It is an amazing time in the area of diabetes, with several groups moving forward with continuous monitoring devices and using that information to adjust insulin doses on a real time basis, every 5-10 minutes. Therefore, at night, when there are not any meals or exercise, glucose control that is great is allowed by these new systems. Folks can go to bed during the night with little risk for hypoglycemia, and wake up with glucose levels in the 100-140 mg/dL range nearly consistently every morning.
These new devices take worries and the stresses of the nighttime from diabetes management. It is a huge advance and many groups are involved.
A group from the University of Virginia also runs on the closed-loop system that produces insulin and, in addition, modulates and will give correction doses mechanically throughout the day and overnight. This apparatus helps and does an amazing job with overnight management quite a bit with meals to monitor blood sugar levels within range. They are beginning a big study that is critical within another year and are working with a commercial group called Type 0.
Roman Hovorka and colleagues in Cambridge, England, have another very great "restricted range" system. It also helps with the meals during the day. With 24-hour use over 3 months, this system has been shown to provide an A1c gain.
Ed Damiano is working on a pump that uses insulin and glucagon. The pancreas secretes glucagon and insulin, as you know. Many times the glucagon isn't controlled efficiently. This means that when a diabetic requires insulin and eats a meal, the blood sugar level may go down but the pancreas may not be discharging glucagon to prevent hypoglycemia.
This device, an "artificial pancreas," discharges glucagon to prevent hypoglycemia. Thus, it enables more aggressive meal coverage. Studies have shown the average glucose in the 146-148 mg/dL range with this device, which can be astonishing glucose management. At the present time, it demands both glucagon and insulin to be infused. Additionally they have a variation of this that uses only the insulin component, which attains control that is comparable to the other devices that use insulin that is only.
These scientists have formed a non-profit corporation and they have created a pilot pump that joins both insulin and glucagon into small cartridges that go into the pump. Again, this can be an integral system. They've been intending to run pivotal trials within the next year roughly.
One unique facet in their algorithm is that it doesn't demand carbohydrate counting for the meal bolus. The consumer can determine whether the sum that is carb is more or less than usual. The algorithm is adaptive, so it really is learning the consumer's basal insulin demands and the demands for meals each day.
I really believe that Medtronic will be the first to come forward, followed in the the next couple of years by all these other businesses running critical trials. We shall have a wealth of systems that folks can choose from, based on their demands.
Ultimately, with a quicker-acting insulin, we should be capable of cover meals so that someone with diabetes could actually be wearing one of these devices, sit down for dinner, and simply eat, without entering carbs or having to think about a correction dose, because it'd all be done mechanically. Which will necessitate a quicker-acting insulin that comes on and off more rapidly, and a number of these insulins are in the pipeline.
I really believe this will revolutionize the weight of diabetes. The aim of all these improvements is to reduce the weight so the diabetic patient can have less concern, less worry overnight, that will be addressed by the first versions, and eventually have the whole day taken care of so that there's no need to think about the amount of carbs being eaten, for the requirement for a correction dose, or what is going to happen with exercise. Get the complete diabetes information at diabetes forum