INSULIN THERAPY – SCIENCE AND TECHNOLOGY NOWADAYS

Associate Professor Gabriela Roman, MD, PhD,

Diabet, Nutrition and Metabolic Diseases Dpt, UMF Cluj-Napoca, Romania

Diabetes mellitus is a very complex chronic disease affecting an increasing number of people. It is associated with serious chronic complications which significantly reduce life expectancy and quality of life. In order to prevent chronic complications an intensive, treat-to-target clinical management should be applied. Glycemic control is a major therapeutic objective. There is now a great body of evidence that intensive insulin treatment combined with glucose selfmonitoring, aiming to achieve near-normal levels of glycated hemoglobin A1c are associated with a significant lower risk of late complications. Diabetes mellitus is a field where new technologies are very important and extremely useful to ensure a long-term successful therapy. Science and technology refers to more physiologic insulin formulations, devices for insulin delivery and blood glucose monitoring. The new insulin analogues are specifically formulated to have either a  flat 24-h duration or a short-acting period for a more sensitive postprandial control. The new devices for insulin delivery are very easy to use and safety. Insulin pump therapy, due to continuous subcutaneous insulin infusion (CSII), provides a modern treatment option that can significantly aid in achieving the therapeutic targets while reducing the hypos and improving the quality of life. CSII is the most physiologic method of insulin delivery currently available, the most important advantages are:  better simulation of the beta-cell function, reduced glycaemic fluctuations, reduced risk for hypos, personal insulin profile, flexible lifestyle, safe overnight glycaemic profile, better cover of “dawn” phenomenon, low insulin doses when required, better adherence to correction of hyperglycaemia. Insulin pumps can be combined with the system that continuously monitor the glycemic values, the sensor-augmented pump, which offers the advantage of on-screen real-time glycemic measurement. Medtronic CGM-Real Time provides interstitial glucose measurement every five minutes – 3-4 days, 864 readings in 72 hours, values displayed real-time and graphic, preset alarms for low or high glucose values. An example of glycemic control under insulin pump, monitored with the continuous glucose system is presented below:

Pump technology is constantly evolving, current research and development efforts are leading toward “closed-loop” pumps, feature moment-by-moment sensors instantaneously translating glucose readings to insulin output.