Primary Care's Evolving Role in Diabetes Technology

Medscape

14-05-2025

It's been more than a century since insulin was discovered, radically changing the course of diabetes treatment. Research continues to yield advances in treatments to help people better manage their diabetes and live healthier, longer lives. Newer medications, like glucagon-like peptide 1 receptor agonists, tend to get all the press, but technology also fosters innovation.
This is good news for every healthcare professional caring for patients with diabetes, including primary care providers, as the number of people with diabetes continues to rise.
'I think it's important to be aware of what is available, so we can steer our patients in the right direction,' said Sos Mboijana, MD, a primary care physician and assistant chief medical information officer at Mid-Atlantic Permanente Medical Group in Washington, DC.
Continuous Glucose Monitoring (CGM) As a Game Changer
Insulin discovery was only the first step. Over the years, scientists continued to explore new treatments and devices that could help people manage their diabetes, including the first blood glucose test strip in 1965, followed by the first electronic meter for self-monitoring of blood glucose in 1970.
The introduction of the CGM system proved to be one of the biggest game changers.
'As a diabetes doctor, I can't imagine managing a patient with diabetes without it,' said Anne Peters, MD, professor of medicine at the Keck School of Medicine of University of Southern California in Los Angeles.
First approved by the US Food and Drug Administration in 1999, CGM allowed people with diabetes to forgo the multiple daily finger pricks to measure their blood glucose levels. As one of its 'Standards of Care in Diabetes,' the American Diabetes Association now recommends offering CGM to patients at the outset of a diabetes diagnosis that requires insulin.
'Continuous glucose sensors have changed the world of diabetes — absolutely,' said Natalie J. Bellini, DNP, assistant professor of medicine at Case Western Reserve University (CWRU) in Cleveland.
Even people with diabetes who do not require insulin therapy now use a CGM device. Some use them all the time, while others use intermittently, according to Bellini, who also serves as a program director for diabetes technology at CWRU's Case Center for Diabetes, Obesity and Metabolism.
Because CGM also allows patients to watch their blood sugar levels rise and fall in real time, it can inspire quicker behavioral changes. People can now obtain a CGM device over the counter on their own, which may also prompt people with prediabetes to make positive lifestyle shifts.
'The rise of continuous glucose monitoring has been great for those who are diabetic, and even those who are not, because it gives patients real-time data into their blood sugars and how certain foods can affect it,' said Neal Patel, DO, a family medicine physician with Providence St. Joseph Hospital Orange, Orange, California. 'For example, an apple may only mildly increase sugar levels in one person, whereas it might spike it in others.'
Patients frequently tell Sarah Tucker Marrison, MD, a primary care physician in Charleston, South Carolina, that they've made changes to their diet based on noticing how certain food choices affected their blood sugar levels.
'I just appreciate when patients are proactive in terms of making changes and responding to some of the information that's available to them to best support their own health,' she said.
Said Mboijana, 'It gets us over the hill with patient engagement.'
More Advancements and Challenges
As technology has evolved, more options have opened for patients with diabetes, especially those who need insulin.
For example, the advent of the automated insulin delivery (AID) system — which is also called a 'bionic pancreas' — uses CGM-informed algorithms to communicate with a CGM device and automatically guides the delivery of insulin.
With this type of a device, a patient with type 1 diabetes no longer has to make all the decisions about giving themselves insulin, removing a significant burden from the patient, said Boris Kovatchev, PhD, director of the Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia. The center conducted research that led to the creation of an artificial pancreas system called Control-IQ.
'This is the best therapy of the moment,' he said of the artificial pancreas technology.
The authors of a recent study in The New England Journal of Medicine suggested AID systems could also be beneficial for patients with type 2 diabetes who need insulin. Their research showed that patients who used AID systems experienced a larger drop in their A1c levels than patients who only used CGM systems.
Currently, many primary care providers say they don't typically manage insulin pumps, including those used as part of an AID system, choosing instead to refer those patients to endocrinologists.
'Those are better suited by practices that are constantly using this kind of resource,' said David Baidal, MD, an endocrinologist with University of Miami Health System and an assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of Miami Miller School of Medicine.
He noted that primary care providers are already strapped for time; managing multiple devices — including downloading the data and using it to make adjustments during clinical visits — may not be feasible for them.
But primary care providers do care for many patients who use CGM devices, and one of the biggest challenges for providers is dealing with the amount of data they now have access to, said Mboijana.
'How do you manage that data?' he said. 'What do you do with it? A fire hydrant of data doesn't really help you unless you have a system to deal with it.'
Not every primary care practice has the resources — including the time or dedicated staff — to download and pore over the data, agreed Bellini. 'It's a little more hit or miss,' she said.
On the Horizon
While many physicians say they're grateful for the advances that are already in use, they also look forward to the future, when cost is no longer a barrier for current technologies. The ADA reported that CGM is still less accessible for certain groups of people, including older patients, Black patients, and patients with Medicaid. Hybrid closed-loop AID systems are increasingly being integrated into clinical practice, but cost is still an issue for many patients who could benefit from using this technology.
Physicians and other diabetes specialists also anticipate even better technologies that may become available.
For instance, each year, the International Conference on Advanced Technologies & Treatments for Diabetes brings together experts focused on pioneering efforts in the field.
The 2025 conference in March included sessions on innovative technologies and research, such as a session that spotlighted research on thioredoxin-interacting protein in pancreatic islet biology and the investigational novel oral therapy TIX100 that's currently in clinical trials.
Baidal suggested that newer algorithms for AID systems may also be able to provide more precise insulin adjustments and help patients spend more time in their target blood glucose range. Glucose-sensitive insulin, or glucose-responsive insulin, could also improve glycemic control and reduce the incidence of hypoglycemia.
Mboijana said he's looking forward to seeing how artificial intelligence may contribute in the future. 'Embrace the technology that's coming down the pike,' he said. 'Be aware of what's happening.'