The world of type 1 (or juvenile-onset) diabetes
has shifted dramatically in just a few years. As recently as the 1980’s, glucose meters used to monitor blood sugars were rare or nearly unaffordable; in the 70’s urine dipsticks provided the only clue to blood sugar levels and the only available insulin came from beef or pork, leading to undesirable side effects. Over the past 10 to 15 years, great strides have been made in the development of new technologies for monitoring and treating type 1 diabetes.
Insulin Delivery Systems
For years, diabetics associated insulin with syringes or pens that would inject insulin up to six times per day. While many still choose to use these traditional methods of insulin delivery, other alternatives are available and still more are being developed.
Inhalable insulin is one possibility in the future of diabetic treatment. Exubera, a brand produced by Pfizer, was recommended for approval by an advisory committee to the Food and Drug Administration in September 2005. While the cost of inhalable insulin may be higher than traditional delivery methods and the drug is not expected to provide difference in diabetes control compared to injectable insulin, many diabetics may consider freedom from injections well worth it. Exubera is expected to reach the market sometime in 2006; other brands will follow in the following years.
But many diabetics have turned to insulin pumps as a more convenient and effective way to treat their diabetes. First developed in the early 80’s and used more and more by diabetics as technology improves, pumps are pager-sized devices that administer insulin at a slow, steady basal rate throughout the day, with larger doses given at mealtimes to cover the carbohydrate content in food. This action is closer in function to how beta cells would work in a non-diabetic. Insulin is delivered through two to three feet of tubing, allowing users to wear the pump almost anywhere on the body. This tubing connects to another very small tube called a cannula, which is introduced beneath the skin by a small needle. The needle, tubing, and insulin supply need to be changed only once every two or three days. Benefits associated with the insulin pump include better overall control, more spontaneity in meal times and food choices, and less pain and skin irritation from needles. Popular brands of insulin pumps include Medtronic Minimed, Deltec, and Animas. Many insulin pumps have hundreds of programmable settings and tools that can help remove human error from insulin administration, such as dosage calculators based on food intake or blood glucose level and insulin ratios for different times of day. While user-friendliness varies from pump to pump, many have found these tools to be convenient and effective.
Diabetes Monitoring and Management
The development and enhancement of glucose monitors over the past twenty years has helped millions of diabetics to improve their control and quality of life. Many glucose meters now are able to upload their information to PC software issued by the meter’s manufacturer. Up to a month of glucose readings can be transferred, charted, and sometimes even analyzed, helping diabetics make informed adjustments to their insulin regimen. Meters are also being incorporated into insulin pump technology: Minimed’s latest pump allows wireless communication between the insulin pump and the BD glucose meter so that pump settings also can be uploaded to the computer for interpretation, and the Deltec Cozmo attaches right to a small glucose meter so that it becomes an “all-in-one” device. (Even though some pumps and meters can “communicate,” users must still perform insulin administration themselves. No insulin will be given without being programmed.)
In the past few years, some researchers have developed different models of a Continuous Glucose Monitoring System (CGMS). Resembling a pump, this device has a sensor which is worn under the skin and provides up to 300 glucose readings throughout the day. This technology, an accompaniment to glucose meter testing, is intended to show diabetics patterns in their glucose levels that occur between regular glucose readings. Most of these devices are now owned by healthcare professionals and “checked out” to patients; Minimed has recently released a version, the Guardian RT, which diabetics can purchase on their own after obtaining a doctor’s prescription.
Symlin, produced by Amylin Pharmaceuticals, was released to the U.S. market earlier in 2005. This medication is a replacement for amylin, a hormone normally produced in conjunction with insulin but that is deficient or absent in diabetic patients. Administered by injection along with insulin shots or a pump, Symlin works to smooth out post-meal blood sugar spikes and may reduce the need for large quantities of insulin in diabetic patients.
Diabetes is being attacked by researchers on a variety of fronts, most of which are either biological or technological. Pancreas transplants have occurred successfully for those with severe complications, and beta (insulin-producing) cell transplants are in clinical trials. Both kinds of transplants, however, can require large amounts of anti-rejection drugs which can have very serious side effects; even with these drugs, some patients’ bodies have rejected their new cells. Researchers are exploring ways to keep this rejection from occurring. Stem-cell research continues as well, although it is limited by governmental regulations.
Insulin pump and CGMS manufacturers are also working to treat diabetes from a technological standpoint. The goal for these companies is eventually a version of an artificial pancreas, or a “closed-loop system” in which a glucose monitoring system and pump will work together to control insulin delivery. Implantable insulin pumps are also being tested; if someday used in tandem with a CGMS, diabetics may enjoy an almost normal lifestyle.
The Diabetes Control and Complications Trial, the largest diabetes study ever performed, was held from 1983 to 1993 by the National Institute for Diabetes and Digestion and Kidney Diseases (NIDDK). The trial confirmed what many people with diabetes and many healthcare professionals already had suspected: tight control of diabetes significantly reduces the risk of diabetes complications such as eye and kidney disease, some by up to 75 percent. This good news has served as even more motivation to develop reliable products that make tight control possible. While a viable cure for diabetes may still be years away, much progress has been made in minimizing the inconvenience, pain, and faults in diabetes treatment. Technological developments are constantly improving, helping millions of Americans to make this disease manageable as we wait for a cure.