New treatments for diabetes

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New treatments for diabetes

In recent years, the research into new treatments and cures for diabetes has shown promise. Research also offers hope that diabetes will become easier to monitor and treat, or even that a cure may be found in the near future. However, all of these treatments are experimental.

Treatment areas currently being explored include:

• Blood sugar monitoring technologies.
• Dietary therapies.
• Insulin therapies.
• Genetic therapies.

If you have a strong interest in any of these treatments, discuss the treatment with your health professional.

New blood sugar monitoring technologies

Better monitors and lancets that minimize the pain associated with the frequent finger sticks or that allow alternate testing sites, such as your forearm, are now in use. The Glucowatch, which is now available, is an automatic blood sugar monitoring device. The GlucoWatch is worn much like a wristwatch. It is about the size of a pager. This monitoring device uses your perspiration to measure the amount of sugar in your blood. Its advantages include dramatically reducing the need for finger sticks and providing an almost constant blood sugar reading. It can help track trends in your blood sugar levels so that you can adjust your diabetes treatment appropriately. Newer models can also sound an alarm when your blood sugar level drops.

The GlucoWatch does have drawbacks. It cannot completely eliminate the need for finger-stick blood sugar tests. It is useful more as an additional monitoring tool rather than as a primary one. The device has a 3-hour warm-up time, a 20-minute lag between readings, and needs to be calibrated with a finger stick test to ensure accuracy. It also needs to be changed and calibrated every 12 to 15 hours. Sweating and changes in skin temperature can alter the results of the blood sugar tests. In addition, all people who wear the device have some degree of skin irritation.

A combination insulin pump and glucose monitoring system was recently approved for adults by the U.S. Food and Drug Administration (FDA). With this system, you insert a disposable sensor under the skin around your waist. The sensor measures your blood sugar over 280 times per day. An alarm sounds if you have unsafe sugar levels. You still need to test your blood sugar using finger sticks to calibrate the device and before changing your insulin dose. This device has the potential to give you more information about how diet, exercise, and medicines affect blood sugar levels.

New dietary therapies

New dietary research has shown that certain foods may have an even more beneficial effect on diabetes treatment than was first thought. For instance, increasing your consumption of soluble fiber has been proven to help prevent high blood sugar (hyperglycemia) as effectively as taking an oral hypoglycemic medication. Also, eating foods with a lower glycemic index may have a small but helpful role in keeping your blood sugar levels within your target range.¹

Diabetes can be greatly affected by what you eat. New research reaffirms this and reinforces the importance of having a registered dietitian on your diabetes treatment team. A registered dietitian can help you determine which new dietary recommendations might be helpful.

New insulin therapies

A lot of new research focuses on alternative methods of giving insulin. The U.S. Food and Drug Administration (FDA) recently approved an inhaled insulin (Exubera) for adults. Inhaled insulin provides insulin in a dry powder form that you inhale through your mouth. Once inhaled, it goes directly to your lungs, where it is picked up by the bloodstream. This device uses rapid-acting insulin and works in much the same way as an inhaler used by people with asthma. More research is needed about using inhaled insulin for children.

Exubera is a rapid-acting insulin. It does not replace long-acting insulins. Exubera comes in only two doses so you cannot adjust the dose of inhaled insulin as finely as injected insulins. Exubera also requires a special inhaler. This inhaler may not be as convenient to carry as injected insulin.

The long-term safety of Exubera is not known. In studies, some people had lower lung function after taking Exubera.² But experts do not know if these effects will get worse over time. If you take Exubera, your doctor will regularly check your lung function.

The insulin patch is another new method currently under development. An insulin patch functions much the same way as a nicotine patch. A patch is placed on your skin, usually on your arm, where it delivers a constant low dose of insulin. To increase your insulin dose at meal times, you remove a tab on the patch to expose the skin to more insulin. While the patch provides a very convenient, painless method of insulin delivery, insulin does not travel through the skin easily.

New shorter needles are available that make it less likely that you would inject insulin into a muscle. Newer needles are also smaller in diameter, which makes injections less painful.

Genetic therapies

Researchers have recently identified a gene that is linked to insulin resistance and that might predispose a person to developing type 2 diabetes. This gene seems to promote excess production of a protein called PC-1, which interferes with insulin's ability to help a cell use glucose. It is hoped that this will help identify people who may develop type 2 diabetes at some point in their lives and possibly help improve their treatment. Possible therapies might include:

• Diabetes vaccines. An experimental vaccine to prevent type 1 diabetes is being tested in mice. The vaccine, composed of DNA, is designed to stop or prevent the body's destruction of its islet cells.
• Gene therapy. Scientists have genetically engineered liver cells to produce insulin. This procedure varies slightly from islet cell transplants because the DNA that produces insulin is actually inserted into liver cells. A drawback of this therapy is that insulin produced by the liver is not regulated in the same way it would be if it were produced by the pancreas. Unfortunately, the liver does not increase the output of insulin when a person eats and then decrease it between meals. Instead, the liver produces a fairly constant amount of insulin. This could cause problems at meal times for some people with diabetes.
• Stem cells. Researchers are exploring whether stem cells might be used to make cells that produce insulin. Stem cells are early cells that have the ability to grow into any type of cell.
• Immune system modulators. Scientists are studying whether certain medicines can be given to people early in the course of their type 1 diabetes to keep their remaining insulin-producing cells from being destroyed.

References

Citations

1. American Diabetes Association (2003). Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 26(8): 2261–2267.

2. Inhaled insulin (Exubera) (2006). Medical Letter on Drugs and Therapeutics, 48(1239): 57–58.

Credits

Last updated:	January 15, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Kathleen M. Ariss, MS, Pat Truman