Could 'Type 3' diabetes harm your brain? What your blood sugar levels mean for Alzheimer’s risk

From gulfnews.com

'Type 3' points to a brain that cannot handle insulin properly

For years, diabetes has been seen as a condition that affects the body — blood sugar, insulin, weight, and long-term heart health. But new research is pointing to a surprising connection: the brain. Some scientists have even given this overlap a provocative nickname: 'Type 3 diabetes.'

It’s not an official medical diagnosis, but the term reflects growing evidence that insulin resistance in the brain may play a role in Alzheimer’s disease. And, this link is too important to ignore.

What is Type 3 diabetes?

Hala Zakaria, Senior Research Coordinator at GluCare.Health by meta[bolic], explains: “Type 3 diabetes’ is an informal, research-driven term describing Alzheimer’s disease as a result of brain-specific insulin resistance. It does not describe classic diabetes affecting blood glucose.”

The distinction matters. Type 1 diabetes is an autoimmune attack on the pancreas, Type 2 stems from systemic insulin resistance, and 'Type 3' points to a brain that can’t respond to insulin properly, which may contribute to cognitive decline. Neurologist Dr. Bobby Jose from Medcare Royal Specialty Hospital sums it up: “‘Type 3 diabetes’ emphasises the idea that disrupted insulin signalling in the brain may contribute to Alzheimer’s pathology.”

A growing body of evidence

The link between diabetes and Alzheimer’s is no longer just speculation. In fact, as Zakaria explains, meta-analyses show 56 per cent higher risk of Alzheimer's and 73 per cent higher risk of dementia in patients with Diabetes compared to non-diabetics.

But not everyone with diabetes faces the same risk. People with long-standing disease, poor glycaemic control, obesity, vascular issues, or insulin resistance are particularly vulnerable. Zakaria adds, “The more uncontrolled one is, the higher the risk."

A 2012 study in the Journal of Clinical Investigation showed that people with Alzheimer’s disease have brain insulin resistance, especially in the hippocampus, even if they don’t have diabetes. This resistance is linked to IRS-1 dysfunction and reduced IGF-1 signalling, which interfere with how brain cells use energy. Higher levels of these markers were associated with worse memory and cognitive decline, suggesting insulin resistance in the brain may contribute directly to Alzheimer’s progression.

What’s happening inside the brain

The brain runs on glucose. When insulin — the hormone that helps cells use glucose — isn’t working properly, nerve cells struggle. As both the experts explain: Brain insulin resistance refers to impaired insulin signalling specifically within cells in the brain. This mainly impacts how brain cells use energy, how we think and remember, and processes that contribute to nerve cell damage.”

Even when blood sugar is normal, studies show people with Alzheimer’s have reduced insulin sensitivity in the brain. The result: Cells struggle to use glucose efficiently, leading to energy shortages, weaker connections between neurons, and trouble forming new memories. That energy deficit also triggers inflammation and abnormal protein buildup — hallmarks of Alzheimer’s. Dr. Jose echoes this: “Nerve cells struggle to communicate, inflammation increases, and toxic proteins accumulate more easily.”

Why early intervention matters

While diabetes hasn’t been proven to cause Alzheimer’s, the correlation is strong enough that experts recommend proactive measures. Zakaria says:
“Early and effective diabetes management has definite potential in reducing overall cognitive decline.” Moreover, large studies show that poor glycaemic control significantly increases dementia risk.

Yet, there’s a glaring gap: “There are currently no formal guidelines recommending routine Alzheimer’s screening in people with diabetes,” she points out.

Detecting Alzheimer’s early

New blood tests measuring a protein called p-Tau217, such as GluCare. Health plasma p-Tau217 test, are emerging as some of the earliest indicators of Alzheimer’s disease. Moreover, research from the National Institutes of Health shows these tests can be nearly as accurate as spinal fluid tests and brain scans, with diagnostic performance around 92–97 per cent.

What is p-Tau217?

It’s a specific form of the tau protein in the brain. Tau normally helps support and stabilise nerve cells, but in Alzheimer’s, it becomes abnormal and 'phosphorylated,' forming clumps that interfere with communication and contribute to memory loss.

