Those who suffer from type 1 diabetes every day must make calculations to inject the right dose of insulin. They must measure the glycemic levels several times to be sure not to make mistakes, must pay attention to the symptoms of hypoglycemia to remedy it quickly. A life with obstacles, but new technologies are helping patients to have easier days to manage.
TOWARDS THE ARTIFICIAL PANCREAS
It was presented during the last congress of the European Society for the Study of Diabetes (EASD). It’s the first device able to deliver basal insulin in a personalised and automatic way in a 24-hour period of time. It is the most similar tool to an artificial pancreas available today, because it independently derives how much insulin to infuse thanks to a sensor that measures glucose in the subcutaneous tissue every five minutes and to an algorithm that analyses the data.
The insulin pump completes the system, which only requires the patient to enter the carbohydrates taken in the meal, making any necessary hormone adjustments, and to periodically calibrate the sensor. The device is also able to predict hypo and hyperglycaemia, protecting the patient from excessive changes in blood sugar.
In use for about a year and a half in the United States, where over a hundred thousand diabetics are using it, it has been shown to considerably increase the time spent in an acceptable range of blood sugar. A big step forward towards an increasingly automatic management of type 1 diabetes. Now the question is how to make it accessible in a uniform manner.
The new technologies also help those who do not have an implantable pump, but must still measure blood glucose efficiently: “Self-monitoring is used to achieve good glycemic control and reduce complications, but in ten years a diabetic can get to sting his finger 20 thousand times”, observes Antonio Ceriello, director of the Diabetes Research Department at IRCCS Multimedica Milano. “A problem for many, so unfortunately only 1 in 3 is constantly monitored to decide when and if to intervene with the correct therapy.”
The novelty that can solve the problem is a sensor that acts as a true “glycemic GPS”: in addition to being small and easy to apply, it measures glucose every five minutes making an automatic self-calibration that avoids the two daily capillary punctures. In addition, it has a good level of predictability, because it can signal the arrival of hypoglycaemia 20 minutes beforehand, giving time to intervene. “This reassures the patient and improves his quality of life”, says Ceriello. “Every day the system provides almost three hundred constant and automatic blood glucose updates, which the patient can read live every five minutes, having all the necessary indications to avoid hypo and hyperglycaemia. And the reliable and safe self-calibration really allows you to always be ‘online with your blood sugar.'”
A ‘DIGITAL CLINIC’
There are sensors that you can almost forget to wear: the majority of current sensors in fact must be replaced after about ten days; but now there is also a sensor with a long life (up to 180 days) that can be implanted subcutaneously and that sends the glycemic monitoring of the patient’s to their smartphone. A mine of data that can now be used by doctors without having to keep complicated “glucose diaries”, but evaluated through a quick and simple analysis algorithm, developed by the University of Bari and presented to the EASD: “Through the integration of the information deriving from glycemic monitoring and the different effects of hypoglycemic drugs, the algorithm helps to immediately understand if the blood sugar is stable and suggests the medicine with the characteristics best suited to the glycemic profile and to the characteristics of the patient”, explains Francesco Giorgino, professor of endocrinology at the University of Bari. “Obviously it does not replace the doctor, but helps to manage the ten classes of drugs available indicating the more or less appropriate for the individual case, for example suggesting products with a good effect on body weight in an overweight patient or the active ingredients that reduce the cardiovascular risk in people at risk “.