Diabetes developments in 2016: Drugs, devices and ditching the needles
Endocrinologist looks into the future of treating kids with type 1 diabetes
The last few years have seen some major progress in the field of type 1 diabetes care in children and adults alike. Progress becomes especially important in light of recent news that type 1 diabetes is increasing in the U.S.
There’s been a lot of progress in type 1 diabetes care in the last five years, and I can only expect more in 2016 and upcoming years. I offer my thoughts on three areas for anticipated progress in type 1 diabetes care.
Insulin has been the mainstay in type 1 diabetes care since its purification and use in 1929. We’ve come a long way from purified animal insulin. We’ve had synthetically produced human insulin now for about 20 years.
Further modifications were made to human insulin creating long and short acting insulin analogs which are used today in basal/bolus insulin plans - considered standard of care in those with type 1 diabetes.
Several new analog insulin, either released or awaiting FDA approval, could be game changers for 2016.
Long-acting insulin activity is currently around 24 hours, but having a longer range of activity may benefit some patients with diabetes. Two new long-acting insulins, Tuojeo and Tresiba, continue working beyond 24 hours and have been approved for use only in adults with type 1 diabetes.
Fast acting insulin is essential at meals to control the rise in blood sugar from carbohydrates eaten. An “ultra-fast” acting insulin faster than the current batch of rapid-acting insulins recently started the review process for approval.
None of the current long or short acting analog insulins are generic. The cost of insulin and other diabetes supplies is a significant ongoing expense. A new “semi-generic” form of the long-acting insulin analog, Lantus, received recent approval.
The release of new analog insulin offers more choices, and research will be essential to see how these insulin can be used in children. Also, the number of insulin and increased choices will hopefully mean lower prices for vital medicine in the future.
Technology continues to move forward in its role helping children and families co-pilot type 1 diabetes.
Continuous glucose monitoring (GGM) continues to move into mainstream as a vital tool giving children and families real-time blood sugar information and better managing the highs and lows in blood sugar.
CGM in the clouds refers to the technology allowing remote monitoring of blood sugars. CGM sensor information is broadcasted via a smart phone to a server where it can be retrieved by using another smart phone or internet connected device. Parents can be hundreds of miles away and still have the comfort of monitoring their child’s blood sugar.
All the major insulin pumps have or will shortly have CGM integration allowing the most efficient use in these two tools together. The ultimate pairing of these tools, the artificial pancreas, continues in development.
The artificial pancreas holds the promise to lessen the work in diabetes care and help children have more stable blood sugars by allowing the insulin pump to use CGM information to make adjustments in insulin delivery.
Ditching the needles
Needles and sharp things are tough reality in diabetes care. Shots and finger pokes are a daily necessity in diabetes care. There’s been talk about non-invasive, needle-free monitoring in diabetes care for decades, but little progress has been made. Although CGM represents major progress, a needle is still needed to insert the device.
Wouldn’t it be great if monitoring of blood sugars or insulin treatment could be done without needles?
2016 has the potential to move forward in this area.
Inhaled insulin was recently approved for use only in adults with type 1 and type 2 diabetes. Further study is needed to see if inhaled insulin has a safe, effective place in treating children with type 1 diabetes.
Google’s glucose-sensing contact lens is probably the most recognized in the effort of various companies developing blood glucose checking without the stick. An ear sensor is being tested by two different companies.
The hormone glucagon is essential in the body to work against insulin and keep blood sugars up. Glucagon treatment, given as an injection, is an emergency measure used in type 1 diabetes when severe low blood sugars happen.
Nasal glucagon development is progressing and will probably reach the market soon with the promise of one less shot needed in an emergency situation of low blood sugar.
Removed first part For all of us in the field of endocrinology, defeating diabetes is the ultimate goal. For now though, I think 2016 offers the promise of new technology making those the life of someone with type 1 diabetes easier.
Research is also ongoing in re-creating insulin producing cells for re-implantation in the body which is the ultimate in defeating diabetes for good and what a great story that would be as we look ahead to 2017.
Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children. Follow him on Twitter: @The Endoguy.