THE FUTURE OF DIABETES CARE

Diabetes Today: A Story of Peril and Hope

Two scenarios loom on the horizon, as the epidemic of diabetes surges across the country. Scene one: even more pressure on the U.S. economy due to costs that are now over $325 billion a year and rising rapidly. Scene two: life-saving discoveries and possibly a cure.

Researchers all over the world are working to tip the balance toward a more positive future.

Transplants, insulin pumps, software that recognizes and adjusts insulin doses, and smartphone apps—often in combination with each other—are captivating the imaginations of researchers and diabetes patients alike.

Ed Damiano has a stake in both camps. An engineer by training and father of a son with diabetes, he is on a quest to build his version of an artificial pancreas, called the “bionic” pancreas. His story, featured in Blood Sugar Rising, captures the high stakes of diabetes management and gives us a glimpse of the light at the end of the tunnel.

The bionic pancreas is just one beacon of hope in diabetes research. Exciting new drugs and technologies show promise of making the disease less frequent and more manageable:

• Insulin pumps provide a calibrated dose of insulin via a micro-needle inserted under the skin. Although at first the pumps were large, they are now about the size of a smartphone, and the micro-needle sensors are worn on the body. They have been widely available for years and are being continually improved to deliver insulin more quickly and to sound alarms for unexpected blood sugar spikes or drops.

• Continuous glucose monitors use sub-skin sensors that record sugar levels about every five minutes. This is real-time data, so the person with diabetes knows whether they need insulin to lower their blood sugar or should eat something to raise the sugar. It also means a person with diabetes doesn’t have to do intrusive finger-tip prick tests repeatedly throughout the day. When insulin pumps and glucose monitors are combined with software that can determine what dosages to give, people with diabetes would have essentially the artificial pancreas of Damiano’s dreams.

• Insulin smartpens, an alternative to pumps,feature insulin cartridges and needles and come in disposable and reusable forms. They connect to smartphones and glucose monitors to display insulin, blood sugar levels and reminders when to take a dose. Data can be shared with family and health care professionals.

• Diabetes vaccine: Research is underway for a Type I diabetes vaccine that targets the virus that may cause the body to destroy its own pancreas cells. Another vaccine originally developed to prevent tuberculosis recently has shown some promise in reducing blood sugar levels in people with long-term diabetes.

• Kidney and pancreas transplants: The 17,000 Americans who receive a new kidney every year experience decades-long relief from diabetes-induced kidney damage. They still have diabetes, but no longer have kidney complications. About 1,000 Americans a year get the rarer pancreas transplant, which eliminates diabetes altogether. The new organ can function for more than 10 years.Simultaneous pancreas-kidney transplants are on the rise, as are pancreas-after-kidney transplants.

• Islet or beta cell transplantation, an experimental treatment for Type 1 diabetes, transfers pancreas cells from one person to another, with the new cells taking on the job of making and releasing insulin. As the procedure is still in the clinical trial phase, only about 1,000 people worldwide have received the cell transplants. Researchers also are working to learn more about our body’s ability to regenerate these insulin-producing beta cells.

The Damiano Family Story

Damiano’s son David was 11 months old when he developed diabetes. His wife Toby Milgrome, who is a pediatrician, recalls the scary day. “I went to get him out of the car seat, and he was just kind of staring—vacant eyes. It was very alarming, very unusual behavior.”

From that moment on, their lives were changed forever. Diabetes became a relentless, 24/7 experience, which, with an infant, was especially unpredictable and nerve-wracking. How can you know how many carbs an infant is getting when he’s still breast-feeding?

Damiano recalls vividly the nonstop checking of blood sugar—sometimes up to 15 times a day—and the multiple insulin shots.

“He had bruises up and down his arms for those first two months when we were giving him injections. That was something that really was hard for us to see.”

Damiano’s “Bionic” Pancreas

Damiano and his wife lived in a constant state of dread.

“The scariest prospect is this phenomenon called dead-in-bed syndrome,” he says. “There's a small number of people with Type 1 diabetes who go to bed at night, and then they don’t wake up.”

One question plagued Damiano. What would happen as David got older, went to college and didn’t have his parents to take care of him? That overriding worry eventually became the seed of inspiration for him.

His vision: a portable, wearable device that automatically controls blood sugar—essentially an artificial pancreas. Other scientists also began chasing this dream, seeing that they could build on decades of technology developments in medical devices and coordinate the functions of continuous glucose monitors, insulin pumps and smartphones.

“It's the integration of those three technologies that makes a system which is really better than the sum of its parts,” says Damiano.

By late 2019, he had raised $126 million to support the final stages of testing required by the U.S. Food and Drug Administration. Other closed loop systems are already on or about to be on the market.

Damiano expects his bionic pancreas, called the iLet, to become commercially available within a year or so.

“This device is around the corner,” he says. “It will get much better therapy to people and require much less of their participation.” It is, he says, a bridge to the future— perhaps as soon as a few decades away—when there’s a cure for diabetes.

Daphne Northrop, editorial project manager at WGBH in Boston, is a broadly published author and editor who specializes in education and health.