Real-World Test of Sugar.IQ App Encouraging in Diabetes

Marlene Busko

June 25, 2018

ORLANDO — Patients with type 1 diabetes who used the "smart" Guardian Connect continuous glucose monitoring (CGM) system and Sugar.IQ app (both by Medtronic) improved their glycemic control in a small, short pilot study.

Overall, patients increased time spent in the normal glucose range by 30 minutes a day, Huzefa Neemuchwala, PhD, MBA, Head of Innovation, Data & Informatics, Medtronic Diabetes Group, in Northridge, California, said during an oral presentation here at the American Diabetes Association (ADA) 2018 Scientific Sessions.

As reported earlier, the US Food and Drug Administration approved the Guardian Connect smart standalone CGM in March. Guardian Connect does not have a receiver and is the first CGM to launch in the United States that has smartphone display as the only option for viewing data.

The company has just begun shipping the new CGM along with the Sugar.IQ app (which is free with the CGM and works on an iPhone). Sugar.IQ, made through a partnership with Watson, will use artificial intelligence technology to pull data from the Guardian Connect and combine it with additional information.

"The Guardian Connect sensor sends your data to the Cloud, where we process it, and the Sugar.IQ app gives the insights back to the patient," Neemuchwala told Medscape Medical News.

The system was designed to help patients who have to manage multiple daily insulin injections, added Pamela Reese, Director of Global Communications & Corporate Marketing, Medtronic Diabetes Group.

The app continually analyzes how an individual's glucose levels respond to food intake, insulin dosages, daily routines, and other factors, so it reveals patterns that can help people with diabetes keep their glucose levels in target range.

"I think it's the future," session chair Anders L. Carlson, MD, Medical Director, International Diabetes Center, and Assistant Professor, University of Minnesota Medical School, Minneapolis, told Medscape Medical News.

Everyone eventually will be moving towards more smartphone-based apps and will want to use apps to manage their diabetes, he said.

Nevertheless, "there is still a big role for education and working with the healthcare team and maybe using this as a tool to complement your usual diabetes team rather than completely replace them," he cautioned.

Also, not everyone with diabetes uses CGM, he pointed out, but tools like this "might help people use CGM in a more productive or more meaningful way."

"I think there are a lot of patients who will say 'So what if I have my blood sugar [level] every 5 minutes? What do I do with that [information]?' "

Now this tool provides "newer ways of seeing glucose data and new strategies for us to react to glucose data."

Fewer Hypoglycemic and Hyperglycemic Events With Sugar.IQ

The CGM and smart app help patients identify patterns — foods that cause glucose spikes or certain days or times of the week when their glucose rises or falls — so patients can make small adjustments to their insulin injections, Neemuchwala explained.

The system can also alert the patient 10 to 60 minutes before they are predicted to reach a pre-set low or high glucose level so that patients can take preemptive action.  

In the pilot study, 256 patients with type 1 diabetes were invited to test the new system for 90 days.  

Researchers then compared times in the target glucose range (70–180 mg/dL) in the 30 days before the study to times obtained 90 days after using the new system. Patients used the Sugar.IQ app twice a day.

Compared with baseline, patients spent 33 minutes longer per day in the target glucose range (P < .15) and hypoglycemia was reduced by 1 event per month (P < .001) while using the app.

A week after receiving insights associated with hypoglycemia, 55% and 54% of users had fewer hypoglycemic and hyperglycemic events, respectively.

"Timely and personalized insights, such as those provided during the Sugar.IQ pilot, may advance patient understanding of glucose trends, aid in behavioral change that improves therapy adherence, and lead to better outcomes," the researchers report.

The company is looking to make the app available for an Android phone and incorporate more data sources, "which could include wearable activity trackers, digital scales, geo-location data, calendar details, and even the weather," said Reese. They also plan to release a system that combines an insulin pump with a smart app.

The study was supported by Medtronic. Carlson has been a member of advisory boards for Insulet and Sanofi, a consultant for Merck, and has received research support from Medtronic and Novo Nordisk.

American Diabetes Association 2018 Scientific Sessions. June 22, 2018; Orlando, Florida. Abstract 16-OR.

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