Digital Diabetes from a Patient Perspective

My personal experience of wearable technology began when I was 10 years old, as a Type 1diabetic from the age of 10 weeks, I was provided with my first Insulin Pump tomanage my diabetes in 2007.

In 2019 I then transferred to my first Continuous Glucose Monitor (Freestyle Libre) and I am now on the Medtronic CGM which uses Bluetooth to interact with the compatible insulin pump to adjust my insulin according to my blood glucose levels. The blood glucose results are also mirrored in a smartphone app, enabling the user to view their results on their phone, rather than having to access their insulin pump.

Diabetes technology has rapidly developed over the past 15 years from when I first had an insulin pump. From a patient perspective, the technology has empowered me to take more control of my diabetes; to use the results presented to me to make changes to my insulin regimes. Being able to access my blood glucose levels without using a conventional finger prick test provides minute-by-minute data which was previously impossible. This can be initially overwhelming to the user, it could cause anxiety if the patient's blood sugar levels are out of range-particularly with the latest Medtronic device that I am using, as the patient has little control and the pump generally does all the decision making using algorithms.

However, in time, I have learned that the algorithms are incredibly intuitive, and having to trust the device is crucial. Once I had learned to allow the technology to perform as designed, I now have so much more freedom, as a huge responsibility for my diabetes control is taken care of.

The educational element of being on an insulin pump and CGM has been faultless, with diabetes nurses working alongside manufacturer reps to deliver detailed training with each new product, allowing the user to feel confident and competent in using the device independently. The lines of communication in case of malfunction or damage to the device has also been impeccable.

However, the communication between specialist and community teams is an area for improvement. With my GP not being aware of my switch to a new CGM being a potential issue. Furthermore, although my Diabetes team has the same access to my blood glucose and insulin doses as I do as the patient, my GP and other community care teams do not. The technology enables care teams to view your data in real time, but only my diabetes team has access to this information via the compatible software.

To better my care would be if primary care teams could have access to this data, to limit venepuncture appointments to measure HbA1C, when the software can estimate this based on my Continuous Glucose Monitoring.

In the future, the same ethos should be applied to secondary care, as if a diabetic patient is admitted to hospital for reasons unrelated to their diabetes, I would argue that they should still have the same autonomy for their diabetes control if they were at home, and that clinicians in inpatient areas could have live access to their blood glucose, should they choose to view it. There are clearly consent issues for data sharing, so that the patient would have to authorise this access to data. However, I believe that this would lead to improved patient outcomes and an improved hospital experience for diabetic patients, who have had good glucose control in the community, and will understand their diabetes management completely. Understandably, mitigations would be in place if a patient became acutely unwell or could no longer manage their condition for a plethora of reasons, but up until that point, I passionately believe that the technology that is available to patients in their own homes, should have a seamless transition into the healthcare setting.

As a Digital Nurse, I can see the possibilities for how tech can improve healthcare and as a patient I am excited to see those possibilities become realities.