Diabetes technology: an update

Diabetes is one of the most prevalent chronic diseases worldwide, with rates that continue to increase. Over 30 years ago, the Diabetes Control and Complications Trial demonstrated that intensive glucose management decreased long term vascular complications. Unfortunately, many people with diabetes still struggle to meet glycemic goals. In this mini-review, we highlight advances in diabetes technology that are associated with improvements in glycemic management. Continuous glucose monitoring (CGM) and automated insulin delivery systems are associated with significant improvements in HbA1c, time-in-range (70-180 mg/dL), and decreases in severe hypoglycemia and diabetic ketoacidosis in people with both type 1 and type 2 diabetes. Recent data shows that these technologies improve outcomes early in the course of type 1 diabetes. CGM is also being explored as a tool to monitor progression through early-stage type 1 diabetes (2 antibodies positive) to identify individuals who may benefit from disease-modifying therapies as well as to prevent the onset of diabetic ketoacidosis at onset of stage 3 (insulin requiring) type 1 diabetes. Adjunctive pharmacologic therapies and artificial intelligence may further expand and improve therapies, offering potential synergistic benefits. However, there continue to be significant disparities in access to diabetes technologies and access to insulin worldwide. This mini-review summarizes recently published data, highlights emerging applications, and underscores the need to pair technological innovation with strategies that promote equitable access and support for diabetes care to improve outcomes for all people with diabetes.