Figure 1: Solid line is showing the average hemoglobin A1c (the biomarker of glycemic control) by age among the type 1 diabetics in USA (n=16,057) . The dashed line is showing American Diabetes Association (ADA) guidelines for adolescents and adults .
It is important to remember that diabetes management is not all about the A1c, but most of us have seen the figure with the exponential risks for secondary diseases that is related to poor glycemic control shown in DCCT study . Furthermore, there is evidence showing that the prior glycemic control has sustained negative effect, even though the control is returned to normal. This is known as “metabolic memory” [5,6,7]
But enough of the gloomy part… Let’s open the door for brighter future and things that may improve individual’s diabetes management. Below is few highlights from ATTD.
Continuous glucose monitoring (CGM), including flash glucose monitoring (FGM)
Okay, CGM and FGM are nothing new, but they are here to stay. Hopefully in future, they will have a wider user base. There are plenty of studies that shows the benefits of CGM , and not only for T1D, but also for T2D . Furthermore, CGM can be cost-effective option for even those T2D who do not use prandial insulin as a form of treatment . In the case of CGM devices, there are two major positive things. Firstly, the manufacturers are eager to develop ways to improve the accuracy of meters, even with less calibration measurements. Increased accuracy will allow CGM to be used for treatment decisions also. Secondly, the increasing competition makes CGM accessible for more diabetics.
Insulin pumps and insulin types
Again, not a totally new thing, but there is some serious potential in these! Device manufacturers are trying to find ways to speed up the insulin absorption with pumps. They are developing solutions e.g. for dispersed injections, ways to tackle Tamborlane effect, intraperitoneal infusion, or even by warming the infusion-site. Insulin manufacturers offer wide variety of things to discuss, but let’s pick the most prominent: Ultrafast insulins! For instance, faster-acting aspart shows 25.7 minutes’ improvement on peak-time when compared to the insulin aspart on the market today and thus, better mimics the endogenous secretion of insulin .
Diabetes management software
This is where the magic happens! We have had the technology to connect pumps, meters and sensors to mobile devices for a long time. Now the devices are actually connected which enables applications to find ways to improve glycemic control. One that I have to mention is Artificial Pancreas (AP); a system that consists of an insulin pump, CGM, and a control device (including control algorithm). Many are aiming to have fully automated closed-loop control systems that would mimic the functions of human pancreas as much as possible. Although that might be far away, hybrid closed-loop algorithms are already here and some are already FDA approved . You might only need to do as little as “announce a meal”, and the system does the rest… almost. There are cases where intensive exercise brings challenges to the controlling algorithms. And with the AP, the competition lies in the controlling algorithm. Who has the most efficient control algorithm which is also safe to use in all cases? Well, we still have to wait for the evidence from multiple studies that are ongoing, but I will say this: The competition is a promise of results!