Devices May Take 'Ouch' Out of Daily Diabetes Checks

Work progresses on inhaled insulin, easier sugar monitoring

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HealthDay Reporter

SATURDAY, June 5, 2004 (HealthDayNews) -- New devices on the horizon might one day help ease diabetics' painful and tedious daily management of their disease.

Advances in the areas of monitoring blood glucose levels and delivering insulin are among several presentations being made this weekend at the American Diabetes Association's annual meeting in Orlando, Fla.

Right now, type 1 diabetics (and many with type 2) have to draw blood up to four times a day to gauge their blood sugar levels.

"Good glucose control prevents eye, kidney and nerve problems, and seems to be associated with a lower risk of heart disease," said Dr. Richard Bergenstal, an endocrinologist and executive director of the International Diabetes Center at Park Nicollet in Minneapolis. Still, he added, only 57 percent of people test even once a day.

One group of researchers is working on a device that measures levels of volatile organic compounds in human breath.

Although this "looked interesting as a scratch-the-surface type of concept," said Dr. Stuart Weiss, a clinical assistant professor of medicine at New York University School of Medicine, the findings will need to be substantiated. Also, there may be a lag between what's going on in the bloodstream and what's going on at the periphery of the body (i.e., the breath), he added. The device would also need to be small to be appealing.

Another set of researchers describe the HypoMon, a chest-belt transmitter that continuously takes measurements on the surface of the skin. One advantage of this system is that it would be able to monitor glucose levels even during sleep. The downside, Weiss said, is that movement and sweat could affect the readings.

Short-term monitoring of blood-glucose levels should not replace long-term monitoring, which is done with the A1c test, Bergenstal emphasized. In fact, the two should work together. "A1c has been best correlated to long-term complications. It measures all blood sugars for a two- to three-month period," Bergenstal said.

A second "hot" area of research involves inhaled insulin. Although this is not yet approved, the idea of inhaled as opposed to injected insulin represents a huge hope to millions of diabetics who hate needles.

One new technology would deliver insulin in 10 to 14 minutes, much faster than the 90 minutes it now takes.

"This methodology allows a person not to have to worry about taking insulin until they actually started eating, and then by using an inhaler about the size of a pocket pager," said Dr. Wayman Wendell Cheatham, senior vice president of medical and regulatory affairs for MannKind BioPharmaceuticals in Danbury, Conn., which is developing the technology.

Marcia A. Testa, a senior lecturer at the Harvard School of Public Health, led two studies comparing an inhaled insulin, Exubera, and medication in terms of patient satisfaction and disease control.

Currently, insulin is the therapy of last resort for type 2 diabetics, to be considered only after lifestyle changes and various medications fail. "The one thing that you know will work is always the last resort," Testa said. "What's the reason for that? Not that it doesn't work, it's that people just don't like to inject."

If insulin were less burdensome to take, Testa theorized, it might be used earlier.

One trial compared Exubera with the pill metformin (Glucophage) in patients who had failed on the drug sulfonylurea. The other mirror-image trial compared Exubera with sulfonylurea in patients who had failed metformin.

"People who were in poorer control did better on inhaled insulin -- not only for efficacy, but they also liked it," Testa said.

More information

The American Diabetes Association has more on blood glucose management.

SOURCES: Marcia A. Testa, Ph.D., senior lecturer, Harvard School of Public Health, Boston; Stuart Weiss, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; Richard Bergenstal, M.D., executive director, International Diabetes Center at Park Nicollet, Minneapolis; Wayman Wendell Cheatham, M.D., senior vice president, medical and regulatory affairs, MannKind BioPharmaceuticals, Danbury, Conn.; study abstracts, June 5-7, 2004, American Diabetes Association annual meeting, Orlando, Fla.

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