The study presents the up-to-date overview on available technologies as well as new approaches and possibilities for diabetes 4.0 therapy as referred to by the authors. The study included the review of six online databases: PubMed, Cochrane Library, Embase, CINAHL and Web of Science, for the search of scientific articles focused on the use of technologies for the management and treatment of diabetes.

The review followed the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to assess the scope of the literature. The search strategy in the previously mentioned databases established that the following English terms should appear in the title or abstract of the article: “Diabetes Mellitus” OR “diabetes” OR “blood glucose assessment” AND “Telemedicine” OR “Mobile Applications” OR “digitization” OR “digital treatment".

“Studies published in English or German between January 2008 and January 2020 that focused on technologies in DM therapy were included. Furthermore, to be included, the studies had to make remarks or comments on the clinical effectiveness, for example, effect on glycemic control, of the type of technology that was presented.”, the authors explained.

The search returned 4,935 results for studies that used any of the following types of technology: glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mHealth apps, telemedicine, and electronic medical records.

The authors noted the following for each of the electronic or digital technologies:

• Glucose monitoring system: Continuous Glucose Monitoring systems measure the glucose level at regular intervals, 24 hours a day, and translate the measurements into data about glucose direction and rate of change.
• Insulin pumps:: Small programmable computerized devices that allow continuous subcutaneous insulin infusions, so a more physiological insulin release can be mimicked. This is realized by an individual basal insulin rate, which is released hourly and set by the medical staff.
• Telemedicine: provides scope for various interventions, such as phone coaching interventions, tele-education, teleconsultations, real-time transmission of blood glucose levels, and web-based case management programs.
• mHealth App: Common features include tracking of blood glucose levels or insulin usage, calculating an insulin dose, monitoring of diet, weight or physical activity, providing education, or allowing communication and exchange of data with health care professionals or social networks.
• Electronic Medical Records (EMR): The use of EMR offers the opportunity to transfer data of diabetes technology, such as glucose monitoring systems, insulin pumps, or insulin pens, directly to the patients’ medical records. This makes everyday life in primary health care easier and is a step toward an automated institution.

“In general, the different types of diabetes technologies offer a chance to individualize diabetology and improve the health and QoL of people with DM. With a look at the great advances that have been made in the last few years, rapid further development of diabetes technologies can be expected. In particular, the opportunity to connect different devices to create an automated insulin delivery will become more important. However, to use the full potential of digitalization, regulations and laws must be created to set standards and ensure data security”, the authors conclude.