Progress in Diabetes Technology: Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress towards the Artificial Pancreas

Abstract

Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood with an estimated prevalence of more than 166 000 cases in children younger than 20 years of age in the US in 2010. 1 Pettitt D.J. Talton J. Dabelea D. Divers J. Imperatore G. Lawrence J.M. et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014; 37: 402-408 Crossref PubMed Scopus (314) Google Scholar The rate of new-onset diabetes also is increasing worldwide, with an increased incidence of 3%-5% per year. 2 Forlenza G.P. Rewers M. The epidemic of type 1 diabetes: what is it telling us?. Curr Opin Endocrinol Diabetes Obes. 2011; 18: 248-251 Crossref PubMed Scopus (89) Google Scholar In 1993 the Diabetes Control and Complications Trial established the benefit of intensive insulin therapy in reducing long-term complications, including retinopathy, nephropathy, and neuropathy. 3 The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329: 977-986 Crossref PubMed Scopus (22760) Google Scholar Despite this now longstanding knowledge, vascular complications attributable to hyperglycemia remain a significant issue in the population with T1D, even in the young-adult population. 4 James S. Gallagher R. Dunbabin J. Perry L. Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review. BMC Res Notes. 2014; 7: 593 Crossref PubMed Scopus (33) Google Scholar , 5 Maahs D.M. Daniels S.R. de Ferranti S.D. Dichek H.L. Flynn J. Goldstein B.I. et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the american heart association. Circulation. 2014; 130: 1532-1558 Crossref PubMed Scopus (123) Google Scholar Recent evidence from the T1D Exchange clinic registry shows that during childhood mean hemoglobin A1c (HbA1c) remains above the target of 7.5% for all age groups, with a peak of 9.2% in the late teenage years. 6 Miller K.M. Foster N.C. Beck R.W. Bergenstal R.M. DuBose S.N. DiMeglio L.A. et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange Clinic Registry. Diabetes Care. 2015; 38: 971-978 Crossref PubMed Scopus (923) Google Scholar This evidence points toward the urgent need for better therapeutic interventions to improve glycemic control across the pediatric population. Innovations in diabetes care are being pursued on many fronts, including education, behavioral interventions, pharmaceutical development, beta-cell transplantation, and immunomodulation to prevent autoimmune beta-cell destruction. Although these therapies aim to provide benefit now and more so in the future, many in the diabetes community believe that the most impactful near-term benefit will be achieved by innovation in the technologies used to manage diabetes.