecosystem for diabetes management. Many fitness trackers and smartwatches can be connected to CGMs to send alerts and inform emergency contacts when the patient has too high or too low blood glucose.

Although these functionalities are currently limited to certain makes of smartwatches and fitness trackers, the support is extending to include many products on the market. This has the potential to improve rates of hospitalization due to severe hypoglycemia or diabetic ketoacidosis.

Now that we’ve discussed the potential of the connected digital ecosystem to improve diabetes care, we need to acknowledge the elephant in the room—accessibility to these advancements. Here are a few issues that limit the possibility of equitable health outcomes:

The first issue arises from the limited insurance coverage of certain cutting-edge technology when it’s still too costly. Most insurance providers require patients to jump through hoops to cover a CGM or an insulin pump. That means any newer iterations of these devices will remain out of the reach of patients for many years to come.

According to the American Diabetes Association, adopting higher-tech diabetes care devices has a positive effect on health outcomes, reducing HbA1c test results and reducing hospitalization due to hypoglycemia or diabetes ketoacidosis. However, not all insurance companies or patients are willing to contend with the upfront cost of upgrading their diabetes care regimen.

Another area for improvement is the relatively low digital health literacy rates among patients from older demographics. These patients usually struggle to adapt to new technologies, especially if it requires internet connection.

Aside from that, there are data security concerns that could be a deterrent for some people to start using CGMs or other personal monitoring devices. That’s because their information would be shared with third parties.

Emphasis on the anonymity of this information is crucial to encourage more patients to adopt these digital health tools.

Creating an equitable health ecosystem allows patients and healthcare providers from all backgrounds to access the same technologies. The availability of data is crucial to achieving this goal, but an even larger part is data decentralization.

The iCoDE project mentioned earlier aims to encourage CGM manufacturers and other stakeholders to make CGM diabetes device data easily accessible from different kinds of devices. Besides minimizing human error as a factor in logging glycemic data, it also allows HCPs to provide their services remotely based on digital health sensor information available on the EHR.

It should also allow support for cellular data as an option to connect CGMs to the EHR for remote or rural locations that don’t have broadband access. After all, not all clinics or hospitals have a consistent and reliable connection to the internet beyond an ethernet cable and a cellular tower.

A huge, neglected part of diabetes care is the mental health aspect of treatment. Many patients struggle with diabetes distress because diabetes self-management consumes much of their energy, which is a significant psychological burden that can lead to diabetes burnout.

The introduction of diabetes technology in place of in-person visits can both reduce the effort needed from the patient and minimize the healthcare-related burdens of catering to hundreds of patients on limited resources.

Healthcare systems, as they stand, weren’t built in one day. There’s a lot that goes into making a truly integrated data ecosystem that can serve doctors as well as support helpful self-management practices for PwDs.

That said, the last few years saw some positive strides in the direction of creating a better-connected system that can benefit patients while making use of the available healthcare resources. From innovating CGMs and the smart insulin pen to the iCoDE project that promises to integrate CGM data into the EHR, it’s slowly but surely coming together.