Alan Frischer, MD, MPH
Advances in Diabetes
More than one in every ten adults in the United States has diabetes. I repeat: more than one in every ten adults has diabetes. That comes to 29 million Americans, including some eight million who may be undiagnosed and unaware. It can be a devastating disease; monitoring, managing, and treating it is difficult, challenging, and costly. Thankfully, this is an exciting time with new advances in the field.
How does a healthy, diabetes-free body operate, and why is a properly functioning pancreas so important? Hormone levels (including insulin, glucagon, and others) rise and fall to keep our blood sugar (glucose) in a normal range. Normally, blood sugar levels rise after we eat. Cells in the pancreas then release insulin, enabling the body to absorb glucose from the blood and lowering blood sugar levels back to normal. Then, when blood glucose levels are low, the hormone glucagon is released from the pancreas and signals the liver to release glucose back into the blood.
For those with type-2 diabetes, the body builds up resistance to insulin and increasingly greater amounts are necessary in order to bring down blood glucose levels. As the disease advances, the pancreas produces even less insulin. With type-1 diabetes, the pancreas doesn’t produce enough insulin, and needs additional insulin injections to bring down the blood sugar levels. Type-2 diabetics often use non-insulin oral or injectable medications or, if that is not effective, insulin injections.
In 2016, the FDA approved the first artificial pancreas. This artificial pancreas is initially being used for Type 1 diabetics, with the more common Type 2 diabetics to follow. The device continuously monitors blood sugar levels and supplies insulin automatically when sugar levels get too high. There is constant communication between the monitoring and the infusion devices. The goal is to reduce high blood glucose levels (hyperglycemia) and minimize the incidence of low blood glucose (hypoglycemia) with little or no input from the patient, and to allow a diabetic patient the opportunity to live a “normal” life!
Another recent potential advance in diabetes treatment is a digital contact lens. Patented in 2014 by Google, and in partnership with the pharmaceutical company Novartis, it measures blood glucose levels from tears. Microchip sensors are embedded between two layers of lens material, and a tiny hole allows tear fluid to seep into the sensor, which then measures blood sugar levels. A thin wireless antenna transmits the data to a phone app. When blood glucose levels approach dangerous levels, the app notifies the user to act by consuming sugar, injecting insulin, or contacting a physician. As with the artificial pancreas, it could eliminate the need to take blood samples (usually through a finger poke) several times a day, and could potentially greatly lower the cost of monitoring blood sugar levels.
We live in exciting times. Stay tuned for these and other advances in diabetes management.