Using technology to help Veterans manage diabetes

Lakshmi Singh, a clinical pharmacist practitioner at the VA Maryland Health Care System (VAMHCS), is dedicated to advancing diabetes care through new technologies. Diagnosed with type 1 diabetes at 24 while in pharmacy school, Singh channels her personal experience into her professional practice as a diabetes provider, educator and Diabetes Technology Program coordinator.

“I was long interested in diabetes, even before I myself became diagnosed with type 1 diabetes when I was 24 years old and, at the time, a student in pharmacy school,” she shared.

Singh’s treatment began with four insulin injections daily and the use of a continuous glucose monitoring (CGM) device. Some CGM devices are paired with insulin pumps, creating a hybrid, closed-loop system that automates blood sugar management. Initially reserved for patients requiring multiple injections daily, the Veterans Health Administration now allows CGM devices for those needing a single injection, greatly expanding access.

As the Diabetes Technology Program coordinator, Singh led an interdisciplinary team to extend CGM prescribing across various services at VAMHCS. This initiative impacts thousands more Veterans by providing essential tools for managing diabetes.

Pioneering automated insulin delivery

Singh also advocates for automated insulin delivery (AID) systems for all insulin-dependent diabetics, including those with type 2 diabetes. Alongside Dr. Elias Spanakis and Jade Churchill, Singh co-investigated a 13-week international trial on AID systems for type 2 diabetes, involving 319 adults. Results published in the New England Journal of Medicine showed significant A1c reductions for those using AID systems. This evidence supported an FDA approval for expanded use in type 2 diabetes.

Real-life impact

Veterans like Andrew Francis and Howard “Jim” Carney directly benefit from these technologies. Francis, a 28-year-old Marine Veteran, initially struggled with traditional finger sticks and injections, and had a negative experience with CGM. Singh persuaded him to retry the device, transforming his diabetes management. “The technology has advanced so much. I can use my [smartphone] to control the device,” Francis said.

Carney, a 90-year-old Army Veteran, has managed type 1 diabetes for 50 years. Singh introduced him to the latest diabetes management technology. “I have all good things to say about my care at VA, particularly Singh, who is the best,” Carney said. He values the device’s capability to alert him during low glucose levels, ensuring timely interventions.

Commitment to excellence

Singh’s expertise and dedication ensure Veterans have access to the best treatment options. “I want to make sure that Veterans in our care who are living with diabetes get every treatment option available to them. Technology can transform their lives and reduce the burden on families,” she added.

Singh’s passion and leadership in diabetes care help Veterans navigate their condition with less stress, providing improved quality of life.