Tech for people with diabetes

More and more patients with diabetes are taking advantage of technology that helps maintain appropriate blood glucose levels and lessens the burden of calculations and finger pricks needed to achieve them. What is the role of the non-endocrinologist physician in helping these patients?Two experts provided advice: Dr. Ilana Halperin, a staff endocrinologist at Sunnybrook Health Sciences Centre in Toronto and associate professor at the University of Toronto, and Dr. Bikrampal Sidhu, an endocrinologist at Kingston Health Sciences Centre and assistant professor at Queen’s University in Kingston, Ont.The right techType 1 and type 2 diabetes are very different diseases when it comes to what technology is appropriate, Dr. Sidhu said. Knowing who should be on what type of technology is key.For people with type 1 diabetes who take insulin, glucose monitoring can help reach blood glucose targets with a lower risk of hypoglycemic events. This can be as simple as a wearable sensor sending information to a reader or cell phone about blood glucose measures. There’s the choice of flash (or intermittent) monitoring or real-time, continuous monitoring.People with type 2 diabetes can benefit from continuous glucose monitoring (CGM), particularly if they’re on insulin. While not necessary or helpful for most patients not on insulin, getting the data from a device might help some who are struggling to maintain their blood sugar levels. Dr. Halperin recently offered a patient a sample of a CGM sensor and it made him realize what foods were spiking his blood sugar levels. While he might not qualify for funding for CGM, he may pay for one every couple of months to make sure he’s on track with diet and exercise.Traditional insulin pumps provide a steady infusion of insulin and require the user to input information about meals or exercise. Now, people with type 1 diabetes can use closed-loop systems, where continuous glucose monitors interact with insulin pumps to provide automated insulin delivery (AID) when needed. “It’s totally changed the experience for people with diabetes, not only in terms of better glucose management, but also improving quality of life,” Dr. Halperin said. Patients sleep better and have less diabetes-related stress, among other positive outcomes.An AID system is the preferred treatment option for patients with type 1 diabetes, states the 2025 Diabetes Canada clinical practice guideline on glycemic management in people with type 1 diabetes. If AID is not possible or not the patient’s choice, the next best choice is CGM in combination with an insulin pump or basal bolus injection, the guidelines note.Most people with type 2 diabetes will not need AID systems, although there have been studies on AID systems in people with type 2 diabetes who take insulin. One was published in the New England Journal of Medicine in March 2025. Patients using the AID system had a significantly greater reduction in glucose blood levels than those using CGM alone.“Unsurprisingly, they work really well,” Dr. Halperin said. People with type 2 diabetes who use them, “are still encouraged to announce their meals but a lot of the heavy lifting is done by the algorithm.”The main trend remains that all patients with diabetes treated with insulin can benefit from CGM, but it’s patients with type 1 diabetes who really benefit from AID systems.Read: Maternal diabetes likely a contributing culprit in neurodevelopment disorders in offspringCosts and coverageThe biggest barrier to using diabetes technology is the cost. All jurisdictions in Canada have coverage for glucose monitoring and AID systems for people with type 1 diabetes, provided certain conditions are met. Coverage for people with type 2 diabetes who take insulin varies depending on jurisdiction. An overview of public insurance coverage is available on the website of Breakthrough T1D Canada, formerly the Juvenile Diabetes Research Foundation (JDRF).For AID systems, the pump can cost up to $7,000, with a cost of supplies ($300 to $400 a month) and cost of glucose monitor sensors ($300 to $400 a month). “I think it will be a while before we see widespread adoption of these systems for type 2,” Dr. Halperin said. If a patient with type 2 diabetes can shoulder the cost and is struggling to manage their blood sugar, it may be appropriate to refer them.TroubleshootingLuckily, all commercially available technologies have phone numbers to call for tech support and websites with resources on how to use the technologies.Physicians should remind patients using CGM that, “If the number doesn’t match their symptoms, they should do an old-fashioned capillary blood glucose or finger poke check,” Dr. Halperin said. There are times when the sensor is not accurate, especially on the first or last day of the 10-to-14-day long wear of the sensor, she said. If the patient is going to make a dosing decision to treat a high- or low-blood sugar reading at this time, it’s a good idea to do a finger poke test first.Some patients with type 1 diabetes may choose a do-it-yourself AID system, where they update the system using open-source code. Patients first adopted these systems when fewer commercial AID systems were available and when coverage was not as comprehensive. Dr. Halperin co-authored a 2023 paper published in the Canadian Journal of Diabetes on how physicians can support patients who use these systems. “Any system that helps patients feel better should be supported by their clinicians,” Dr. Halperin said. Uptake for DIY systems was only 30% in her clinic. It’s a lot of work to build the app, update it, manage the technology as well as the disease, with no easy telephone number to call for help. Still, physicians should understand the basics, she said. “Whatever system my patient chooses, I should be educated enough to know how to adjust insulin settings to optimize glycemic control.”Skin irritation can occur with wearable sensors. For some people the sensor doesn’t stick properly, or the glue comes off. Patients can buy skin glue and/or use products like Skin Tac to make sure their skin is tackier and stickier in the area where they’ll wear the sensor. Patients can also put on bandages or patches to hold the sensor in place, Dr. Sidhu said.If a patient has itchy skin around the sensor area, Dr. Sidhu recommended using an asthma inhaler or a nasal spray like Flonase or Flovent. Spray a bit directly on the skin where the sensor will go before putting the sensor on. “It acts as a little anti-inflammatory right under the sensor. That can actually prevent those reactions,” he said. It works better than a cream.Technology in pregnancyNot all glucose monitoring technology is approved for use in pregnancy by Health Canada, “But we offer it to almost everybody in my pregnancy clinic,” Dr. Sidhu said. “It’s a lot easier to measure your sugars on a sensor than off.” Thousands of Canadian patients have gone through pregnancy using glucose monitoring technology without concern and there’s evidence of benefit of real-time CGM in patients with type 1 diabetes who are pregnant.With AID systems, “Targets are higher than what we would consider acceptable in pregnancy. For that reason, they’re not approved,” Dr. Sidhu said. “Most endocrinologists would say it’s still better than we could do without those pumps.” There’s mounting evidence showing the benefits of patients using AID systems in pregnancy, and patients should not be taken off AID systems if they’re pregnant.“Pregnancy is not a reason to not be on technology,” Dr. Sidhu said.Other specialistsAID systems should be supported by an endocrinology or diabetes management team. If a patient with type 1 diabetes isn’t connected to a team, make a referral, Dr. Sidhu said. Even the most well-informed primary care physician or other specialist might not know about some of the recent developments in the area.Once a patient has decided on a system, learn about it from the company’s website. There’s information on how to access the data and how to assess the device. Physicians can also access resources on technology at type1better.com, a program run out of McGill University and through clinical resources offered by Diabetes Canada.“I would encourage all family doctors to get comfortable with putting in continuous glucose monitors themselves. Do it once or twice. They’re very simple things to do,” Dr. Sidhu advised. “When you can show your patient, they’re much more likely to use it and get the benefit out of it.”Finally, recognize that patients are the experts. They’re often active on various online forums about diabetes technology. Dr. Sidhu recently learned from a patient about the best waterproof bag to protect an AID system when scuba diving or surfing in salt water, a fact he can now share with other patients.

Tech for people with diabetes

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