Type 1 diabetes is a disease in which people need to take several injections to keep their blood sugar at the right level. Injecting insulin is not a pleasant process, but it is the lifeline of patients with type 1 diabetes. This raises the question of whether technology can provide a solution, relieving patients from the pain and stress caused by type 1 diabetes. People with type 1 diabetes do not produce a hormone called insulin, which allows glucose in the blood to enter the cells, thereby providing the body with energy. Instead of using the insulin produced by their pancreas, people with type 1 diabetes receive their insulin by injection. In addition to the pain of the needle, the injections can cause skin irritation, and over time, the blood can shrink or thicken. If someone with type 1 diabetes goes without insulin for a long time or takes the wrong dose, it is very likely that they will end up seeing their blood sugar drop alarmingly low, resulting in them having to be hospitalized.
Zhen Gu, a professor in UCLA, noted that for people who use insulin, the treatment is given by subcutaneous injection. This is a daily injection that can be quite painful and uncomfortable. Gu and his team are working on a wearable patch that can deliver insulin through the skin. The patch consists of an array of microneedles that deliver insulin. The microneedles, just 800 micrometers long, are made of a polymer matrix of an enzyme called phenylboronic acid (PBA). They sit just below the top layer of the skin and react to changes in blood sugar. When the wearer of the patch begins to experience high blood sugar levels, a reaction takes place that changes the electrical charge of the PBA molecules, causing the microneedles to swell and release insulin into the skin. Once glucose levels drop to normal, the needles stop releasing insulin. The patch will be about an inch across and will be replaced either every day or two to three times a day, depending on how often the user would normally inject insulin. It is a painless system that could improve the quality of life for these people.
Other research efforts are also looking at the potential of microneedles to deliver insulin. In particular, MIT and the pharmaceutical company Novo Nordisk have developed an insulin pill. Normally, insulin cannot be taken as a tablet, as it would be broken down by the highly acidic environment of the stomach and therefore cannot be transported into the bloodstream. In MIT’s system, once the pill reaches the small intestine, the outer coating breaks down and the soluble microneedles go into the intestinal wall to transport the insulin. companies hope to offer people “struck” by type 1 diabetes a better quality of life, using the technology and specifically systems . The artificial pancreas, also known as a “closed-loop” insulin system, is “worn” on the body at all times. A tiny plastic tube that sits under the skin records the level of glucose in the interstitial fluid, the fluid that surrounds the body’s cells. The glucose monitor relays the user’s blood sugar level to the pump, which changes the amount of insulin it delivers to keep the user’s blood sugar at the right level. Most systems available today are known as “hybrid” closed-loop systems, and they provide the basal insulin level. However, the user must report more information about their meals and manual blood pressure readings to the system to get “bolus” doses, which are quick shots of fast-acting insulin taken around meals. Insulin pump equipment companies are working on closed-loop systems that can automatically deliver both basal and convenience doses, so that human intervention is not necessary.
According to James Hayward, principal technology at IDTechEx, the question of how big the difference is between hybrid closed-loop and full closed-loop has yet to be answered. A full closed-loop system, including bolus doses, would be ideal, because it is essentially a pure artificial pancreas approach. While a full artificial pancreas may be a few years away from commercial availability, the market for hybrid devices is likely to grow.
Siddharth Shah, a program in Frost & Sullivan’s transformational practice, said the market for insulin pumps is growing, but their cost, which can run as high as $7,000, is far from affordable. That’s a problem that manufacturers seem to have recognized, so they’ve come up with new ways to charge to address the high cost. Instead of simply agreeing to a set number of units, agreements between hardware vendors and insurers—like the one between UnitedHealthcare and Medtronic—have focused on health outcomes. According to the two companies, patients using closed-loop systems had 27 percent fewer hospital admissions than those without.
There are signs in the broader healthcare space that closed-loop systems are better at maintaining blood sugar control than manual alternatives. In particular, a study in the New England Journal of Medicine found that people with type 1 diabetes who use closed-loop systems have more normal blood sugar levels than those who take their insulin only through injections. Another factor that may help boost blood sugar is a growing movement toward interoperability. Companies like Tidepool offer software to manage closed-loop systems that include glucose monitors and insulin pumps from different manufacturers. In addition to handling glucose transport, such apps can also allow users to provide data about their lifestyle, diet, and other events to better manage their blood sugar levels.
