Update on recent advances in technology in type 1 diabetes

Those living with type 1 diabetes (T1DM) require daily adjustments of exogenous insulin doses and frequent glucose monitoring to optimally manage their condition. Consequently, it is one of the most challenging long-term conditions to live with. Recent years have seen major progress in the management of T1DM, with minimally invasive glucose monitoring technology and glucose-responsive insulin delivery systems, also called hybrid closed-loop systems. This narrative review focuses on three key areas: continuous glucose monitoring (CGM), hybrid closed-loop (HCL) systems, and connected pen devices, sometimes known as smart pens. We describe features of commonly used devices in the UK NHS and summarise their key evidence base. Randomised controlled trials and real-world studies of CGM devices have shown improved haemoglobin A1c (HbA1c) levels, improved sensor-based metrics such as higher time spent in the target glucose range, and reduced rates of hypoglycemia. HCL studies have similarly shown improved HbA1c and other sensor- based glucose outcomes. Further recent innovations for insulin users include connected insulin pens, which allow the display and recording of insulin delivery information. In addition to glycaemic benefits, novel diabetes technology has been shown to improve quality of life and to give higher treatment satisfaction. Some disadvantages of technology include alarm burden, connectivity problems and premature device failure. To get the best from novel diabetes technology, appropriate training and education are required, specifically in identifying and dealing with critical system failures such as cannula failure and the risk of ketoacidosis. Recent recommendations from the National Institute of Health and Care Excellence (NICE) regarding HCL further underscore the growing significance of these advances in diabetes care.