The p-Tau217 blood test measures this protein in the bloodstream — a far easier, less invasive alternative to spinal fluid tests or PET scans. Some research even shows elevated p-Tau217 levels up to 20 years before symptoms appear. Doctors often use this to flag high-risk individuals, then confirm findings with imaging or spinal fluid tests, according to a study titled Plasma Phosphorylated Tau 217 to Identify Preclinical Alzheimer Disease, in JAMA Network.

Another tool is the p-Tau217 to β-amyloid ratio, used in tests like Lumipulse G, approved by the FDA for adults over 55 with memory symptoms.

This test looks at both tau changes and amyloid build-up, the two main Alzheimer’s markers. In fact, it predicts Alzheimer’s with about 92 per cent positive and 97 per cent negative accuracy compared with PET or spinal fluid tests, offering a much less invasive option.

Currently, however, these tests are approved only for people with symptoms, though research hints at future preclinical use.

The risk increases in people with poor glycaemic control, long disease duration, obesity, vascular co-morbidities, and insulin resistance, as well as older adults. The more uncontrolled one is, the higher the risk...

Hala ZakariaSenior Research Coordinator at GluCare.Health

When insulin isn’t working properly in the brain, nerve cells struggle to communicate, inflammation increases, and toxic proteins such as amyloid-beta and tau accumulate more easily processes that contribute to memory loss and cognitive decline....

Bobby Josespecialist in neuro-surgery of Medcare Royal Speciality Hospital

Should people with diabetes check their brain health?

Both experts say yes. Zakaria stresses: “Periodic cognitive assessment as part of clinical care is advisable,” while Dr. Jose adds, “It is generally better to monitor cognitive health regularly, because diabetes, particularly poorly controlled diabetes, significantly increases the risk.”

Can diabetes treatments help?

Research is promising but still early. Dr. Jose notes, “Insulin therapy, GLP-1 agonists, and metformin have been studied. While the evidence is promising, these treatments are not yet approved specifically for Alzheimer’s.”

Zakaria echoes this: managing diabetes through medication and lifestyle changes may lower Alzheimer’s risk, but no trial has yet shown a direct prevention effect.

Diabetes doesn’t cause Alzheimer’s — but it does make the brain more vulnerable. Experts argue that maintaining good metabolic health, keeping blood sugar, blood pressure, and weight under control, remains one of the most important ways to protect long-term brain health.

https://gulfnews.com/lifestyle/could-type-3-diabetes-harm-your-brain-what-your-blood-sugar-levels-mean-for-alzheimers-risk-1.500377397 

The Quiet Epidemic: Why People With Diabetes Lose Their Sight

From mynewstouse.com

For the nearly 40 million Americans living with diabetes, the threat to their vision unfolds quietly, often without warning. Diabetic retinopathy, a complication that damages blood vessels in the retina, has become the leading cause of blindness among working-age adults in the United States. Yet what makes this epidemic particularly tragic is that it doesn’t have to be this way. 

“The vast majority of severe vision loss from diabetic retinopathy is preventable,” said Janice C. Law, MD, retina specialist in Tennessee. “Studies show that regular eye examinations and timely interventions can reduce the risk of severe vision loss by 90 percent.” 

Still, many Americans are falling through the cracks. Only about 60 percent of people with diabetes receive the annual dilated eye examinations recommended by the American Academy of Ophthalmology, a shortfall driven by lack of access, awareness, and time. 

Expanding Access to Care 

If you or someone you care about has diabetes, schedule a dilated eye exam today. Uninsured or underinsured? See if you qualify for a no out-of-pocket cost medical eye exam through EyeCare America®. This public service program matches volunteer ophthalmologists, physicians who specialize in medical and surgical eye care, with eligible patients aged 18 and older who need eye care. Visit www.aao.org/eyecare-america to learn more. 

                                   People with diabetes are particularly at risk for vision problems and should see an eye doctor regularly

When to See a Doctor 

In its early stages, diabetic retinopathy often presents no symptoms at all—a fact that underscores the importance of preventive screening rather than waiting for problems to emerge. 

“Even if your vision seems fine, a yearly dilated eye exam is important,” said Dr. Law. “By the time patients notice flashing lights, blurred vision, floating spots, or other warning signs, the disease may have already progressed significantly.” 

