Diabetes treatments are becoming more effective by the day, and scientists may be years away from developing an artificial pancreas that detects and regulates blood sugar (glucose) levels. And in the meantime, new drugs and insulin devices could make life easier and safer for people with diabetes.
“We have more and more options,” said Dr. Michael German, medical director of the UCSF Diabetes Center, “which is good because people with diabetes have different symptoms, so more options help medical staff provide each patient with the provide the right medication.”
New options for treatment
Quick-acting inhaled insulin
The insulin inhaler, available in February 2015, is for adults with type 1 and type 2 diabetes. Patients can use it before a meal to inhale short-acting insulin.
Unlike the old inhaler, which was the size of a jar of shaving cream, this inhaler is easier to use and can be taken anywhere.
“It’s very small, just a little bit bigger than a whistle,” said Sethu K. Reddy, MD, director of adult diabetes at the Joslin Diabetes Center at Harvard Medical School.
This inhaler may not be suitable for people with diabetes who smoke or have lung disease such as asthma or emphysema.
Wearable insulin management device
The device is not yet available in the US, but may soon be submitted to the US Food and Drug Administration (FDA) for approval. The device combines an insulin pump with a dynamic glucose monitor, a step toward an artificial pancreas. The device automatically stops pumping insulin when blood glucose levels drop and resumes pumping when blood glucose levels rise.
“Hypoglycemia is a real problem that needs to be addressed, especially for people with type 1 diabetes,” Mike said. This device may be particularly helpful for people who are hypoglycemic but not experiencing any symptoms.
Ralizumab
Doctors have used this drug to treat macular edema in patients without diabetes. But in February 2015, the FDA approved this drug as the first eye drug to treat diabetic retinopathy. Diabetic retinopathy is a serious disease associated with diabetes and one of the leading causes of blindness in adults in the United States.
Artificial pancreas
Patients who take multiple daily injections of insulin to treat type 1 diabetes may want a device that can ease the burden of blood glucose control. A portable artificial pancreas could one day be both an insulin pump and an ambulatory glucose monitor. This device may be able to calculate insulin doses and pump insulin based on its own blood glucose readings.
Scientists are working on several different models of the device. Some scientists are working on a second pump with glucagon, a drug for severe hypoglycemia.
Experts say that such devices are likely to be on the market by 2020. But it may take a while to work out all the problems that will be encountered in real-world situations.
Saito said, “I don’t think there will be an immediate use of these devices to tightly control blood sugar, it’s like a regular car versus a race car. With a regular car, small changes in control may not cause problems, but if you’re driving at 180 miles per hour, small changes can cause problems. Avoiding severe hypoglycemia is critical.”
Other drugs under investigation
“There are several studies that are developing longer-acting insulins that are more predictable and consistent,” Setu described. Scientists are also trying to study more concentrated forms of long-acting insulins to reduce the number of injections needed.
Saying, “A syringe can hold 100 units of insulin, so if you need to inject a higher dose, you have to inject again. For people with type 2 diabetes who may need a high dose of insulin, reducing the number of injections to one would be convenient.”
Researchers are also investigating whether stem cells can be used to treat or even cure diabetes. Unlike other types of cells, stem cells have the potential to take on new roles. Scientists hope to direct stem cells to produce insulin that can respond to the ups and downs of blood sugar levels in the body. Setu said, “There’s still a lot of work to do, but we’re confident in that.”