Have Glucose Monitors Come of Age?

sensor1People with diabetes who must use insulin have fantasized for a long time about an automatic device to help them keep insulin levels in the proper range, increasing the hormone after eating, for example, and tapering it off gradually as the body does in those without diabetes.  Now a study in the New England Journal of Medicine describes a prototypical two-monitor system that may pave the way:Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes.

The strategy is called ‘sensor augmented pump therapy’ and employs two devices:  one monitors glucose levels in the blood continuously via a patch worn on the abdomen, and the other is an insulin pump with a reservoir and a needle inserted under the skin of the abdomen, which delivers the hormone when needed in response to the sensor.  Here’s how it looks, above.

The study randomized almost 500 adults and children with poorly controlled type 1 diabetes to either regular insulin injections and independent glucose monitoring or to the system integrating a sensor and a pump to more automatically regulate blood levels of the hormone.  After one year of use, the group with the more automated system had a better hemoglobin A1c, also known as glycated hemoglobin, than the group who monitored their own levels and injected insulin on their own.  It’s worth reiterating that this measure of how many sugar molecules are attached to hemoglobin, the oxygen carrying component of red blood cells, is an average of how well blood sugar has been controlled over the previous three months or so.  Clinicians have become convinced that hemoglobin A1c, or glycated hemoglobin, is a much better metric to assess the efficacy of insulin therapy than a single measurement of blood glucose at a single point in time.  The take home message is this:  if you have diabetes this test should be done regularly.

So does this study mean that finally (!) an integrated system for measuring blood sugar and delivering insulin has been developed?  As Rick says in the podcast, probably not.  This system was fairly complex and required a very motivated user with computer skills.  Educating everyone with insulin-dependent diabetes to manage their condition this way would be a huge undertaking.  The good news is it does pave the way toward more automated systems, with the ultimate objective of mimicking the body’s functioning as much as possible.  The goal is to reduce the many negative consequences of poorly controlled diabetes, especially cardiovascular problems, nerve and eye disease and others.  A worthy goal as the number of people with diabetes is projected to spike sharply as a consequence of obesity and overweight.

Other topics this week include avoiding eye consequences of diabetes, also in NEJM, and still in NEJM (!) the adverse events associated with testosterone use in elderly, frail men.  Finally, we round it out with the benefits of prostate cancer screening in the Lancet.  Until next week, y’all live well.

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