Advances in insulin management have come about in the form of insulin pumps and FlexPens, but progress in the search for a cure is slow due to a lack of investment
DIABETES AFFECTS about 285 million people worldwide, according to the International Federation of Diabetes. More than 200,000 of these live in Ireland. Classified as a chronic illness, it has serious long-term implications if not controlled or managed carefully.
There are two types of diabetes, type 1 and type 2. The first occurs when the pancreas no longer produces insulin; hence insulin is administered subcutaneously in order for a person to survive, and without proper control can prove fatal. Type 2 is associated with being overweight, an unbalanced diet and lack of exercise, thus the pancreas is unable to produce a sufficient amount of insulin to work properly.
It is not known what causes type 1, but doctors believe it is as a result of various environmental factors. A study published in Making Diabetes Count: What Does the Future Hold?(2007), clearly shows the worrying prediction for a dramatic rise in the number of adults in Ireland who will develop type 1 diabetes from 2005 to 2015. A growth of 2,000 cases is expected. As a result, advancements in the treatment of type 1 diabetes are imperative to address this forthcoming sharp growth.
According to Anna Clarke, health promotion and research manager of the Diabetes Federation of Ireland, “the Government gives €1 million per annum for charities to apply for up to €50,000 matched funding for research in diabetes, but this is not specific to finding a cure”.
Disturbingly, despite the rise in the number of patients with type 1 diabetes, there is a “paucity of diabetes research into finding a cure for diabetes in Ireland at the moment”. To tackle this slowdown in research, the federation later this year will launch Diabetes Ireland Research Alliance in association with Juvenile Diabetes Research Foundation UK, so “money can be ring-fenced into finding a cure for diabetes in Ireland”, says Clarke.
This cutback has been noted among medical consultants. “There is no doubt that there is little research into type 1 diabetes in Ireland, with most of the research in this country focusing on type 2 . . . and given the downturn in the worldwide economy, there are less funds available for scientific research in general,” says Prof Seamus Sreenan, consultant in diabetes and endocrinology at Connolly Hospital in Blanchardstown and associate professor in the department of medicine at the Royal College of Surgeons.
On November 14th, World Diabetes Day (the birthday of Frederick Banting who, with Charles Best, conceived the idea that led to the discovery of insulin in 1922), marks the quest in finding a cure to treat the approximate 28 million people worldwide who rely on insulin to survive.
While advances have been made in controlling diabetes, progress in terms of finding a cure has been slow. “I am sure that there will be a cure in the future but I am realistic and believe it more than likely will not happen in my lifetime,” says Naomi (31), who was diagnosed with type 1 diabetes in 1987 at eight years old.
The way in which insulin is administered today differs from 1987, when Naomi first commenced using syringes. More often people today use FlexPens, where a small needle – 6mm in length – is attached to an insulin-filled pen. The user adjusts the pen to the amount of insulin they require at meal times.
Claire (30) was diagnosed with type 1 diabetes in 2005, and has only ever used a FlexPen. “I have recently started to use the FlexPen more frequently each day, in order to achieve better control so as to minimise any long-term negative effects. Do I like it? Not a bit. I do it because in the long term there is no choice in the matter.”
Nevertheless, insulin is a life-saver, and the easier the method of administering it, the better it is for somebody living with type 1 diabetes. Those working in the area of endocrinology insist that “your life is not to fit around diabetes; diabetes is to fit around your life”.
This motto has given rise to the development of insulin pumps. This device is known to be popular for its flexibility and for providing better blood- glucose levels in people with type 1 diabetes, in particular among athletes, doctors and those living busy lives with irregular eating patterns.
The pump, similar looking to a pager, is worn on your clothes and connected underneath the surface of your skin. It administers insulin at a continuous basal rate that is fully programm-able over a 24-hour period.
Recent models come with a sensor that can tell when the blood sugar is too high, too low or changing too rapidly. This is vital for people unable to recognise hypoglycaemia or hyperglycaemia. Prof Sreenan adds that “such a pump-sensor is sometimes referred to as an ‘artificial pancreas’, and has been referred to as the holy grail of type 1 diabetes research”.
Last May, after 22 years of syringes and FlexPens, Naomi commenced using an insulin pump, because “at some point in the future my husband and I would like to start a family. Having good control is very important at all times, but for the safety of a child it is really important at the time of conception and throughout pregnancy.
“I was putting lots of work into trying to get my haemoglobin A1c (HbA1c) less than 7 per cent, but I just couldn’t seem to be able to quite get there.”
A HbA1c test records the amount of sugar in a person’s blood over a 12-week period, and a result less than 7 per cent is recommended. However, since starting to use an insulin pump Naomi has noticed “a significant change in the reduction of my HbA1c results”.
Despite the appeal of such a popular device, there are those who are put off by it. Claire says that “nobody can tell I have diabetes unless I tell them. However, the idea of having something attached to me, regardless of how small, is bound to attract some attention, and I don’t want to stand out for having that.”
Insulin inhalers, which were used by people who disliked needles, have since been removed from the Irish market. Though no evidence indicated side effects on the lungs, Sreenan says “there was a lack of evidence of benefit when compared to injected insulin”.
Most recently, possible developments in immunotherapy are proving to be most exciting among doctors and users of insulin. Though in its initial stages, a group at Yale University in Connecticut, including an Irish doctor, are carrying out pioneering research into newer treatments for type 1 diabetes.
“They have used a drug that specifically targets the immune cells that collect in the pancreas and are thought to cause the damage to the islets,” says Sreenan. “Studies have shown better control of diabetes, and that the pancreas continues to work for longer in the shorter term after treatment, though it is not a cure.”
Claire says that “anything that makes my life similar to the way it was pre-2005 I am interested in. Providing I have good control in the years to come I am excited and interested in immunotherapy. I would love to wake up one day with my pancreas working again, with no thoughts of injecting . . . ”
“The major development over the next 10 years, I believe, will be in the area of diabetes-associated technology. With the refinement of pumps and sensors, I think we will see the development of the ‘artificial pancreas’ – a pump linked to a sensor that will adjust the insulin administered by the pump according to changes in blood-sugar levels,” confirms Sreenan.
