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Diabetes care improves with present day technology

Compared with relying on urine glucose test strips and a single blood glucose measurement at each visit to the doctor, home blood glucose monitoring and the HbA1c test have allowed a degree of blood glucose control which was unimaginable at their inception. The focuses on glucose meters, continuous glucose monitoring devices, insulin pumps, and getting clinicians connected to technologies has improved diabetes care in the present day.

Dr. Shankar Kumar, Founder and Director, MS Diabetes Centre

Dr. Shankar Kumar, Founder and Director, MS Diabetes Centre

To start off is the capillary blood glucose monitoring devices. The currentt home BG meters use capillary blood samples ranging from 0.3-1.5 microliters The sample is analyzed the enzymatic/biosensor reaction alone, while others convert the enzymatic reaction into an
electrochemical signal first Although whole blood is used, the meter output is calibrated to provide results that correlate with plasma glucose values. Enhanced devices like the Freestyle InsuLinx, approved in Europe in 2011, allows patients to program their insulin-to-carbohydrate ratio, correction factor, and target BG into the meter. This information enables the meter to recommend the next insulin dose based on BG and carbohydrate intake.

Communication with other devices is available with the radiofrequency technology which can transfer BG data to insulin pumps. All currently available insulin pumps are enabled with this feature. The non-invasive glucose monitoring is the goal of the future. Past attempts at non-invasive glucose monitoring failed to reliably separate glucose values from noise without an actual blood sample.
Scientific and technological progress have allowed for other, different techniques to be tried, which overcome difficulties faced in the past.

Continuous glucose monitoring (CGM) is now possible with real-time continuous glucose monitoring (RT-CGM) which allows for continuous measurement of interstitial glucose concentrations. A small, enzyme-coated filament (

The Juvenile Diabetes Research Foundation (JDRF)’s proposed steps towards development of the artificial pancreas. This include a sensor-augmented pump that will shut off for a specific amount of time when the user does not respond to a low glucose alarm, a hypoglycemia minimizer that adjusts insulin delivery when a low glucose is predicted, a hypoglycemia and hyperglycemia minimizer that will decrease insulin delivery if a low glucose is predicted and increase it if a high glucose (e.g., >200 mg/dl) is predicted, a fully automated closed loop with insulin only, a fully automated multi-hormone closed loop system.

Samrt insulin is the new watchword in diabetes today. Initially a creation of a nanotechnology scientist from MIT and now being developed by Merck, SmartInsulin is an insulin that has been chemically modified to release insulin in response to glucose in the bloodstream. It is believed that this will allow for better postprandial insulin coverage while minimizing the incidence of hypoglycemia, all with only one injection per day. Smart Insulin is still in preclinical studies.

 

The writer is Dr. Shankar Kumar, Founder and Director, MS Diabetes Centre, Indiranagar, Bangalore.

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