Apps/ smart pens

Abstract

The integration of digital health technologies, including connected insulin pens (smart pens) and mobile health (mHealth) applications, has demonstrated benefits in the management of individuals with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D). These technologies automatically record insulin doses, provide missed-dose reminders, integrate continuous glucose monitoring data, and support therapeutic decision-making, enabling a more personalized and data-driven approach to diabetes care.

In T1D, a recently published investigator-initiated randomized clinical trial demonstrated that the use of a connected insulin pen cap significantly reduced time spent in severe hyperglycemia (>250 mg/dL), decreased glycemic variability, and improved patients' confidence in insulin administration. Among participants with high adherence, an absolute 8% increase in time in range was observed.

In T2D, the use of smart pens with active dose reminder functions has been associated with lower mean glucose levels and greater HbA1c reduction compared with conventional insulin pens. In addition, a recent meta-analysis showed that mHealth-based interventions reduce HbA1c by approximately 0.3% to 0.5%, with the greatest effect observed during the first three months of use, followed by attenuation at six months. Clinical benefits are further enhanced when mobile applications are combined with ongoing support from healthcare professionals.

Beyond improving glycemic outcomes, these technologies enhance treatment adherence, reduce dosing errors through bolus calculator functions, and have been associated with lower healthcare costs, primarily owing to reductions in hospitalizations and emergency department visits.

Despite these benefits, adoption remains limited. In countries where these technologies are available, only 4–15% of people with T1D use connected insulin pens, although healthcare professionals estimate that up to 73% could potentially benefit from them. Important implementation challenges remain, including the long-term sustainability of clinical benefits, device costs, reimbursement limitations, the digital divide, and interoperability across digital platforms.

Overall, current evidence supports the incorporation of connected insulin pens and mHealth applications as complementary tools for insulin therapy. However, additional independent, long-term studies, particularly in T2D, are needed to confirm their impact on clinical outcomes. Concurrently, efforts should focus on reducing barriers to adoption and ensuring equitable access for individuals most likely to benefit from these technologies.