Diabetes technology decision guide

The best diabetes technology for you

A key part of treating type 1 diabetes today is diabetes technology. The range of technical options continues to grow. It’s important to explore how technology can support you in achieving your diabetes goals. But how do you go about this?

GOOD TO KNOW:

Step 1 is to determine which goals you want to achieve in your diabetes treatment.

Step 2 is to ensure that you have enough knowledge about diabetes, technology, and everything related to it.

Step 3 involves other important aspects of technology, such as how easy it is to use and how long you’re allowed to use a system.

Step 4 is to look at which diabetes technologies are available. There are several types of tools and devices.

Step 5 Once you know enough about what you want and what’s possible, you make a choice.

Step 1: Setting Clear Goals

It starts with identifying what you personally want to achieve. You do this together with your specialized diabetes care team. They help you define your diabetes treatment goals — what you aim to accomplish through your treatment.

Examples of Diabetes Goals

Diabetes goals are personal. Everyone may have different goals. For example:

I want to lower my HbA1c from 8.2 mmol/l to 7.5 mmol/l.
I want fewer high blood sugar levels at work or school because they affect me significantly.
I want fewer hypos after exercising, because I often have to eat extra, even though I’m trying to watch my weight.
I don’t want to go from one hypo to another, but I do want to aim for the lowest possible glucose levels to reduce the risk of complications.
I want to worry as little as possible about my blood glucose levels.

What Do You Measure in Type 1 Diabetes?

When determining glucose levels and diabetes goals, there are several key metrics to consider:

HbA1c: This is an estimate of the average blood glucose over the past two to three months. HbA1c doesn’t always reflect how you feel, because it represents a single value over a long period. It doesn’t show how many highs or lows you’ve had, or how much your glucose levels fluctuate.
Time in Range (TIR): This refers to the time your glucose levels are within the target range — typically between 3.9 and 10.0 mmol/l. Time Below Range: The time your blood glucose is below 3.9 mmol/l. Time Above Range: The time your blood glucose is above 10.0 mmol/l.
Variability Factor: It’s beneficial if glucose levels don’t swing too much between low and high. The variability factor indicates how much your glucose levels fluctuate.

At Diabeter, we prefer to combine these three glucose metrics. Together, they provide the best insight into how someone’s glucose regulation is going — and often reflect how much someone is affected by diabetes.

Step 2: Gathering sufficient knowledge

Once you know what’s important to you, choosing diabetes technology becomes easier. It helps if you have enough knowledge about diabetes, technology, and everything that comes with it.

It may sound obvious, but we’d still like to emphasize it: You need to have sufficient understanding of:

Low and high blood sugar levels: You know the symptoms, causes, and how to manage them.
Carbohydrates and nutrition: You know how to count carbohydrates and understand how food affects glucose levels.
Technical terminology: You’re familiar with the key terms and actions used in diabetes technology.

Responsibilities

Be mindful of the responsibilities that come with using diabetes technology. For example:

Instruction, training, and practice: You can only use diabetes technology if you receive proper instruction. This often involves attending a training session. It also takes time to get used to the technology — keep this in mind.
Sharing technology data: Diabetes technology provides detailed insights into glucose regulation. While you naturally review this data yourself, it’s important that your diabetes care team can also access it. This ensures you receive the best possible support for your diabetes management.

Step 3: Usage and reimbursement

When choosing diabetes technology, several other factors are important. Consider the following:

Ease of Use: This refers to how easy the technology is to use in daily life. Often, it’s about simple things like how clear the pump’s screen is or how convenient the buttons are. It also includes what you still need to do yourself to manage your glucose levels.
Reimbursement: Not all diabetes technologies are reimbursed for everyone with type 1 diabetes. Continuous glucose monitoring (CGM) is the most notable example. Strict rules apply for CGM reimbursement.
Data Collection and Usage: Each type of diabetes technology works with different systems and software. It’s helpful to explore which method suits you best.
Duration of Use: There are rules for how long different diabetes technologies can be used. For example, an insulin pump usually needs to be replaced every four years.

Step 4: Availability of iabetes technology

Are your diabetes goals clear?
Do you have enough knowledge about diabetes technology and what to consider?
Then it’s time to explore the different options. There are many systems available.

Note: The overview below includes only diabetes technologies that are currently reimbursed by health insurance. Technologies still under development or research are not listed.
We update this information regularly.

1. Partial Automated Insulin Delivery

This is also known as Automated Insulin Delivery (AID) or a Hybrid Closed Loop system. It consists of several technological components:

An insulin pump
A continuous glucose monitor (CGM)
A software algorithm that calculates insulin doses based on glucose levels

Together, these three elements enable partially automated insulin delivery.
Some systems can perform this function almost entirely automatically.
People using an automated insulin delivery system can sometimes achieve a Time in Range (TIR) of over 80 percent.

