Introduction
Diabetes technologies, historically divided into blood glucose level measurement and insulin delivery instrumentalities, are the terms to describe all kinds of devices and software that help patients with diabetes to control their glycemic level, prevent complications and acute events, and enhance the quality of life. The majority of healthcare organizations are continually developing measures oriented to diabetes treatment improvement. In 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress organized an international panel of scientists and patients to summarize and advance the knowledge on continuous glucose monitoring (Danne et al., 2017). Recently, The American Diabetes Association (ADA, 2019) has updated its “Standards of Medical Care in Diabetes” with an additional section dedicated to modern diabetes technologies, treatment tools, and guidelines. The purpose of this research is the investigation of contemporary diabetes treatment facilities, their benefits, limitations, and integration into nursing practice.
Insulin Delivery
Insulin delivery is currently performed with a syringe or pen injecting, insulin pumps, or automated insulin delivery devices. Syringes or pens are commonly used by patients with type 1 and type 2 diabetes; these tools allow the delivery of insulin in a fast and effective way to improve blood glycemic levels. Choosing between a syringe or pen, a physician necessarily considers the self-management capabilities of a patient, his preferences, dose schedule, and insulin type. According to ADA (2019) “the most common syringe sizes are1 mL, 0.5 mL, and 0.3 mL, allowing doses of 100 units, 50 units, and 30 units of insulin, respectively” (p. S72). Insulin pens come as a disposable (with a single insulin dose) and reusable (with replaceable cartridges) device for push-button injections and an optional memory function of timing and doses.
Continuous subcutaneous insulin injections (insulin pumps) are being used for diabetes treatment in recent years; these tools provide patients with rapid-acting insulin doses throughout the day for glucose control. This measure requires the use of tubing and a cannula to deliver insulin, although, modern devices are attached directly to the skin. The pump therapy for adults and children is successfully used from the stage of diagnosis; though, it is performed after an in-depth examination of the patient’s individual characteristics, appropriate insulin delivery system, insulin type, and potential complication risks. Nevertheless, despite the risk of ketosis, device wearability discomfort, and possible mood disorders, continuous subcutaneous insulin injections are commonly chosen by individuals with high socioeconomic status, determined by the level of income, education, ethnicity, and health insurance.
Glucose Level Measurement
Glucose level measurement is considered critical for effective diabetes treatment and patients’ life level maintenance. Measurement of glycated hemoglobin has continuously been the traditional method of blood glucose control, although it does not reflect interday glycemic excursions and increases hypoglycemia and hyperglycemia risks (Danne et al., 2017). Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) were developed as modern diabetes treatment measures to improve blood control and the quality of living for insulin-dependent and insulin-independent patients.
Self-monitoring of blood glucose was included in diabetes therapy as an effective, complementary method of glucose level observation. The frequency of checking depends on the patient’s age and diabetes type. All patients, while monitoring their blood glucose, should receive essential instructions concerning the technique and results. SMBG is crucial for insulin-dependent patients to avoid morbidities: they are forced to assess glycemic level every day before food ingestion and postprandially, before bedtime, exercises, and important tasks, after low blood glucose treatment, and in case of glucose level decrease expectancy (ADA, 2019). The majority of patients require up to 6-10 checks per day, although the frequency can be varied individually. Despite that standard glucose monitors initially perform accurate results, inappropriate temperature, level of blood oxygen saturation, and test strips’ condition can influence accuracy.
Continuous glucose monitoring measures interstitial glucose; this method is safe and effective for patients with well-control insulin-dependent diabetes, which does not require daily SMBG. CGM devices are represented in two types – real-time continuous glucose monitoring (rtCGM), which contains alarms informing about glycemic excursions, and intermittently scanning CGM (isCGM), which is performed on-demand and approved only for adults (ADA, 2019). CGM results provide more opportunities for a thorough examination and analysis of patients’ data as CGM metrics contain an average glucose level, percentage of time in the target range, hypoglycemic range, and hyperglycemic range. Combined with automatic pump therapy, rtCGM substantially reduces the risks of hyperglycemia episodes and their severity. rtCGM, as close to daily monitoring as possible, can improve neonatal incomes for pregnant women with insulin-dependent diabetes.
Conclusion
In recent years, diabetes treatment measures are continually improving to minimize risks of complications, provide qualified medical assistance, and reduce patients’ burden of living with diabetes. The measurement of glycemic blood level to prevent excursions of glucose and insulin delivery facilities are two basic components of diabetes therapy. Moreover, diabetes treatment measures and tools are chosen for individuals according to not only age, diabetes type, the extent of disease, personal characteristics, and preferences but their socioeconomic status and cultural differences as well.
References
- American Diabetes Association. (2019). 7. Diabetes technology: Standards of medical care in diabetes – 2019.Diabetes Care, 42(Suppl. 1), S71–S80. Web.
- Danne, T., Nimri, R., Battelino, T., Bergenstal, R.M., Close, K.L., DeVries, H.,…Phillip, M. (2017). International consensus on use of continuous glucose monitoring. Diabetes Care, 40, 1631–1640. Web.