Smart Pens and Insulin Pump Therapy for People with Type 2 Diabetes

Globally, approximately 7.5 percent of people with type 2 diabetes require insulin therapy. In the UK, data from the National Diabetes Audit indicates that around 10 percent of individuals with type 2 diabetes are on insulin. This is despite the increased use of GLP1 agonists and SGLT2 inhibitors in recent years, which has reduced the number of people treated with insulin.

People with type 2 diabetes on insulin often face challenges due to their underlying insulin resistance, necessitating high doses of basal insulin. However, these doses can become increasingly ineffective as the dose-response curve starts to flatten out once doses exceed about 30 units. When basal insulin doses surpass 60 units daily or when post-prandial glucose levels are poorly controlled, bolus insulin is often added. This can be with specific meals where carbohydrate content is greatest and/or glucose peaks are most marked, or with all meals. Yet, the same problem occurs when higher doses of bolus insulin are required.

The availability of higher-concentration insulins, such as U200 insulin degludec (Tresiba) and lispro (Humalog), and U300 insulin glargine (Toujeo), helps mitigate the flattening of the dose-response curve to some extent by increasing the insulin dose at which the curves start to flatten out. However, those requiring very high doses of insulin often have poor glycaemic control that does not respond well to escalating doses, and these high doses are commonly associated with significant weight gain in individuals who are usually already significantly obese. Moreover, insulin doses, particularly at mealtime, may be insufficient due to underestimation of the carbohydrate content of the meal or missed doses, which adversely impacts glycaemic control.

Administration of insulin by smart pens or insulin pumps can help address some of these issues that perpetuate suboptimal glycaemic control. Smart pens provide more accurate dosing and better tracking of insulin administration, which can help prevent missed or incorrect doses. Insulin pumps offer continuous subcutaneous insulin infusion, allowing for more precise adjustments in insulin delivery based on real-time glucose monitoring. These technologies can improve glycaemic control, reduce the risk of weight gain associated with high insulin doses, and enhance overall management of type 2 diabetes for individuals requiring insulin therapy.