Research in the field of diabetes management has taken two main directions: (1) improving the effectiveness and reducing the invasiveness or other burden of existing treatments and (2) pursuing the “complete solution” to the diabetes problem. Improvements in current therapy include making glucose monitoring and insulin delivery less invasive and more patient-friendly, and many significant advances have been made in this context in the past two decades. Among these have been the development of insulin pumps and of non- or minimally-invasive techniques for sampling blood. New, fast-acting forms of insulin have been introduced. There has been considerable research in non-injection dosage forms for insulin, and the first inhaled insulin product has recently been approved. This could herald a new era in insulin therapy.
Still within the boundaries of improving existing treatments, manufacturers hope to succeed in development of an “artificial pancreas.” This is the term used to describe a system in which continuous glucose monitoring is linked electronically to continuously variable insulin delivery, effectively making diabetes control automatic and freeing the patient to get on with his/her life. The technology behind an artificial pancreas lies simply in linking essentially existing glucose monitoring technologies with infusion delivery in an autonomous, feedback loop that would normalize blood glucose control without frequent patient or clinician intervenion. The premise is that a healthy pancreas is able to regulate blood glucose levels via combined glucose monitoring and insulin infusion and such roles are now currently provided in separate systems monitored frequently (multiple times daily) by the patient or clinician.
More radical approaches to diabetes mellitus, also the subject of vigorous research, include ways of replacing the whole cumbersome business of glucose testing and insulin administration with normally functioning pancreatic cells. Transplantation of healthy pancreatic islets into diabetic patients has been explored, but the problems of rejection are a significant hurdle. More promising is the modification of adult or embryonic stem cells so that they develop into pancreatic beta-cells capable of being implanted in the patient and serving as a replacement for the insulin-secreting cells that have been destroyed.
Further in the future are developments based on genetic manipulation. Several gene anomalies have been identified as related to the development of type 1 diabetes in particular, and these may present targets for intervention to prevent the disease from developing.
Across this spectrum of possible developments — improving existing monitoring, improving existing insulin infusion, developing an integrated pump/monitor and cell-based or genetics-based “cures” to diabetes — there are a startling number of products, technologies and active companies.
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