**6. Conclusion**

*Type 2 Diabetes - From Pathophysiology to Modern Management*

**5. Mobile and computer applications (apps)**

physician to have almost real-time access to data [53].

overdose or under dosing.

control.

meters and other devices.

Reports or Profiles.

able in 2019. (Personal Observation).

extra incentive to be more compliant with their regimen.

Having the data readily available and reminders on their phone can provide an

2.Improvement with the risk of insulin dose errors. Access to dosing and timing of insulin can facilitate more accurate doses and limit the risk of accidental

This being a relatively new technology, these devices will need to demonstrate improvement in clinical and QOL (Quality of Life) outcomes, cost effectiveness, ease of training and use. However, many of the technologies discussed above have underwent the same scrutiny. The issue of cybersecurity as with any connected DM devices will need to be resolved to maintain patient confidentiality and integrity of the data. Smart pens may be an alternative to individuals who do not want CSII therapy for a multitude of reasons but would like to intensify their regimen and have access to appropriate dosing and timing of insulin to improve their glucose

Data Management software for diabetes has been available since the late 1980s to early 1990s. However, acceptance and adoption by both patients and physicians has been slow. The issues have been the ability to download or upload data with each device having its own set of software and cable connections. In many cases, physician offices had upwards of 6–10 different connections to obtain data from SMBG

Over the past two decades, a number of innovations were developed that "streamlined" the ability to obtain data from patient devices. There has been an improvement in device connectivity with most devices now able to utilize Bluetooth technology thus eliminating the need for multiple cables or hubs. Additionally, smartphone technology has decreased the cost and complexity of data sharing. The use of automated uploads from devices to the "cloud" has allowed both patient and

Proprietary cloud data platforms from multiple device manufacturers have been able to provide secure data and have developed common formats, easing the burden on physicians and their offices to maintain multiple programs. Also, many of the device companies, including those manufacturing SMBG devices have developed complex reporting capabilities that have been designated as Ambulatory Glucose

The multitude of apps for the patient with DM has led to concerns of quality and safety. Apps available at both the Google Play store and Apple App Store may little or no oversight. A recent study in 2016 found that the majority of apps from the Google Play store did not meet the minimum requirements or did not work appropriately [54, 56] Additional studies are needed to fully investigate the efficacy and utility of mobile applications with regard to the treatment of individuals with Type 2 DM. Another approach is to combine the mobile application, the cloud with a remote coaching system. Studies are now ongoing to assess the effect of individuals using a smart phone-based glucose monitoring system which automatically moves data to a secure cloud-based site [55]. A designated "diabetes coach" which is a health care provider (RN, NP or physician) then reviews the data several times per week and remotely connects with the patient to provide recommendations or discussion. Results are pending in these studies and hopefully preliminary results will be avail-

**106**

This chapter attempted to briefly outline the technological advances in the treatment of Type 2 diabetes mellitus. It is noted the technology has improved the quality of life, blood glucose control and possibly decreased the risk of complications. However, it must be pointed out to the reader that technology, no matter how advanced, does not substitute for personal interaction with patients. The ability to know your patient, his/her lifestyle, stressors, etc. plays an important role in designing the proper treatment regimen. Continued advances in technology will in the future make the physician/healthcare provider and the patient's ability to control his/her blood glucoses less complicated but ultimately the decisions to maintain diet, exercise, monitoring of glucoses remains with the individual.
