Voice-enabled CGM benefits blind patients with diabetes
medwireNews: Using voice-enabled continuous glucose monitoring (CGM) may help improve glycemic control and reduce severe hypoglycemia in legally blind patients with insulin-treated diabetes, US researchers report.
Writing in Diabetes Technology & Therapeutics, H Kaan Akturk and colleagues from the Barbara Davis Center for Diabetes in Aurora, Colorado, explain that diabetes management can be challenging in this group of individuals because “[i]nsulin administration products such as pens and pumps and glucose monitoring systems are not widely optimized for visually impaired patients with diabetes.”
The first and, at present, only CGM device to address this is the Dexcom G6 system, say. Akturk et al. They explain that Dexcom G6 users can ask the voice-enabled Siri feature (Apple Inc, Cupertino, California, USA) to read out their glucose readings and display their graph directly on a locked smartphone screen.
In the current study, the researchers retrospectively reviewed the impact of this feature in seven legally blind patients (mean age 49 years) with diabetes (mean duration 43 years) who were on intensive insulin therapy. Four of the participants were taking insulin via multiple daily injection and the remaining three were using an insulin pump.
The team found that, after 12 months of Dexcom G6 with Apple Siri use, there was a significant reduction in glycated hemoglobin. At baseline, mean levels ranged from approximately 7.2% to 10.0% (55–86 mmol/mol) among the patients, while after 12 months this range was approximately 5.0% to 8.8% (31–73 mmol/mol).
Furthermore, time spent in the target blood glucose range (70–180 mg/dL; 3.9–10.0 mmol/L) increased significantly from an average of 50.9% at 3 months to 56.8% at 12 months, without a corresponding increase in time spent in hypoglycemia.
Indeed, the mean time spent in hypoglycemia (<70 mg/dL; 3.9 mmol/L) was 2.3% at 3 months and 2.2% at 12 months, while the mean time spent in severe hypoglycemia (<54 mg/dL;3.0 mmol/L) was 0.6% and 0.4%, respectively.
There was also a reduction in the number of severe hypoglycemia episodes requiring medical assistance. In the 12 months prior to initiating Dexcom G6 with Siri use, one patient experienced three episodes and five patients each experienced one episode. By comparison, there were no such episodes recorded in any of the patients in the first 12 months of Dexcom G6 with Siri use.
Akturk and co-authors point out that the Dexcom G6 Siri feature does not alert patients by itself. They say that patients “must use [the] Dexcom app on the smartphone with customizable loud alert settings to be alerted for hypoglycemia and hyperglycemia.”
They say that patients can then ask Siri their glucose level and proactively improve diabetes control.
The team believes that “[i]nstant accessibility to glucose levels on CGM may decrease the constant supervision of visually impaired patients on intensive insulin therapy to caregivers and may decrease the response time for hypoglycemia.”
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