Although the study is in its infancy, researchers are trying to develop a device that can detect glucose levels using sweat.
In 2016, a team from the Hong Kong Polytechnic University and Zhejiang University in China developed such a device to help early diagnosis of diabetes.
The technology is part of two fields, one called optofluidics, which melds the fields of photonics (using light to detect certain chemicals), and the other called microfluidics (controlling small amounts of fluid along microchannels).
The researchers hope that this device will eventually be used to detect glucose levels in a person’s body from droplets of sweat, but more tests on the “lab-on-a-chip” need to be made.
In particular, the device uses a fiber-optic biosensor and a microfluidic chip, creating a way of monitoring glucose levels that promises to be not only cheap but also portable.
What are some other ways glucose levels may be measured in the future?
Many research institutions are working hard to find a way for people with diabetes to measure glucose levels without having to prick fingers, thighs, or arms.
For example, in 2015, the University of California at San Diego reported it had developed a temporary tattoo that used electrodes and sensors to measure blood glucose levels.
Google (yes, the search-engine company) is also seeking better glucose monitoring through the use of contact lenses for people with diabetes.
The computer company Apple is working on a smartwatch that can monitor and display health-sensor data including blood glucose levels (such a watch is available but so far without the blood glucose readings).
And in 2014, a saliva test kit called the iQuickIt Saliva Analyzer went through clinical trials to measure blood glucose with a simple saliva test.
It works by putting a one-time-use strip (called a Draw Wick) into the person’s mouth for a few seconds, obtaining a small sample of saliva.
Although none of these devices or methods is currently available to the general public, it shows that there are institutions, and people, who are sensitive to the plight of people pricking their fingers day after day to monitor their blood glucose levels.
Are there any devices that screen for prediabetes and type 2 diabetes without using needles?
Yes, in 2016, a device produced in Canada was developed that tests for prediabetes and type 2 diabetes without needles, blood, or fasting (currently, it is used only in Canada and the European Union and only as an investigational device in the United States).
The Scout DS™ device uses technology that employs light to detect and measure specific biomarkers associated with prediabetes and type 2 diabetes.
The patient lays his or her arm in the device’s armrest, and in around 80 seconds, a number is displayed on the attached screen.
If the score is high, then the patient is advised to see a health care professional for a follow-up evaluation.
It is hoped that such a device can be used in other places, such as pharmacies, offices, etc., to allow quick screenings, to catch people who are at risk for diabetes or allow an easy check for people who have diabetes.
FUTURE MEDICINES TO TREAT DIABETES
Will there ever be a generic insulin?
As of this writing, there is no generic insulin on the market.
In 2012, the Food and Drug Administration outlined many tough standards for the approval of biosimilars (generic versions of medications that are made by microorganisms), including insulin.
As of this writing, there is no generic insulin being submitted or tested by the FDA, but that may change soon.
The patents for several types of insulin will soon expire, meaning there may be more of an interest in developing generic insulin.
But it will take a long time for testing and approval.
What study is being conducted to determine whether metformin can help delay or prevent type 1 diabetes in at-risk children?
Although in its infancy, at this writing, a six-year study is being conducted in Scotland to determine whether the oral medication called metformin, the most commonly prescribed diabetes medicine in the world, taken by people with type 2 diabetes, can help prevent, or at least delay the onset of, type 1 diabetes in at-risk children. One of the reasons for the interest is that Scotland has the third-highest rate of type 1 diabetes in the world, and for reasons yet unknown, the numbers continue to rise.
For people with type 2 diabetes, metformin decreases the amount of glucose in the liver.
It also improves the body’s insulin sensitivity not only in the liver but also in muscles and fat cells.
This process also helps protect beta cells in the pancreas from stress.
Type 1 diabetes is an autoimmune condition in which the pancreas’s insulin-producing beta cells are destroyed.
The researchers believe that stress signals sent out by the beta cells is what starts the immune-system attack in type 1 diabetes, not a problem with the immune system itself.
They hypothesize that relieving the stresses on the beta cells in at-risk children will stop the process of developing type 1 diabetes.
And that relief may come from taking metformin.
What drug more associated with the lungs is currently being tested on people with diabetes?
O ne drug associated with the lungs (in particular to treat emphysema) is currently being tested on people with type 1 diabetes, called by the general name alpha-1 antitrypsin (A1AT; several companies call the drug by specific names, but they are not mentioned here).
In type 1 diabetes, the body’s autoimmune system attacks the beta cells that are responsible for secreting insulin from the pancreas.
