Smart insulin pens: new technology contributes to increased connectivity in diabetes treatment
Since the use of glass syringes, and later disposable syringes, to administer insulin, a lot has been done to improve insulin delivery and diabetes follow-up. With the development and commercialisation of the Novopen in 1987, a first step was taken towards more sophisticated insulin pens. The HumaPen Memoir (Eli Lilly), the NovoPen 5 and the NovoPen Echo (Novo Nordisk) are examples of pens with a memory function that records the dose, date and time of previous injections.
Meanwhile, these first smart pens have evolved further into pens that can connect to a smartphone via Bluetooth or NFC (Near-Field Communication). This makes it possible to download the data on insulin injections via specific "applications" and to consult it when desired. Various platforms and apps were developed for this purpose such as Glooko, mySugr and LibreView. The InPen, when used with the associated app, also provides bolus advice. Through a partnership between Novo Nordisk and Abbott, the NovoPen 6 and NovoPen Echo Plus are recently compatible with the FreeStyle LibreLink app.
In addition to the smart pens, there are also smart pen caps and clips available that are applied to a classic insulin pen to allow for a similar connection. Smart pen caps are placed on the pen or replace the original cap and record insulin timing. Smart pen clips are clipped to the pen and can record both insulin timing and insulin dose.
The insulin data from the smart pen can also be combined and visualized together with the sensor's glycemia data, either from CGM (continuous glucose monitoring) or FGM (flash glucose monitoring) devices, which offers important benefits for both people with diabetes and healthcare providers.
The use of smart pens leads to fewer missed boluses and a more adapted and safer dose titrations, which can improve adherence. Clinically, this translates into a better "Time in Range (TIR)", which is the time that glycemia is within an acceptable range (typically defined as 70-180 mg/dL). This is also associated with a lower risk of severe hypoglycemia (<54 mg/dL). The availability of the timing and dose of the insulin injection, along with the glycaemia curves, certainly contributes to the dialogue between people with diabetes and health care providers. During the consultation, both can get a more complete picture of glycaemic control, which makes better tailor-made advice possible.
Table 1: Overview of current and future solid insulin pens and pen caps (© Dr. Inge Van Boxelaer, Diabetotech)
Table 2: Current and future penclips (© Dr. Inge Van Boxelaer, Diabetotech)
This new development of smart pens with the possibility to connect to other platforms is certainly promising for the improvement and simplification of diabetes treatment. For people with diabetes, it will be easier to monitor insulin injection data, leading to greater satisfaction and adherence. The exchange of data between people with diabetes and healthcare providers is optimized and leads to better glycaemic control, increased safety (less hypoglycaemia), and the possibility of tailor-made therapeutic advice.
The smart pen technology is still in full development and we can certainly expect further technological (r)evolution in the future.
Dirk D’Hooge, former Director Clinical Medical and Regulatory Affairs at Novo Nordisk