Robert Courgi, MD: Personalized Diabetes Telehealth Care

What are some of the most pressing trends in diabetes today?

When it comes to the diabetes pipeline and what's out there, there's a few items that come to mind. We're all eagerly waiting an insulin pill. It would be lovely, but insulin is a protein that gets degraded by the gastric acid, so there's always been talk and studies but nothing has really panned out.

There's talk of pancreatic transplants, and great strides have been made in that I was lucky enough to attend a lecture at the Endocrine Society, and the pancreatic transplant will occur. But right now it's the electronics that will really be taking off with diabetes.

There's so many different ways and so many different options. When you look at personalization of care, and diabetes trends, now we like continuous glucose monitoring systems. Hemoglobin a1c is a great test, but it can miss things because it's a three-month average. Now, the new term in the diabetic jargon is the time that the patient's glucose is in range. So, with so many different CGMS that are currently available, they'll have disposable CGMS, implantable CGMS. So this is something the patients were just dreaming of — the Dick Tracy watch where you just look and see where your sugar is.

And the technology is actually going to go to your phone. They'll be beaming it in there. Ultimately, this will combine with the insulin pump, creating the artificial pancreas. Medtronic has a product on the market now that has combined the continued glucose monitoring and closed loop insulin pump. It's just plug-and-play. You get the device, you turn it on, it will montior your sugar, it will adjust the basal rates as necessary if your sugars run high, it will autocorrect those sugars.

The only thing it does not do is that premium bullet list. So when people, when they eat a meal, they still need to count their carbohydrates and inject the insulin. So this is new to market, it's expensive, right now really limited to young type 1 diabetics, but I just see the use of this increasing exponentially.