These are exciting times for diabetes care. Dramatic progress has been made in the past 10 years and it is starting to make a real difference for the more than 320,000 New Zealanders estimated to have the condition.
“It has been a revolution, particularly for type 1 diabetes” says Ben Wheeler, an endocrinologist at the University of Otago. “What we have available to manage diabetes and get people healthier has really changed.”
Type 1 diabetes occurs when the body’s immune system attacks and destroys the insulin-producing beta cells of the pancreas. Symptoms most often begin in childhood or adolescence and require managing with regular insulin for the rest of a person’s life. Until recently, this has involved checking blood glucose levels with multiple finger prick tests every day then injecting the insulin manually to keep it in a healthy range.
“But the age of finger pricking is coming to an end,” says Wheeler.
New technology has been a game-changer. Now, if you have type 1 diabetes you can track your glucose levels and whether they are rising or falling with a continuous glucose monitor. These are generally worn on the arm and can transmit the information to an automated pump, which delivers the precise amount of insulin required, essentially acting as an artificial pancreas.
Pharmac has now funded this equipment for all those with type 1 diabetes and Wheeler says it has the potential to improve not only a person’s health but their whole life. His research on the devices has shown major benefits. A recent 13-week randomised trial involved 80 children and young adults who were divided into a group that received automated insulin delivery and a control group with usual care. “These were people who were really struggling to control their blood glucose and experiencing an enormous burden with their diabetes and sometimes with life in general,” says Wheeler.
Researchers can tend to shy away from harder-to-treat individuals but Wheeler reasoned that if the technology was good enough, his young participants would wear it. Also, a system that made most of the decisions on their behalf might be exactly what they needed.
“What we found with this study is that nine out of 10 people will quite considerably improve with this technology, sometimes dramatically,” he says. “They had huge improvements in their health. We knew that it works wonderfully for people who are healthy and have very structured lives. Now we know that even in the most trying circumstances, it is extremely helpful and can totally change outcomes for those who are struggling.”
Uncontrolled diabetes has serious consequences. It can cause nerve damage and makes it more difficult for the body to control blood pressure and cholesterol. The risk of cardiovascular disease is higher and there is more chance of developing several types of cancer.
“Many people don’t realise how big a deal diabetes is,” says Wheeler. “Managing it well brings enormous benefits.”
Type 2 diabetes isn’t an auto-immune condition – it is linked to things like being overweight and having a family history – but it also affects glucose control. There have been advancements here, too, with new medications that lower blood sugar levels, help with weight loss and reduce the risk of complications by protecting the heart and kidneys.
Although the new insulin delivery systems aren’t funded for type 2 diabetes, Wheeler can see benefits for some, particularly with the self-tracking aspect.
“When you arm people with continuous data, it changes lifestyle,” he says. “If they eat a big meal of white rice and see their blood sugar shoot up, they may decide to have salad next time or change to brown rice.”
The focus now is on making automated insulin delivery even better. The pumps are small electronic devices, connected to the body via an infusion set, which includes a thin cannula that goes from the reservoir where the insulin is stored and into the body. With the models currently funded in New Zealand, this needs to be changed every three days, says Wheeler. “But this technology will continue to become more automated so that people can focus on living well, not on the minutiae of managing their diabetes.”
