To understand why behaviour is so important, it helps to look at what type 1 diabetes actually means for a patient. People with type 1 diabetes produce too little or no insulin at all. They must administer insulin for life in order to keep their blood sugar balanced. In the past, this was done with insulin pens, where the patient did the calculations themselves. Nowadays, smart insulin pumps combined with glucose sensors largely adjust automatically. These new pumps make life much easier for patients, but they still require user input. For example, patients must indicate when they are about to eat or exercise. Martijn showed that this patient behaviour ultimately determines the best possible outcome.
Excellent regulation
Martijn studied 160 patients at the hospital ZGT who use the MiniMed 780G insulin pump from Medtronic, one of the most widely used pumps in the Netherlands. Without any intervention from the patient, the pump already ensures good glucose regulation, with a ‘time in range’ of 70%. This refers to the percentage of time a patient’s glucose levels are within the desired range. Martijn’s research demonstrated that with additional effort from the patient, regulation becomes excellent. Patients who keep the pump’s algorithm active for long periods and properly enter their meals into the pump – also called ‘bolusing’ – achieved even better results: they spent 80 to 90 per cent of their time within range. That means fewer complaints now and fewer complications later.
Decision tree as a tool
Medtronic also recommends using relatively strict pump settings. These settings push the algorithm to aim for lower glucose levels, which also led to better results in Martijn’s study. However, only a small number of people used these settings, with many hesitant to switch due to fears of hypoglycaemia. To reduce this uncertainty, Martijn worked with diabetes nurses, Technical Physicians and internists to develop a decision tree: a tool to help determine when stricter settings are safe and useful.
“Previously, many healthcare providers weren’t sure whether to put patients on stricter pump settings. As a result, only about 40 per cent of patients used the optimal settings. With the decision tree, we now have a clear step-by-step guide. Healthcare providers can make the right choice more easily. As a result, many more patients have switched to optimal settings: the percentage increased from 40 to almost 70,” Martijn explains.
Reduced disease burden
Martijn’s research shows that patient behaviour still plays a key role in achieving the best glucose regulation. At the same time, he emphasises the progress made in recent years: “Insulin pumps are becoming increasingly advanced. We now see that patients using these systems are doing much better with far less effort than before with insulin pens. Still, one should not underestimate how much time and energy it takes each day to manage diabetes, even with such a system. I hope that through research and the development of even more advanced technology, this disease burden will continue to decrease in the future.”
A conscious choice
Martijn deliberately chose diabetes care because he enjoys supporting patients over a longer period and making step-by-step progress together. “Diabetes care is unique because technology is so closely intertwined with patients’ daily lives,” he explains. Within his Master's in Technical Medicine at UT, this combination of medicine and technology came together beautifully. During his internship, he not only analysed data behind a laptop but also spoke directly with patients in the clinic. This allowed him to connect research and clinical practice right away. Martijn is pleased that his research is so directly applicable in practice: “We can now give better advice to patients and support healthcare providers with data.”
Making a difference
Alongside his graduation project, Martijn also took part in UT’s Research Honours programme last year. There, he learned how to write up his results as a scientific article, which will soon be submitted for publication. In October, Martijn will start as a Technical Physician at the diabetes outpatient clinic of Medisch Spectrum Twente in Enschede. “I am very happy to continue my passion in diabetes care, and I hope I can make a difference for people with diabetes.”
Text: ZGT
