Diabetes is a global health problem, with over 199 million women living with the condition, a figure that is expected to rise to 313 million by 2040. Understanding, accessing and managing diabetes throughout various stages of a woman’s life, including menstruation, pregnancy and menopause, is complex yet critical.
Increasingly, healthcare manufacturers are looking at how smart diabetes devices, wearables and artificial intelligence (AI) technologies can support women with diabetes. Advanced algorithms and smart connected devices aim to make a difference for women living with diabetes by simplifying and even automating the decision-making process of delivering life-saving insulin.
According to UK research charity Diabetes UK, real-time continuous glucose monitoring (CGM) should be offered to pregnant ladies with type 1 diabetes free on the NHS. The technology is also a potential solution for pregnant women who are on insulin and have type 2 diabetes, gestational diabetes or another form of the condition.
To ease diabetes management for women, companies are launching small, all-in-one wearables that measure and send real-time glucose values wirelessly to a smart device or receiver. Real-time glucose monitoring systems (GMC) can eliminate the need for daily finger pricks by measuring glucose at regular intervals, 24 hours a day, using a small sensor inserted under the skin.
CGM systems are designed to provide the user with real-time insights, enabling women to check their sugar levels at any time and provide details of patterns in sugar levels. The device can also alert users when their levels rise too high or drop too low, helping them manage their glucose levels throughout the day.
Insulin pumps can use advanced algorithms to “learn” an individual’s patterns of insulin use to automate insulin delivery every five minutes. Adopting this technology offers personalised doses to auto-correct highs and minimise lows.
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“Some women experience higher glucose levels during menstruation,” says Dr. Jennifer McVean, paediatric endocrinologist and Medical Affairs Program Director for Medtronic Diabetes. “Autocorrections, which can occur as frequently as every five minutes, can help women achieve more time in the target range during their periods.”
Providing diabetic care throughout pregnancy
Smart diabetes tech during preconception, pregnancy and post-birth is gaining attention. Diabetes UK backs the use of CGM systems to support pregnant women in managing diabetes. Following research in this area, the charity states that CGM can help women achieve optimum glucose levels, resulting in fewer complications for their babies. CGM also helps pregnant women stay in their target glucose range, known as time-in-range, for longer, which benefits mother and baby.
“Real-time CGM has been proven to improve HbA1c levels, increase time in range, and improve neonatal outcomes,” says Shay Speakman-Brown, Head of Market Access, Dexcom, citing a 2020 research study. “Wearing it can reduce the number and length of admissions to the neonatal intensive care unit, and babies are less likely to be born large for gestational age (LGA).”
During pregnancy, women can draw upon this real-time information to share with their wider healthcare teams to ensure ongoing observations and care adjustments are made if needed. “Tight glycaemic management is never more important — or more difficult — than when you are expecting,” confirms Speakman-Brown.
A 2017 study on sex disparities in diabetes revealed that 40% of women are at the age where they may choose to have children, a time where the implications of diabetes are perhaps at their peak. The growing prevalence of high blood sugar, or hyperglycaemia, also requires further research as it remains “massively neglected and undertreated”.
Much-needed improvements in prevention, diagnosis and treatment need to stay on the agenda to support women during preconception, pregnancy and postpartum care.
Innovation and research are needed to reflect better understanding
“Unfortunately, people with diabetes still face stigma and misunderstanding about their condition, especially if they must inject insulin or interact with their insulin pump in a public place,” says Dr McVean. “Miniaturising diabetes technology is important for those women who desire discretion, as well as for younger girls who could benefit from devices with a smaller footprint,” details Dr McVean.
Clinical studies seek to understand diabetes better. Medtronic is supporting two external research programmes focusing on outcomes for women with diabetes. One external research programme is studying the use of its latest hybrid closed-loop insulin pump in pregnant women. Additionally, an observational study will investigate the effect of diabetes technology on women and their babies after pregnancy.
“While current advanced hybrid closed-loop insulin delivery systems that deliver autocorrections every five minutes, as needed, have significantly reduced mealtime burden, there is still more work to be done,” says Dr Ohad Cohen, Senior Medical Affairs Director for Medtronic Diabetes in Europe and Professor of Medicine at Sheba Medical Center, Israel.
A fully automated closed loop system that does not require exact carbohydrate counting would be a “welcome development for all”, Dr Cohen relays.
The fight to achieve health equity continues
Diabetes does not discriminate. “However, we know meaningful healthcare inequities accessing diabetes technology exist,” says McVean.
Women with type 1 diabetes have a 40% higher excess risk of premature death than men with the condition, and those with type 2 diabetes have up to a 44% higher excess risk of coronary heart disease and a 27% higher excess risk of stroke, the sex disparities in diabetes study found.
The researchers recognised that while biology might have a role in these differences, sex differences in psychosocial factors, health-seeking behaviours and healthcare provision are likely to have a more dominant influence.
Research has also highlighted diabetes’ disproportionate impact on racial and ethnic minority and low-income adult populations in the US. A 2021 study sought to progress these findings of unequal vulnerabilities, which it states have been magnified since the Covid-19 pandemic, by conducting a scientific review of the social determinants of health and diabetes. These factors have become vital intervention targets in achieving health equity.
Prioritising affordability and broad access to sophisticated technologies such as GMC can ensure that technology reaches more people with diabetes. Talking about the development of its latest technology, a spokesperson for Abbott says: “We took steps at every stage to make it affordable and available to the millions of people with diabetes — starting with our R&D, supply chain and high-speed automated manufacturing, then creating a consistent global price and working with governments to reimburse it.” Advancements have been made, but further research to find technological solutions that provide girls and women equitable and holistic support to ease the burden of managing diabetes throughout all stages of their lives continues to be a priority.