New developments in diabetes technology: challenges and opportunities

New medical technologies are often developed and introduced at a much slower rate than patients and clinicians could wish. There are many reasons for this, including unanticipated complications arising during trials and the overarching need to ensure patient safety. In some cases, moreover, concepts emerge well before the technology exists to make their realisation a possibility. For example, the idea of automated insulin delivery for people with Type 1 diabetes was first mooted in the 1950s, but it is only in the last decade or so that advances in technological miniaturisation have allowed for the development of practicable ‘artificial pancreas’ systems. These systems vary, but typically comprise a wearable continuous glucose monitor (CGM), a wearable insulin pump, and a smartphone-mounted control algorithm with the capacity to deliver precise insulin dosage in response to the user’s changing subcutaneous glucose levels. Recent research has attested to the significant benefits arising from these systems in both lab and free-living settings, with adults in one 12-week home study experiencing an 11% improvement in time spent in glucose target range and a 39% decrease in hypoglycaemia. (1)

However, these impressive findings do not mean that every user will experience artificial pancreas systems the same way, or derive equal benefits from using them. In two recent thought-pieces for The Lancet Diabetes & Endocrinology, I surveyed some of the broader issues that are likely to confront users (and advocates) of these systems as they begin to filter through to widespread usage. The first of these short essays highlighted the psychosocial complexities of technology usage in general, and artificial pancreas systems in particular. (2) Every human-technology interaction is a complex encounter between individuals and artefacts, characterised by unpredictability and variability of every kind. Consequently, use of multi-device systems such as artificial pancreas systems multiply the potential for divergent (and potentially conflicting) interpretations, practices, and outcomes, in addition to placing significant new burdens on users in terms of training, equipment management, user input, and additional interactions with healthcare professionals. The picture is by no means entirely negative, and emerging qualitative research attests to positive and transformational experiences occasioned by artificial pancreas usage, including increased reassurance, greater peace of mind, and improved sleep. Nevertheless, the unavoidable complexities of technology usage mean that clinicians and managers cannot assume that artificial pancreas systems will automatically attain wide and appropriate uptake. There will always be some individuals (and potentially some groups) whose specific life experiences and attitudes towards technology render long-term usage of any medical technology impractical.

My second essay (3) focused on a specific (and neglected) area of technological experience: the role of medical aesthetics. Clinicians and technologists often focus on the technical capacities of new pieces of medical technology. While this is understandable, it tends to underplay the importance of visual aspects. Yet the aesthetics of new technologies can be of vital importance from the perspective of the user, particularly when (as is increasingly the case) the technology in question is a wearable device. Wearable medical devices can signal the presence of illness to others, and can also remind the user of their own condition; consequently, they can support stigmas surrounding particular disorders. Stigma arises when negative characteristics are attributed to individuals by others (social stigma) or by themselves (self-stigma). In the diabetes world, however, recent developments have sought to challenge stigma through visibility, as when Sierra Sandison wore her insulin pump while appearing as a contestant in the 2014 Miss Idaho beauty pageant. Sandison shared a photograph of the moment on social media together with the hashtag #showmeyourpump, leading thousands of others to share images of their pumps. Others have sought to personalise their diabetes technologies in fashionable ways, using adhesive stickers or clever accessories (e.g. the ‘Hanky Pancreas’ range by Jessica Floeh) that make a virtue out of necessity. Manufacturers, too, increasingly seek to manufacture aesthetically pleasing devices, such as the t:slim insulin pump which is marketed as a ‘sleek, modern design.’ Future developments in smart clothing and high fashion/technology hybrids offer yet more possibilities to challenge stigma through clever design that marries clinical effectiveness with aesthetic appeal.

 

References:

1. Thabit H, Tauschmann M, Allen JM, et al. Home Use of an Artificial Beta Cell in Type 1 Diabetes. N Engl J Med, 2015; DOI: 10.1056/NEJMoa1509351.

2. Farrington C. The artificial pancreas: challenges and opportunities. Lancet Diabetes Endocrinol, 2015; 3: 937.

3. Farrington C. Wearable technologies and stigma in diabetes: the role of medical aesthetics. Lancet Diabetes Endocrinol, 2016; DOI: 10.1016/S2213-8587(16)00075-9

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