Dr Fountain On Diabetes Technology & More

Dr. Annabel Fountain, endocrinologist and Medical Director of Fountain Health is raising awareness of the use of technology to help people living with diabetes to control their sugars.

A spokesperson said, “One of the most significant and rapidly spreading worldwide health issues of the 21st century is diabetes. In Bermuda, the known prevalence of diabetes is 14% compared with 8.2% worldwide. D

“Uncontrolled diabetes is a major risk factor for the development and progression of complications such as kidney disease, blindness, nerve damage and poor circulation [which can lead to amputations], heart disease and stroke. People living with diabetes who control their sugars are unlikely to develop these long-term complications. The increasing convenience, portability, and unobtrusiveness of devices for diabetes has supported users to live their lives without limitations.

“Many inventions are born out of necessity. In 1983, an insulin pen device was introduced in the UK which meant that people with diabetes no longer needed to use syringes. It was invented by mother and physician, Dr Sheila Reith, whose daughter had type 1 diabetes. NovoNordisk launched a similar device for the US in 1985.

“The first insulin pump was a 60kg bedside device. Now pumps are small enough to be worn in a pocket, on your belt, or just affixed to your skin. These are pre-programmed to continuously deliver insulin in tiny doses all day. Additional insulin can be given for meals and to correct any higher glucose levels. The user must tell the pump how much carbohydrate or sugar they’re going to consume so that the pump can calculate how much insulin to give.

Dr. Fountain said: “When I returned home to Bermuda in 2010, about 2% of people living with type 1 diabetes in the UK were using insulin pumps. I was taught the principles of insulin pump therapy but my experience was limited, so I’m extremely grateful to some very magnanimous individuals who allowed me the time, working with them, to become competent and confident in the use of insulin pumps. Since then, there have been many more advances including the integration of insulin pumps and glucose monitors.”

“Multiple studies have shown that people who monitor their sugar levels have better outcomes and those that monitor multiple times per day do even better. Until the 1970s, insulin could only be assessed through glucose levels in a person’s urine at home. The first blood glucose home testing meter weighed 3lbs which was not very portable. The glucose sensors that are now available were first approved by the Food and Drug Administration [FDA] in 1999. These do not measure blood glucose but the sugar in the fluid under the skin.

“The biggest advantage to a glucose sensor is that the user doesn’t need to do a painful finger prick to obtain information about their sugar levels. Insulin can be checked every minute with no pain. The sensors also record information between checks to show what happened earlier and the glucose reading has an arrow next to it indicating what’s going to happen next. The user can see the impact of everything they encounter during the day, including food, drinks, exercise, stress, illness, and other factors.

“Research has demonstrated that CGMs, when used properly, have the potential to diminish the probability of long-term complications linked with diabetes. This has been shown in people living with type 1 or type 2 diabetes. CGMs were initially prescribed mostly to people with type 1 diabetes using insulin pumps but have since been shown to improve outcomes for those using oral medications and insulin injections.

“What people with diabetes eat is a critical part of managing their diabetes, “said Charles Henderson, Chief Executive Officer of the American Diabetes Association [ADA]. “Personalised nutrition using CGMs has the potential to revolutionise diabetes management by providing individuals with more data and tools to manage their glucose levels, improve their quality of life, and reduce the risk of diabetes-related complications.”

According to Dr. Fountain: “There are lots of options so that you can find what works best for you. From blood glucose meters and continuous glucose monitoring [CGM] to cutting-edge insulin pumps and more, devices are easier to use and less invasive, so that much of the work of diabetes self-care is becoming automated.

“Many people living with type 1 and type 2 diabetes can benefit from using CGM. By consistently monitoring glucose levels, people living with diabetes can promptly detect and address fluctuations. Those that would benefit the most are people that have trouble reaching and maintaining target blood sugars. CGMs are particularly useful if you often have lows and are unaware of when they happen [hypoglycaemia unawareness]. My focus when supporting someone living with diabetes is to educate them and empower them to manage their own health better.”

“Low blood sugars [hypoglycaemia] significantly reduce quality of life for people living with diabetes and is reported to account for 6-10% of all diabetes related mortalities. The cost of hospital admissions related to hypoglycaemia is about 40% higher than those without hypoglycaemia. CGM has been shown to reduce the frequency and severity of hypoglycaemia, significantly improving quality of life. This technology should not be reserved for the “young”. A study of 80,000 people living with diabetes associated with more than 100,000 hospital admissions showed that 72% of those admissions were in people aged over 60 years old.

“The Bermuda Diabetes Association [BDA] first made Medtronic insulin pumps available on island about 20 years ago. In 2018, Fountain Health started importing Dexcom glucose sensors, which are the most accurate CGM, used in trials of the artificial pancreas. They also bring in the Tandem insulin pumps that were used in those trials. Dr. Fountain said: “We are very pleased that community pharmacies in Bermuda now stock Dexcom supplies so we no longer need to import these. We continue to provide Tandem insulin pumps and other accessories to people living with diabetes in Bermuda.”

“Diabetes currently affects over 415 million persons worldwide, and by 2040, that figure is predicted to reach 642 million. Approximately half of people living with diabetes don’t know they have it.

“Dr. Fountain completed her specialist training in the UK in 2010. She is certified in Endocrinology, Diabetes and Internal Medicine and provides care to people with a range of health conditions and disorders related to hormones, including diabetes. Visit fountainhealth.bm for more information about diabetes and treatment, education, and support.”

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