1A. Virtually Automated Systems

Also known as advanced hybrid closed loop. Examples include:
Medtronic Minimed 780G, Ypsopump with CamAPS, Kaleido with Diabeloop, and Omnipod5.

Limitations of this system:

You always need a combination of a glucose sensor and an insulin pump.

The system can process certain amounts of carbohydrates automatically with insulin.
For meals, you still need to enter carbohydrate amounts into the pump so it can deliver a bolus.
Some carbohydrates are handled automatically, but the pump makes many decisions on its own — you need to learn to accept this.
You must continue to think along with the pump, especially in special circumstances.
You may become more dependent on the technology, as it regulates blood glucose most of the time.

Advantages of this system:

The system can predict and prevent hypoglycemia.
It automatically corrects high blood glucose levels.
Users of this system, as far as known, achieve the highest time in range.
It is also the most effective system for preventing hypoglycemia.
The system relieves users of many tasks.

1B. Partially Automated Systems (Hybrid Closed Loop)

Also known as hybrid closed loop. An example is the Tandem T:slim X2 with Control-IQ.

Limitations of this system:

You always need a combination of a glucose sensor and an insulin pump.
For meals, you must manually enter insulin doses into the pump.
The system corrects high glucose levels by delivering more insulin than the preset amount.
A correction bolus can be given automatically once per hour if the glucose level exceeds 10 mmol/l.
The pump makes many decisions on its own — you need to learn to accept this.
You must continue to think along with the pump, especially in special circumstances.

Advantages of this system:

The system can predict and prevent hypoglycemia.
It automatically corrects high blood glucose levels.
It relieves users of many tasks.
Finger pricks are not needed to ensure accurate readings from the associated Dexcom sensor.
In changing circumstances (e.g., vacation, weekends, illness), you can use different personal profiles.

1C. Systems Still in Development

Three systems in this category are still under development:

Inreda AP: A new system consisting of 1 infusion set for insulin, 1 infusion set for glucagon, 2 sensors

2. Insulin Pumps and Glucose Sensors Without Integration

An insulin pump is an important piece of diabetes technology.
Even when people with type 1 diabetes use an insulin pump and glucose sensor without integration, glucose regulation often improves.
However, it does require more manual effort to manage blood sugar levels.

Limitations of this system:

More manual work is needed to regulate blood glucose. The system does not deliver insulin automatically.
Time in Range is often lower than with automated insulin delivery systems — typically between 50% and 60%.
An app or bolus calculator is often needed to calculate boluses or determine how much active insulin is in your body.

Advantages of this system:

There is more choice in insulin pumps and glucose sensors.
You are not fully dependent on diabetes technology.

3. INSULIN PEN WITH A GLUCOSE SENSOR

A glucose sensor helps regulate blood glucose levels, even when someone with type 1 diabetes injects insulin using an insulin pen.

Limitations of this system:

A lot of manual effort is required to manage blood glucose.
You are fully responsible for administering insulin yourself.
The "time in range" is generally lower than when using an insulin pump—often between 40 and 50 percent. With frequent injections throughout the day, the time in range can be slightly higher.

Advantages of this system:

You don’t have an insulin pump attached to your body.
You are not entirely dependent on diabetes technology.

4. INSULIN PUMP OR INSULIN PEN WITHOUT GLUCOSE SENSOR

It is also possible to regulate blood glucose using a blood glucose meter with a pump or pen.

Limitations of this system:

Limited insight into glucose levels during the day and night.
A lot of manual effort is required to manage blood glucose. You are fully responsible for injecting insulin and measuring blood glucose yourself.
The "time in range" that people with type 1 diabetes achieve with this method is often between 30 and 40 percent. If you measure with a finger prick 8 times or more per day, the time in range can be slightly higher.

Advantages of this system:

You don’t have any fixed components attached to your body.
You are not entirely dependent on diabetes technology.

Step 5: Making a final choice

Once you know enough about what you want and what the options are, you can make a decision about diabetes technology. Even then, there are still plenty of options to explore. Several companies manufacture insulin pumps and glucose sensors.

If you are being treated at Diabeter, you can discuss this with your own diabetes care team. They can provide additional information and help think through what truly fits best with your situation.

WEBINARS ON DIABETES TECHNOLOGY

Diabeter also regularly organizes webinars about choosing an insulin pump and glucose sensor. You’ll receive an invitation through your diabetes nurse at Diabeter.

CHOOSING FOR FOUR YEARS

When you choose a system, it’s usually for a period of four years. This is because the health insurer reimburses an insulin pump once every four years. In some cases, there may be medical reasons to switch systems earlier. This can only be done in consultation with your diabetes care team. A medical specialist must submit a request for early replacement.

MORE ABOUT DIABETES TECHNOLOGY

The “Kieswijzer” (Choice Guide) from diabetes aid supplier Bosman is specially designed to help with choosing diabetes technology. It provides information about various systems. The website also features instructional videos that can assist in making a decision.

Go to the Bosman Choice Guide