Toward the improvement of diabetes treatment: recent developments in technical support.

Abstract

Diabetes is recognized as one of the most severe health problem in the world. It spares no one, attacking men, women, children, and the elderly. Diabetes is the leading cause of kidney failure, blindness in adults, nervous system damage, and amputations. It is a major risk factor for heart disease, stroke, and birth defects. Diabetes is currently one of the most costly diseases in both human and economic terms. Diabetes is a metabolic disorder resulting from insulin deficiency, insulin resistance, or both. There are several possible realizations of the so-called artificial or bio-artificial pancreas (AP, BAP), systems which should automatically and efficiently substitute for the lost function of the # cells. Any types of AP/BAP are routinely used for the treatment of diabetes. Currently, for ambulatory insulin-treated diabetics, only application of intensive therapy can effectively delay the development and progression of the above-mentioned life-threatening late complications of diabetes. Ideal intensive insulin treatment should mimic as closely as possible the secretion of insulin by # cells in healthy people. The crucial factors that determine the efficiency of this type of treatment are the effective monitoring of the patient's glycemic control (monitoring phase) and the accurate delivery of insulin according to established algorithms (treatment phase). The monitoring phase includes blood glucose measurements, the transfer of all parameters measured and noted by the patient to a physician, and clear registration of the data. The treatment phase concerns selection of the optimal insulin regimen and effective insulin delivery to the patient. Delivery of insulin is most commonly realized either intermittently using multiinjection techniques or continuously by portable pumps. However, several others methods of delivery are under development. The main objective of this article is to discuss in detail recent technical developments in intensive insulin treatment, stressing the existing problems and reviewing the best applied solutions.