When should a person with diabetes have an eye exam? 

If you have type 1 diabetes, you should have eye examinations at least yearly beginning 5 years after being diagnosed with diabetes. Your ophthalmologist may recommend more frequent examinations. 

If you have type 2 diabetes, you should see an ophthalmologist at least yearly as soon you are diagnosed, regardless of your age. Follow your eye doctor’s recommendation about how often you should be rechecked, as this varies for every individual. You may need to have your eyes checked more often than once a year. 

But diabetes isn’t the only reason to see an ophthalmologist. All healthy adults should have a comprehensive eye exam by age 40 when early signs of cataract, glaucoma, and age-related macular degeneration?may begin to emerge. 

“Forty is typically when subtle signs of eye disease begin to emerge,” Laura C. Fine, MD, chair of EyeCare America, explained. “Many times, people don’t even notice any changes to their vision during these early phases of disease. However, vision-saving treatments are most effective when the disease is caught early.” 

The Treatment Gap 

Ophthalmologists have more tools than ever before for diagnosing and treating eye diseases. But these innovations cannot help patients whose disease goes undiagnosed or who remain unaware of their condition’s severity. 

The message is clear: The technology to save sight exists. What’s needed now is making sure that everyone who needs it can access it in time. 

https://www.mynewstouse.com/stories/untitiled,37792 

You asked, we answered: Can you lower your A1C without medication?

From nebraskamed.com/health

Question:  

I've heard that you shouldn't lower your A1C below 6% using diabetes medications because it can cause other health risks and possibly low blood sugar (known as hypoglycaemia). Is diet the best way to get off diabetic drugs? 

Answer from Nebraska Medicine endocrinologist Gunjan Arora, MD, MBBS: 

Your A1C is a blood test that shows your average blood sugar level over the past three months. It’s one of the most important numbers your doctor uses to check how well your diabetes is being managed.

What is a good A1C goal?

There isn’t one perfect A1C goal for everyone. Your ideal number depends on things like your age, other medical conditions, your risk for low blood sugar and your overall health.

For most adults with diabetes, the American Diabetes Association recommends an A1C below 7%, as long as it can be done safely without causing low blood sugar. Some people might aim for a lower number, and some might aim for a higher one. Your doctor will help you decide what’s right for you.

Is an A1C of 6% safe?

For some people, aiming for an A1C as low as 6% may not be helpful. Studies show that very strict control with medications doesn’t always prevent complications and may even increase the risk of low blood sugar or other side effects.

Whether a 6% goal is right for you is something you and your doctor should decide together based on your full health history.

Can you reach a low A1C through diet alone?

Once you and your doctor decide on a target A1C, there are several ways to reach it:

• Lifestyle changes (like healthy eating and regular physical activity)

• Oral medications

• Injectable medications

• Insulin

If your doctor says it’s safe and appropriate, some people can lower their A1C to around 6% through diet and lifestyle alone. However, lowering your A1C below 6% with diabetes medications is usually not recommended because of the risk of dangerous low blood sugar episodes.

The bottom line

Whether you should aim for an A1C of 6% — and whether you should do so with or without diabetes medication — depends on your personal health needs. It’s a decision best made with your doctor.

https://www.nebraskamed.com/health/questions-and-answers/diabetes/you-asked-we-answered-can-you-lower-your-a1c-without 

Am I at risk of diabetes? How to spot the signs

From saga.co.uk

Around 1.3 million people in the UK have undiagnosed diabetes and 12.1 million are prediabetic. We explain the warning signs and how to tell if you are at risk 

First of all, what is diabetes? Diabetes is a condition where your blood glucose (sugar level) is too high because your body can’t make enough (or any) of the hormone insulin, or the insulin you are producing isn’t working well.

It’s estimated that more than 5.8 million people in the UK have type-1 or type-2 diabetes, including 1.3 million who are undiagnosed for type-2, according to the charity Diabetes UK. Around 1.5 million people living with diabetes in the UK are over the age of 65.

There are also 12.1 million adults living with prediabetes, with blood sugar levels higher than normal, but not high enough to meet the threshold for a type-2 diabetes diagnosis, but who are at risk of developing it.