As the disease progresses and more and more of the beta cells no longer function, the person with type 1 diabetes usually becomes completely dependent on insulin.
It is thought that the A1AT drug may help those with type 1 diabetes if the clinical trials prove successful.
In particular, researchers believe the A1AT may stop pancreatic inflammation and allow the survival of active and operating beta cells.
A form of A1AT was first tested on animals with diabetes, with promising results.
Another smaller-sample test on humans who had type 1 diabetes was run around 2012, with results showing that many of the participants were able to take significantly less insulin than when they started the trial.
The alpha-1 antitrypsin drug is currently being control-tested on many pediatric and young-adult patients with type 1 diabetes in several cities across the United States and in other countries, with most of the projected results expected by 2017.
But there is one caveat: At this writing, the drug may be successful only with people with newly diagnosed diabetes or periods during which there may still be some existing functioning beta cells in the pancreas.
What other conditions have been treated with the anti-inflammatory drug alpha-1 antitrypsin (A1AT)?
Type 1 diabetes is currently the center of study for the anti-inflammatory drug known as alpha-1 antitrypsin (A1AT), but it has also been used in the past for other health conditions. For example, it has been used to treat people with severe lung diseases, such as emphysema. It is also hoped that besides type 1 diabetes, A1AT can eventually be used to treat other autoimmune diseases, such as rheumatoid arthritis and certain types of asthma.
NEW WAYS OF TREATING DIABETES
What is islet-cell transplantation?
Within the islets of Langerhans are the important alpha and beta cells.
The alpha cells produce glucagon, while the beta cells secrete insulin, both important in keeping blood glucose levels balanced in the body (for more about the islets, see the chapter “How Diabetes Affects the Endocrine System”).
Islet-cell transplantation involves the pancreas, specifically the islets of Langerhans.
In particular, the beta cells are found in small clusters (islets) of the pancreas and are responsible for producing insulin.
Researchers hope not to transplant the entire pancreas but to target, extract, and replace only those cellular components that are needed to restore the pancreas’s normal function.
What is an “artificial pancreas”?
At this writing, an artificial pancreas is not a physical unit that replaces a person’s own pancreas but is a combination of two technologies, a unit that monitors a person’s glucose levels and a pump that delivers the correct amount of diabetic medication to the person to balance their glucose levels.
This mimics what a person’s pancreas would do in terms of monitoring glucose levels and determining how much insulin or glucagon the body needs.
For a person without diabetes, the body’s pancreas naturally finds a good balance between glucose, insulin, and glucagon.
But for a person with diabetes (especially type 1), insulin is needed several times a day to keep blood glucose levels in check.
The artificial pancreas helps people with type 1 diabetes whose beta cells make little, if any, insulin by monitoring blood glucose levels and compensating for imbalances with insulin and glucagon pumps.
An artificial pancreas would function much like a real one, producing insulin, glucagon, and amylin.
What artificial pancreas for type 1 diabetes recently received approval from the Food and Drug Administration?
I n fall 2016, the FDA approved the world’s first “artificial pancreas,” called the Medtronic MiniMed 67G hybrid closed-loop system, for people with type 1 diabetes (age 14 older). This system automatically monitors blood glucose levels and then provides the person with the correct dosage of basal insulin with relatively little input from the user. It can be used in “auto mode,” meaning completely automatically, or users can calibrate the unit for a more hands-on approach.
The melding of this type of technology is not new.
These pieces of equipment have been around since the 1970s, but the larger devices were clumsy to use.
Today’s technology has allowed scientists to develop much smaller devices.
People can use smartphone technology to keep balanced glucose levels no matter what activity they pursue or what they eat.
For example, one version of an artificial pancreas has been tested many times and includes a smartphone that has an “artificial pancreas” app.
A person’s continuous glucose monitor takes measurements every few minutes and wirelessly sends the information to the smartphone that contains the artificial pancreas app, which uses the measurements to calculate how much insulin or glucagon to give the user.
From there, the smartphone beams the information to two pumps the person is wearing to balance the glucose levels.
In this case, the insulin pump delivers medication to lower the blood glucose level, or the other pump containing glucagon delivers medication to raise the level.
Will there ever be a true artificial pancreas?
The ultimate goal for people who have diabetes and researchers who study the disease is to develop what is often termed a “bionic pancreas,” one that could actually replace a person’s non-functioning pancreas. In fact, there are laboratories working on melding the continuous glucose-monitoring units with insulin and glucagon pumps to create such an artificial pancreas.