Technology that delivers diabetes care

Whether you have diabetes yourself or you know someone with it, it is a condition that is very common. So would you believe that we don’t know exactly how many Irish people have diabetes nor where they are in the country? That’s because there is no National Diabetes Registry.

However, that is set to change. In recent weeks, the HSE has begun appointing a team to develop a new National Diabetes Registry to determine the prevalence of the condition in Ireland.

Up until now, we have been relying on approximate figures. The national charity for diabetes, Diabetes Ireland, estimates that 300,000 people live with diabetes here.

Its national-level estimates are based on the Scottish Diabetes Survey 2021, which revealed that there were 327,927 people with a diagnosis of diabetes in Scotland, representing approximately 6% of the population.

Using the Irish Census data 2022, Diabetes Ireland argues that, if the prevalence of diabetes is similar to Scotland, it would mean that there were 308,948 people with diabetes in Ireland in 2022.

People living with diabetes will be very familiar with the traditional methods of testing their blood sugar levels with finger-pricking and insulin dosing. But in recent years, diabetes technologies have improved massively, helping people to manage this chronic illness.

Irish Country Living spoke to Dr Kate Gajewska, clinical research and advocacy manager at Diabetes Ireland, and Dr Mick Molloy, emergency consultant in Wexford General Hospital and member of the Irish Medical Organisation consultant committee about the condition.

As well as working in the medical field, both Kate and Mick have type 1 diabetes. Those with type 1 diabetes must take insulin because their pancreas doesn’t produce it. Insulin is an extremely important hormone that enables energy intake from food.

Kate says: “In the last few decades, the technology advancements have been just incredible and it really shows how medicine, research and tech can be used to improve the way people live with chronic conditions.” Since getting an insulin pump in 2000, Kate says her lifestyle has become much less “restricted”.

Quality of life

“For many years, the standard way of delivering insulin used to be via injections from insulin pens. People would inject themselves, in some cases up to 15 times a day,” Kate explains.

“For years, I had to do finger-pricking with a blood glucose meter. The insulin pump is a small device and I have it connected to my body via infusion sets and I can change this infusion set every couple of days. If you want to deliver insulin, you just have to click a few buttons.”

“They are a lot more accurate because they can provide insulin by 0.25 units whereas with insulin pens, the minimum amount that you can deliver is 0.5. Insulin pumps give better accuracy and then you also have pre-programmed basal rates, which delivers insulin continuously 24/7.

“In terms of quality of life, the insulin pump has given me a lot more flexibility, especially with my food and how I eat. I remember when I first got it, I could finally go out with my friends and eat pizza. And it wasn’t a big deal because the pump could deliver insulin to maintain appropriate blood glucose levels in my body.”

The insulin pump is a game changer for many when it comes to insulin delivery, but another extremely important development in recent years is the Continuous Glucose Monitoring (CGM), that enables needle-free monitoring of glucose levels on a continuous basis.

“CGM measures your blood glucose levels continuously, every one minute or every five minutes, and it shows you the blood glucose levels on the graph so you know whether your levels are rising or falling. You have a sensor inserted in the arm or belly. It depends on the manufacturer, but some sensors last for a week, others have two weeks, and then you replace it,” says Kate.

Graphs are shown on a reader or on a mobile phone app. “From a practical point of view, it’s made an absolutely unbelievable difference when it comes to managing diabetes. You see exactly what is happening, whether the sugar level will go up or down.

"If there’s any kind of danger related to your blood glucose level, the system will alert you. It keeps you safe. There’s plenty of evidence suggesting that it improves diabetic management and quality of life.”

In Ireland since late 2023, CGMs have been rolled out and recommended as the main blood glucose monitoring type for all people with type 1 diabetes.

The HSE has implemented a reimbursement application system for CGM sensors since December 2023 and in July 2024, the HSE announced a list of preferred CGMs covered by the Long-Term Illness (LTI) Scheme.

The third piece of diabetes technology that has taken away a lot of the burden and decision-making from people, is automated insulin delivery via hybrid-closed loop systems.

Kate explains, “It’s a computer algorithm that is installed on the pump. It takes data and information from blood glucose levels. It’s almost an artificial pancreas because the device sees what your blood glucose levels are, and based on that, the insulin is delivered for you semi-automatically. You still have to inform this device when you eat or exercise but then the system will do the rest.”

System overload

While access to data through technology is improving diabetes care in many ways, Mick says that, for some people, too much information can cause concern.

“The technologies are good for managing health and giving you lots more data,” he says. “For some people, the ability to know and to be confident that their sugars are normal is very reassuring. Data can be used well but for some people less is more. The more information they get, the more concerned they can be about their own health.

“Usually the GP has a very good handle on that person’s ability to cope with stresses and not give them too much information, tell them what they need to know, but not worry them excessively,” he adds.

“The apps that the CGM and insulin pump can link with give very good feedback, a history going back weeks and months. The apps show trends over time which can be an early sign of something else going on – another infection which may not yet have raised its ugly clinical head, like a urinary tract infection which hasn’t quite manifested.”

However, Mick does not use the insulin pump or CGM to manage his own diabetes for personal reasons.

“I play sports – boxing and rugby where there is a lot of movement and a lot of contact. The monitor that is on the CGM is usually on the back of the forearm or back of the upper arm and they do come off.

“The insulin pump itself has quite a large needle and pulling the big needle in and out would cause more problems for me. I’m still on intermittent insulin, which is working fine for me.”

Despite the advances in technology, Mick stresses the need to continue to look after your general health as part of managing diabetes.

“The big thing is you can’t ignore your health just because you’ve got these devices. You need to get out, be more active, and look at your diet. Engaging in more physical activity is a very simple thing that really would help a lot of people with diabetes.”