People With Diabetes Using Insulin Flying Across Multiple Time Zones: Limitations and Opportunities for Diabetes Technologies.

Increasingly, people with diabetes (PWD) are using wearable and other devices to support self-management. During air travel, there are 4 stakeholders involved in maximizing the safety of wireless devices for diabetes care used in flight: (1) manufacturers of the devices, (2) airlines, (3) the Transportation Security Administration, and (4) the U.S. Food and Drug Administration. These stakeholders have all developed technologies and policies that assist PWD who prepare for and take appropriate actions during long-haul flights. This article discusses the performance and use of 6 classes of specific wireless diabetes devices during an airplane flight, including the following: (1) blood glucose monitors, (2) continuous glucose monitors, (3) insulin pumps, (4) smart pens for dosing insulin injections, (5) advanced hybrid closed-loop systems, and (6) spinal cord stimulators for painful diabetic neuropathy. Through the policies and safeguards of the 4 stakeholders and the proper self-care measures that insulin-using PWD can take, it is possible to maintain safe glycemic levels on flights across multiple time zones.

Benefits and risks of apps for patients.

PURPOSE OF REVIEW: As smartphones have become deeply integrated into our daily lives, diabetes apps have emerged as valuable tools for people living with diabetes (PWD's). Whether as standalone apps or companion apps to diabetes devices such as glucose meters or insulin pumps, they aim to help patients better manage their diabetes. However, with almost a half million health apps available, it is important to have a framework for understanding their benefits and disadvantages. RECENT FINDINGS: 2020 was the first year that every insulin pump and continuous glucose monitor manufacturer in the United States offered a smartphone companion app for their flagship products. These companion apps enabled cloud-based data synchronization, which in turn proved to be extremely timely as the COVID-19 pandemic shifted many diabetes clinic appointments to the telemedicine format. The American Diabetes Association and European Association for the Study of Diabetes Diabetes Technology Working Group recently published a consensus report highlighting the current state of diabetes digital app technology. SUMMARY: While diabetes apps offer unique conveniences and advantages for PWD's, it is equally important to fully understand their potential pitfalls to better inform all diabetes stakeholders: patients, healthcare professionals, regulatory agencies, researchers, and policy makers.

Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy.

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)-mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.

Is There an App for That? The Pros and Cons of Diabetes Smartphone Apps and How to Integrate Them Into Clinical Practice.

IN BRIEF Diabetes applications for electronic devices (apps) leverage the computing power and wireless connectivity of smartphones to offer unique advantages over more traditional tools such as paper logbooks and glucose meters. As these apps and the devices they connect with continue to evolve, health care providers play an important role in guiding patients by recommending specific apps, demonstrating best practices on their usage, and cautioning against their limitations.

Feasibility of remote real-time guidance of a cardiac examination performed by novices using a pocket-sized ultrasound device.

Background. The potential of pocket-sized ultrasound devices (PUDs) to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users. Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE) through wireless guidance of novice users. Methods. Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD), LA enlargement (LAE), ultrasound lung comets (ULC+), and elevated CVP (eCVP). Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc.) attached to the PUD and transmitted data wirelessly. Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds. Results. Novice versus sonographer imaging yielded technically adequate views in 122/135 (90%) versus 130/135 (96%) (P < 0.05). CLUE's combined SN, SP, and ACC were 0.67, 0.96, and 0.90. Technical adequacy (%) and accuracy for each abnormality (n) were LVSD (85%, 0.93, n = 5), LAE (89%, 0.74, n = 16), ULC+ (100%, 0.94, n = 5), and eCVP (78%, 0.91, n = 1). Conclusion. A novice can perform the CLUE using PUD when wirelessly guided by an expert. This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.