How technology has changed diabetes management and what it has failed to achieve.
Tremendous improvements have modified diabetes management from pure clinical diagnosis and the discovery of insulin to continuous subcutaneous insulin infusion (CSII) coupled with continuous glucose monitoring (CGM) to allow patients to adapt insulin delivery to glycaemia on a virtually "real-time" basis. Insulin was first discovered in 1923 and, in less than a century, it has been purified, humanized and now synthesized by genetically modified microorganisms. Insulin analogue, kinetics and reproducibility now allow near-normal glycaemia to be targeted without increasing hypoglycaemia, thus allowing greater flexibility in the patient's day-to-day life. In addition, advances have been made over the past few decades in the development of the necessary and complementary technologies for insulin infusion, glucose measurement, glucose insulin interaction and telemedicine. The major remaining limitations are the lack of glycaemic regulation on insulin administration and the burden of parenteral delivery. Thus, the dream of both patients and diabetologists is to close the loop and to build an artificial pancreas.
Department of Endocrinology, Diabetes, Metabolic Diseases, Pôle NUDE, HUS, Université de Strasbourg, Strasbourg, France.
L
L
Ratheau
N
N
Jeandidier
F
F
Moreau
S
S
Sigrist
M
M
Pinget
D015190:Blood Glucose Self-Monitoring / Q000639:trends; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D007332:Insulin Infusion Systems / Q000639:trends; D008297:Male; D019397:Pancreas, Artificial / Q000639:trends; D012648:Self Care / Q000639:trends
D007004:Hypoglycemic Agents; D007328:Insulin