Use of technology in type 2 diabetes

Using technology in type 1 diabetes had been a major game changer in the past few years. First came insulin pumps, then continuous glucose monitoring (CGM). Pairing the two to create hybrid closed loop or automated insulin delivery (AID) technology then took it to a new level.
The result: lower HbA1c, fewer hypos and improved quality of life for people living with type 1 diabetes.

So, can using the same technology help people living with type 2 diabetes?

This article provides an update on the use of technology in type 2 diabetes.

Type 2 diabetes represents 9 out of 10 cases of diabetes worldwide. This figure will rise by almost 50% in the next 20 years. At the same time, only half of people living with type 2 diabetes achieve an HbA1c of 7% or under. The goal is to aim for a time-in-range (TIR) of 70% and above keep time-below-range (TBR) under 5%. You can learn more about TIR here.

Most data on CGM use is for people living with type 2 diabetes who use long acting and short acting insulins separately. This is also known as basal-bolus insulin regimens:

CGM reduces HbA1c. Compared to self blood glucose monitoring (SBGM), CGM reduced HbA1c by around 0.2-0.3%. This was whether CGM was in real-time or intermittently scanned. It also significantly increased TIR by 10% and reduced TBR by 0.6%
CGM improves quality-of-life perspective. It helped to reduce hypo burden and increase treatment satisfaction. CGM gives more flexibility and may improve lifestyle changes around food choices and physical activity.
Using CGM in hospitals reduced hypos, hypers, diabetes ketoacidosis and diabetes-related comas.
However, there has only been one trial for people who use long acting insulin only. There are no studies on technology for people who use mixed insulin.

Insulin pump use in type 2 diabetes

HbA1c dropped by an extra 0.7%-1.4% without increasing risk of hypos. This is compared to basal bolus regimens.
Improvements in quality of life and diabetes distress lasted for at least 6 years.
Using automated insulin delivery further increased TIR by 32% and reduced time-above-range (TAR) by 22%!
Using connected insulin devices like smart insulin pens lowered HbA1c by 0.7%. Using notifications and alerts gave an extra 0.3% reduction, although research is in early stages.

Emerging research

Very little research is done in people with early onset Type 2 diabetes or in pregnancy.
Those with kidney disease receiving dialysis found CGM improved TIR by 38% in inpatients and by 15% in outpatients.
In the elderly, reduced brain function or sensory losses had made it more challenging to use technology. In two studies, CGM reduced HbA1c by 0.3-0.5% compared to SBGM. Another trial showed closed loop system increased TIR by 27.4% and reduced TAR by 27.7%, while TBR unchanged (<1%).

Summary

Technology is showing great potential to improve health outcomes in people living with type 2 diabetes. CGM and pump use, especially if automated, are both frontrunners. Using technology can reduce the cost of managing diabetes around the burden on the healthcare system. It can also improve the quality of life of people living with type 2 diabetes. More research is needed to confirm its benefits for some at-risk groups.

How can you get involved?

Contact your local member of parliament to advocate for more equitable access to technology
Sign the petition for equitable access to diabetes tech for all people with all diabetes types.

Above content is summarised from “The use of technology in type 2 diabetes and pre-diabetes: a narrative review” by Liarakos et al (2024).