Diabetes Update

DOCTOR'S VIEW ARCHIVE

Report From The National ADA Meeting 2003

Medical Author: Ruchi Mathur, M.D.
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

I have just returned from the American Diabetes Association's 63rd scientific sessions held in New Orleans this year. Aside from being slightly confused over the awe of Bourbon Street, I found certain parts of the meeting quite informative. I'd like to share with you a few particularly interesting updates regarding, therapies, interventions, and tools for the management of diabetes.

I. Inhaled Insulin

Aventis and Pfizer are currently in the process of developing an inhaled form of insulin. The brand name is Exubera, and it is a fast acting (rapid acting) insulin. Currently this form of insulin is in Phase III trials (human trials) in the U.S. Clinical studies have thus far demonstrated that the drug is effective, and easy to use. It is administered in a similar fashion as the typical asthma medications people inhale, with some alterations in the delivery device. The major concerns over the long term use of inhaled insulin is its effects on the lungs, and their function. Studies looking at lung function testing are currently underway. Other things to remember about inhaled insulin is that it is a short acting preparation, so a longer acting (basal) insulin would still have to be given in the form of an injection and blood glucose monitoring is still needed multiple times a day. In addition to inhaled insulin, there is research in progress on oral insulin. However, inhaled insulin appears more promising.

II. New Insulin Pumps

The ultimate goal of therapy for type 1 diabetes is to find a way to prevent the insulin producing cells (beta cells) from being destroyed. Alternatively, the goal is to make some kind of external device as close to a functioning pancreas as possible. A device like this would have to sense the levels of glucose in the blood, and respond by generating an appropriate level of insulin to bring the blood glucose down, without dropping it too low. This system would have to be self contained and continuous. Well, we're not there yet, however, there are some interesting advances in insulin pump therapy. 

The newest is called Cosmore. It is not currently available on the market, but hopefully should be soon. It is an updated insulin pump, with the ability to provide estimates of the amounts of insulin needed based on data programmed into it. More interesting than that, when you turn this pager size device over, there is a port to which a glucose meter can attach. This glucose meter, made by Freestyle, is the size of a lighter. A teststrip with the patients blood on it is inserted into this meter. The meter then provides a digital display of the blood glucose value. In addition, this information is transmitted to the pump, which then offers a suggestion as to whether any insulin should be injected, and the amount. The patient then can override the pump and say no, or choose their own dose, or go with the pumps suggestion. It's a very interesting advancement in technology, and will provide the patients an opportunity to carry the meter on the pump instead of separately. One less thing to worry about.

III. New Meters

Insulin meters are becoming fascinating tools. They no longer take over 20 seconds to read out a result, nor do they use much blood. Meters, such as the One Touch Ultra and Freestyle, are reading values in less then 5-7 seconds and using very small quantities of blood. Some meters such as these also offer the option of testing blood at other sites, such as the forearm instead of the fingertips. In addition, there are multiple computer programs and downloads compatible with meters, and even ways to adapt PDAs to store blood glucose readings along with other diabetes information, such as HbA1c values, and cholesterol panels. The One Touch Ultrasmart is basically a health PDA, reading and storing glucose values, and providing areas to enter carbohydrate information, exercise logs and health check information. For those so inclined, these are valuable devices for providing insight and encouragement to maintain optimal health.

IV. Implantable Glucose Sensors

One of the more interesting lectures I attended was about some research being done in Denver. This group was looking at a surgically implanted glucose sensor and described their results using this device. This device, called the DexCom G1 sensor is implanted into the abdominal wall, and after a few weeks post surgery, blood supply grows around it. It is able to sense blood glucose levels very 30 seconds and transmit that data to an external receiver (pager size) worn on the patients belt where this information is stored. The receiver shows values to patients at certain intervals. Basically, this study showed that by having glucose values available to patients as often as every 5 minutes, patients overall glucose control improved, and their risk of having low blood sugar decreased. The implantable sensor takes about 2-4 weeks (after implantation) to start to sense glucose levels (since the blood supply must develop around it) and was used for a number of months in this study. There were no adverse events noted. This device is not available for patient use.

V. New Drug Therapies

Amylin Pharmaceuticals presented a clinical study on the use of one of their hormone like compounds called exenatide. For a little background information, there is a hormone made in the bowels of humans called GLP-1. This hormone (also known as an incretin) has the ability to enhance glucose dependent insulin secretion from the pancreas, slow stomach emptying, and overall improve glucose control. It is a very short acting compound, so a synthetic compound that mimics its actions has been developed called exenatide. When this compound was given to patients in the study, those who continued their oral medications, HbA1c fell from an average of 8.6% to 7.2%, with 50% of study patients reaching a goal of HbA1c <7.0%. Further research is being done on this compound.

Summary

Advances abound in many areas of diabetes research. From the basic task of trying to make insulin producing cells live longer, to manufacturing devices to aid in improving the lifestyle of patients with diabetes, to designing education resources to help prevent the development of diabetes. The above list is an example of only a few interesting areas a vast number of researchers are studying. If not a cure, the near future holds ways to dramatically improve care for people with diabetes, resulting in improved quality of life. Stay tuned!

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