In the digital age, diabetes management is undergoing a revolution. The application of smart medical devices, especially smart insulin pens, provides patients with unprecedented convenience and precision. This technological advancement has made blood glucose control more scientific and efficient, greatly improving treatment compliance and effectiveness.
Novo Pen ®6 is a leader in this innovative trend, which digitizes and visualizes insulin injection behavior through precise dose control and convenient data recording function, which is convenient for doctors and patients to review treatment data at any time, and can also play a reminder role of insulin injection, ensuring the continuity of treatment, reducing the omission and error of injection, thereby improving patient compliance and treatment effectiveness.
In this issue, a clinical case from Cangzhou People's Hospital is selected, which is sorted out by Dr. Wang Chenting, and Professor Liu Jianfeng makes wonderful comments to share the experience of digital blood glucose management.
Basic Information
Male patients prefer to eat large amounts at dinner.
Chief complaints: dry mouth, polydipsia, polyuria for 10 years, aggravated for half a month.
History of present illness: 10 years ago, there was no obvious cause of dry mouth, significant increase in water intake, the details are unknown, increased urine output, no urgency, frequency, and painful urination. The amount of food eaten was significantly increased compared with before, and there was obvious fatigue, easy fatigue, no pre-meal hunger, palpitations, sweating, etc., accompanied by weight loss. 就诊于当地医院，诊断为“2型糖尿病”，未规律诊治。 At present, the blood glucose is not regularly monitored, accompanied by numbness and tingling in the limbs. 半月前患者间断出现上述症状加重，自测空腹血糖约12 mmol/L。
Anamnesis: hypertension for several years, up to 180/100 mmHg, normal use of telmisartan 40 mg once a day, blood pressure control.
Family History: Diabetes Family History.
physical examination
He is 166 cm tall, weighs 76 kg, has a BMI of 27.58 kg/m2, and has a blood pressure of 160/90 mmHg
Laboratory tests
Glycosylated hemoglobin (HbA1c) 10.4%
空腹血糖（FPG） 15.55 mmol/L
餐后2h血糖17.1 mmol/L
空腹C肽1.29 ng/mL
餐后2h C肽3.67 ng/mL
Fasting insulin 10.2 μU/mL
甘油三酯(TG) 1.53 mmol/l
Total cholesterol (TC) 4.52 mmol/L
Low-density lipoprotein cholesterol (LDL-C) 2.69 mmol/L
High-density lipoprotein cholesterol (HDL-C) 1.25 mmol/L
肾功能kar 67.0 μmol/l,bin 3.2 mol/l
肝功能 ALT 12 u/L , AST19 u/L , WHITE 46.5 g/L
INVESTIGATIONS
头颈部+冠脉CTA显示冠状动脉粥样硬化，同时伴有多处血管轻度至重度狭窄，右侧大脑中动脉M2段存在局部重度狭窄。
Fundus photography: both eyes have clear optic disc borders, normal color, and punctate hemorrhages and cotton wool spots can be seen in the retina.
尿微量白蛋白与尿肌酐比值（ACR）： 2.76 g/mol
β the results of tests related to cell function
diagnosis
Type 2 diabetic peripheral neuropathy, type 2 diabetes mellitus, hypertension (grade 3 very high risk), coronary atherosclerosis, severe local stenosis of the right middle cerebral artery, type 2 diabetic retinopathy.
Treatment and follow-up
Initial treatment
In view of the patient's poor treatment compliance, lack of regular diagnosis and treatment, lack of regular blood glucose monitoring, poor dietary control, especially large dinner intake, resulting in large blood glucose fluctuations, and postprandial blood glucose elevation, the fasting blood glucose and postprandial blood glucose levels were improved during hospitalization with insulin aspart + insulin pump therapy (since June 19, 2022) (Fig. 1).
Fig.1 Blood glucose profile of insulin pump therapy during hospitalization
CSII, continuous subcutaneous insulin infusion, OGTT, oral glucose tolerance test
Adjusted treatment regimen
To help patients develop a long-term glucose control regimen to achieve the following control goals for blood glucose levels:
- 空腹血糖（FPG）4.4~7.0 mmol/L ，
- 餐后血糖(PPG)<10 mmol/L
- HbA1c ：7%
The treatment regimen was adjusted from insulin aspart + insulin pump to gludec aspart double insulin refill + smart insulin pen (Novo pen ®6) as the main hypoglycemic regimen, combined with four oral hypoglycemic drugs (OAD): sitagliptin phosphate, 100 mg, 1/day, acarbose, 50 mg, 3/day, dapagliflozin, 10 mg, 1/day, repaglinide, 1 mg, 2/day, oral before breakfast and dinner.
