DIABETICMedicine DOI: 10.1111/dme.13352
Editor’s Selection: This Month’s Highlighted Articles Diabetes technology Diabet. Med. 34, 603–603 (2017) Technology, the ‘science of craft’ from the Greek, has been defined by the Merriam–Webster Learner’s Dictionary as ‘the use of science in industry and engineering to invent useful things or to solve problems’. The use of technology dates back to prehistoric times, when humans discovered how to transform the natural resources around them into simple tools, and since then we have strived to control our environment through ever more sophisticated machines and devices. Although technology has a huge potential to do good, philosophical arguments have debated whether technology improves our lives or worsens it, with critics arguing that it alienates and divides people. The management of diabetes has changed markedly over the years with the development of new medical devices and technologies whose goal is to make self-management easier for those with diabetes. With an ever-increasing array, it is incumbent on healthcare professionals to evaluate their use critically before embracing those technologies that work. The field is moving so fast that clinical trials often cannot happen quickly enough to assess their effectiveness as, by the time the trial has completed, the technology is obsolete and superseded. This is a major challenge for clinicians and researchers, not least in the light of the results published in this month’s issue. The ‘must-have’ Christmas present in 2016 was a personal activity tracker as the enthusiasm for self-monitoring has fed the increasing commercial success of these devices. Combined with associated websites, they seem to make a difference by increasing activity levels through personal goals and challenges; people with Type 2 diabetes also share this benefit, as demonstrated in the systematic review and meta-analysis by Baskerville et al. [1]. A note of caution, though, is that neither accelerometers nor pedometers were associated with improvements in glycated haemoglobin, body mass index, blood pressure or lipid profile, perhaps reflecting the complexity of human behaviour. The Walking Away from Type 2 Diabetes trial assessed the effect of a short structured education programme that incorporated the use of a pedometer in people at risk of diabetes [2]. Again, activity levels increased during the intervention but there was no effect on metabolic health. Furthermore, the participants did not maintain their activity levels in the long term after the intervention ceased. Elsewhere in this month’s issue, Rabbone et al. [3] report high rates of insulin pump failures of up to 22.1% per year
ª 2017 Diabetes UK
amongst children with Type 1 diabetes. More encouraging, however, are the results of the StenoABC study, which demonstrated that people with Type 1 diabetes beginning advanced carbohydrate-counting obtained greater reductions in HbA1c when they used an automated bolus calculator to guide their insulin doses [4]. The history of diabetes innovation is that at first it is taken up by enthusiasts with the ability to pay before a wider acceptance is reached and reimbursement is agreed. This is just as much the case today as previously; the letter by McKnight and Gibb describes the experiences of 130 people with Type 1 diabetes, approximately 3% of their clinic population, all of whom had self-funded the use of flash glucose monitors [5]. Of those with current or previous use of the technology, 60.2% belonged to the least deprived quintile, with only 4.1% in the most deprived quintile. Those using the monitor had greater reductions in HbA1c than non-users and a higher proportion reached their glycaemic targets. While technology has the potential to make the lives of people with diabetes better, if less affluent people have limited access to the innovation, these technological advances risk leaving them behind and could widen the well-recognized health inequalities for outcomes in diabetes. R. I. G. Holt Editor-in-Chief, Diabetic Medicine University of Southampton
References 1 Baskerville R, Ricci-Cabello I, Roberts N, Farmer A. Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2017; 34: 612–620. 2 Yates T, Edwardson CL, Henson J, Gray LJ, Ashra NB, Troughton J et al. Walking Away from Type 2 diabetes: a cluster randomized controlled trial. Diabet Med 2017; 34: 698–707. 3 Rabbone I, Minuto N, Bonfanti R, Marigliano M, Cerutti F, Cherubini V et al. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study. Diabet Med 2017; 34: 621–624. 4 Hommel E, Schmidt S, Vistisen D, Neergaard K, Gribhild M, Almdal T et al. Effects of advanced carbohydrate counting guided by an automated bolus calculator in Type 1 diabetes mellitus (StenoABC): a 12-month, randomized clinical trial. Diabet Med 2017; 34: 708–715. 5 McKnight JA, Gibb FW. Flash Glucose Monitoring is associated with improved glycaemic control but use is largely limited to more affluent people in a UK diabetes centre. Diabet Med 2017; 34: 732–734.
