Glucose-responsive insulin and diabetes
device as stated by the NHS is: £1,000 for a monitor that does not need a pump, £500 for a monitor that works with an insulin pump and £40-£60 for subcutaneous sensors, £2,000- £3,000 for an insulin pump. 5 For a complete automatic system one could be spending around £2540 for a monitor, pump and sensors, with sensors needing to be replaced every 7 days. The life expectancy for those with diabetes type 1 is on average reduced by more than 20 years
Figure 2. Example of a Continuous Glucose Monitoring system. (Webb, 2020)
compared to the 10 years for type 2, with diabetes being the fifth most common cause of death in the world. Of course, both types of diabetes are terrible and it is the aim of modern medicine to find ways of removing such problems from the lives of humans, but it is quite clear that, although the majority of cases of diabetes are type 2, type 1 diabetes is the most difficult struggle from day to day, and if it is not looked after and maintained properly, it can result in foot amputations, heart diseases and strokes, partial and complete loss of sight and even nerve damage. 6 Ever since the 1970s, methods of engineering the preparation of insulin that can alter and automatically adjust it s activity to match the constant fluctuations of the body’s blood sugar levels ha ve been long sought but usually to no avail, with none of the proposed methods being suitable for development, and further clinical trials. 7 However, in more recent years, there have been promising developments in the area of creating and testing of glucose-responsive insulin and its required delivery system. The main hurdle being tackled is that insulin has a very specific strength and effect. There are several types of insulin that are given to people who suffer from type 1 diabetes: Rapid-acting, Short- acting, Intermediate-acting, and Long-acting. 8 As their name suggests, they each have different lasting effects on the blood sugar levels, and if one is not careful, injecting the wrong type could result in death. This is why an insulin molecule that can remain in the body and is sensitive to the blood sugar levels of the person which can then adapt automatically would change the lives of people suffering from type 1 diabetes, removing the fear and danger of hypoglycaemia and the risks that come along with it. The more successful studies and technologies follow a more specific train of thought: the insulin itself should not be glucose responsive, but rather the delivery system. Research is being done into delivery systems that can mimic the way in which the pancreatic endocrine system works by self-monitoring and regulated insulin release without the involvement of the patient themselves. The regular closed system, externally controlled monitor and pump will always face some inaccuracies as they are electronically controlled and can cause fibrosis over time. 9 For glucose-responsive delivery systems to be successful, several criteria must be met, such as the rapid in vivo activation in a similar fashion to that of the pancreatic cells that store, produce, and secrete insulin, the ability to keep the delivery
5 Continuous glucose monitoring (CGMs) 2021. 6 Avoiding complications 2018. 7 Hoeg-Jensen 2021. 8 Type One Diabetes 2020. 9 Luo et al. 2021.
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