After using Novo Pen6 ®, patients can know the dose and time of insulin injection at any time through the data system, understand the blood sugar control, and begin to pay attention to dietary control, no longer eat a large amount of dinner, and the treatment compliance has been improved. At discharge, the patient had an FPG of 5.4 mmol/L and a 2-hour PPG of 8.8 mmol/L, and had good glycemic control. After discharge, the patients maintained the above treatment regimen for up to six months (Fig. 2).
Fig.2 Treatment plan before and after admission
Discharge follow-up results
After two follow-ups, the levels of FPG, PPG, and HbA1c reached the control target, and the blood glucose was stable (Fig. 3).
Fig.3 Blood glucose follow-up results
Case summary
The patient is a middle-aged man with a history of diabetes for 10 years and is overweight. In the past 1 year, the pancreatic islet function has failed rapidly, and the blood glucose regulation is difficult during the current admission, and the islet function assessment is not good. Patients were treated with premixed insulin prior to admission, but did not respond well to glycemic control. Patients eat a large amount of dinner at dinner, and if the dinner intake is insufficient, it will directly affect the quality of sleep at night. Due to the insufficient islet function and poor lifestyle adherence of the patient, it is difficult to reach the ideal level of postprandial blood glucose and fasting blood glucose, and blood glucose fluctuations are frequent and difficult to stabilize.
In order to help patients develop a simplified hypoglycemic regimen and long-term stable glucose control, according to the characteristics of the case, we consider a more accurate and intelligent treatment regimen - insulin degludec aspart + oral hypoglycemic drugs, combined with the precision injection technology of Novo Pen ®6. During hospitalization, patients can keep abreast of the treatment through the data system, begin to pay attention to dietary regulation, no longer eat a large amount of dinner, and the treatment compliance has improved compared with before admission.
At discharge, the patient's FPG decreased to 5.4 mmol/L, 2 h PPG to 8.8 mmol/L, FPG 4.9 ~5.7 mmol/L, 2 h PPG 8.0 ~8.7 mmol/L, and HbA1c <7% during the follow-up period, all of which reached the control goal and the blood glucose control was stable.
Case reviews
Prof. Jianfeng Liu
Director of the Department of Endocrinology and Metabolism of Cangzhou People's Hospital
Master's supervisor
Director of Cangzhou Branch of National Standardized Metabolic Disease Management Center
Member of the Endocrinology Branch of Hebei Medical Association
Executive Director of Hebei Diabetes Prevention and Control Association
Member of the Standing Committee of the Endocrinology Branch of Hebei Emergency Medicine Association
Member of the Standing Committee of the Obesity Committee of the Bethune Research Society
Vice President of Cangzhou Thyroid and Breast Disease Society
This patient has a history of diabetes for 10 years, is overweight, and recently faces the challenge of rapid failure of pancreatic islet function. During admission, patients experienced difficulty in regulating blood glucose and poorly assessed islet function, highlighting the urgency and complexity of treatment. The patient's previous regimen used premixed insulin, but glycaemic control was suboptimal, especially after meals. In addition, the patient's dietary habits also pose a challenge to blood sugar regulation, and insufficient dinner intake can affect the quality of sleep at night, which in turn may affect the blood glucose level the next day.
In this context, in order to help patients achieve a simplified hypoglycemic regimen and long-term stable control of blood glucose levels, we adopted a treatment regimen of insulin degludec aspart + oral hypoglycemic drugs, combined with the precision injection technology of Novo Pen ®6. The intelligent characteristics of Novo Pen ®6, through accurate memory and intelligent connection, greatly improve the patient's treatment compliance, reduce the omission of injection, and thus improve the compliance rate of blood sugar control.
The precision injection technology of Novo Pen ®6 not only provides patients with a more convenient and comfortable injection experience, but also helps patients better monitor and record the dose and time of insulin injection through digital management. In this case, the application of Novo Pen ®6 enabled the patient to effectively participate in blood glucose management and improve the patient's compliance with medication and dietary control. In addition, the digital and visual advantages of the Novo Pen ®6 can also help doctors adjust the treatment plan in time, so as to achieve more accurate blood sugar management. At discharge, the patient's FPG had been reduced to 5.4 mmol/L, and the 2h PPG was controlled at 8.8 mmol/L, showing good glycemic control. During the subsequent six-month follow-up period, the patient achieved the long-term glycemic control goal, and the FPG was maintained at 4.9~5.7 mmol/L, the 2h PPG was 8.0~8.7 mmol/L, and the HbA1c was also maintained within the ideal range of less than 7%, indicating that the patient's glycemic control was stable and good.
Through the precision treatment of Novo Pen ®6, patients not only improved their treatment compliance, but also achieved long-term stable control of blood glucose levels, which is of great significance for preventing and reducing the risk of diabetes complications. The efficient, convenient and personalized blood glucose management program of Novo Pen ®6 has significantly improved the treatment effect and patient satisfaction, and is an important innovation in modern diabetes management.