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Editor’s Selection: This Month’s Highlighted Articles Diabetes technology Diabet. Med. 34, 603–603 (2017) Technology, the ‘science of craft’ from the Greek, has been defined by the Merriam–Webster Learner’s Dictionary as ‘the use of science in industry and engineering to invent useful things or to solve problems’. The use of technology dates back to prehistoric times, when humans discovered how to transform the natural resources around them into simple tools, and since then we have strived to control our environment through ever more sophisticated machines and devices. Although technology has a huge potential to do good, philosophical arguments have debated whether technology improves our lives or worsens it, with critics arguing that it alienates and divides people. The management of diabetes has changed markedly over the years with the development of new medical devices and technologies whose goal is to make self-management easier for those with diabetes. With an ever-increasing array, it is incumbent on healthcare professionals to evaluate their use critically before embracing those technologies that work. The field is moving so fast that clinical trials often cannot happen quickly enough to assess their effectiveness as, by the time the trial has completed, the technology is obsolete and superseded. This is a major challenge for clinicians and researchers, not least in the light of the results published in this month’s issue. The ‘must-have’ Christmas present in 2016 was a personal activity tracker as the enthusiasm for self-monitoring has fed the increasing commercial success of these devices. Combined with associated websites, they seem to make a difference by increasing activity levels through personal goals and challenges; people with Type 2 diabetes also share this benefit, as demonstrated in the systematic review and meta-analysis by Baskerville et al. [1]. A note of caution, though, is that neither accelerometers nor pedometers were associated with improvements in glycated haemoglobin, body mass index, blood pressure or lipid profile, perhaps reflecting the complexity of human behaviour. The Walking Away from Type 2 Diabetes trial assessed the effect of a short structured education programme that incorporated the use of a pedometer in people at risk of diabetes [2]. Again, activity levels increased during the intervention but there was no effect on metabolic health. Furthermore, the participants did not maintain their activity levels in the long term after the intervention ceased. Elsewhere in this month’s issue, Rabbone et al. [3] report high rates of insulin pump failures of up to 22.1% per year
ª 2017 Diabetes UK
amongst children with Type 1 diabetes. More encouraging, however, are the results of the StenoABC study, which demonstrated that people with Type 1 diabetes beginning advanced carbohydrate-counting obtained greater reductions in HbA1c when they used an automated bolus calculator to guide their insulin doses [4]. The history of diabetes innovation is that at first it is taken up by enthusiasts with the ability to pay before a wider acceptance is reached and reimbursement is agreed. This is just as much the case today as previously; the letter by McKnight and Gibb describes the experiences of 130 people with Type 1 diabetes, approximately 3% of their clinic population, all of whom had self-funded the use of flash glucose monitors [5]. Of those with current or previous use of the technology, 60.2% belonged to the least deprived quintile, with only 4.1% in the most deprived quintile. Those using the monitor had greater reductions in HbA1c than non-users and a higher proportion reached their glycaemic targets. While technology has the potential to make the lives of people with diabetes better, if less affluent people have limited access to the innovation, these technological advances risk leaving them behind and could widen the well-recognized health inequalities for outcomes in diabetes. R. I. G. Holt Editor-in-Chief, Diabetic Medicine University of Southampton
References 1 Baskerville R, Ricci-Cabello I, Roberts N, Farmer A. Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2017; 34: 612–620. 2 Yates T, Edwardson CL, Henson J, Gray LJ, Ashra NB, Troughton J et al. Walking Away from Type 2 diabetes: a cluster randomized controlled trial. Diabet Med 2017; 34: 698–707. 3 Rabbone I, Minuto N, Bonfanti R, Marigliano M, Cerutti F, Cherubini V et al. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study. Diabet Med 2017; 34: 621–624. 4 Hommel E, Schmidt S, Vistisen D, Neergaard K, Gribhild M, Almdal T et al. Effects of advanced carbohydrate counting guided by an automated bolus calculator in Type 1 diabetes mellitus (StenoABC): a 12-month, randomized clinical trial. Diabet Med 2017; 34: 708–715. 5 McKnight JA, Gibb FW. Flash Glucose Monitoring is associated with improved glycaemic control but use is largely limited to more affluent people in a UK diabetes centre. Diabet Med 2017; 34: 732–734.
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