According to new research from the York Health Economics Consortium, diabetes costs the NHS around £10.7 billion a year – 6% of the UK health budget and is predicted to rise to £18 billion by 2035.

What are the different types of diabetes?

“There are two main types of diabetes, type 1 and type 2,” explains Emma Pike, deputy head of clinical at Diabetes UK. Type 2 makes up 90% of cases, Type 1 about 8% and other rare types 2%.

“Unfortunately, it’s a condition where a lot of stigma persists” says Pike, citing a YouGov poll which found that 86% of people with type 1 and 75% with type 2 say they experience blame and judgement for their condition.

What is type-1 diabetes?

“Type 1 is an auto immune condition where your body’s own immune system attacks the cells that produce insulin in the pancreas, causing blood sugar levels to increase,” says Pike.

Type 1 is most commonly diagnosed in childhood with symptoms appearing within days or weeks, but it can occur at any age, including in your seventies and eighties.

Getty

Diabetes can be diagnosed with a straightforward non-fasting blood test.

Am I at risk of type 1?

Although type-1 diabetes can run in families, many people develop it without any family history.

Some studies suggest that certain viral infections can accelerate or trigger type 1 in people with a genetic predisposition.

How can I spot the symptoms of type-1 diabetes?

“Type-1 diabetes symptoms have a much more sudden onset than type 2,” says Dr Parijat De, a consultant physician specialising in diabetes at the private HCA The Harborne Hospital and the NHS Midland Metropolitan University Hospital.

“These will usually come on in a matter of days and weeks, due to lack of insulin produced by the body and it can have a dramatic effect.”

Dr De says that the symptoms of diabetes fall under the four Ts:

•  Toilet (frequent urination)
• Excessive Thirst
• Tiredness
• Thinness (unintentional weight loss)

“A lot of symptoms can be nonspecific including dry mouth and blurred vision, as well as recurrent infections such as thrush, urinary tract and skin infections, and cuts taking longer to heal, and can have other causes,” says Dr De.

Another symptom is breath that smells fruity (similar to pear drops). This can be one of the signs of diabetic ketoacidosis (DKA), when the body breaks down fat for energy instead of glucose. Other symptoms of DKA can include nausea and vomiting and abdominal pain, as well as increased thirst and needing to pee more, confusion and passing out.

DKA is a medical emergency that needs treatment with insulin, IV fluids and electrolytes in hospital.

How is type-1 diabetes treated?

Because your body is not producing insulin, insulin replacement therapy is necessary with either injections or insulin pumps, small electronic devices that deliver insulin throughout the day.

There are also hybrid closed-loop systems (an artificial pancreas) which link up continuous glucose monitoring (CGM) with insulin pumps, automatically adjusting insulin levels. These are now being rolled out by the NHS in England for specific groups, a world first.

What is type-2 diabetes?

“In type-2 diabetes, blood glucose levels are high due to the body not producing enough insulin, or the insulin does produce not working properly,” says Pike.

Type-2 diabetes is more common in adults but there has been an increase in the number of children being diagnosed with the condition. It can go undiagnosed for years as sometimes there are no symptoms or people don’t notice them.

What are the symptoms of type-2 diabetes?

Dr De says the symptoms of type 2 can be similar to type 1.

“The key thing is that they will have a much slower onset than those of type 1,” explains Dr De. “They can go unnoticed for a long time – you can live with prediabetes for years as prediabetes doesn’t have any symptoms. Part of the problem is that some of the symptoms such as tiredness are very common and may be caused by other medical conditions, or in older people just put down to getting older.”

Dr De adds: “The fact that many people with type-2 diabetes can remain asymptomatic for a long time doesn’t help the situation.”

The most common symptoms of type-2 diabetes include excessive thirst, needing to pee more, extreme tiredness and unintended weight loss (without dieting). People with type 2 are generally (but not always) overweight or obese.

Other symptoms may include dark patches developing in the folds of the skin such as the armpits, itchy skin, candida albicans yeast infections under the breasts and around the groin, recurrent urinary tract infections, as well as fatigue and mood changes and blurred vision.

Am I at risk of developing type-2 diabetes?

Risk factors for developing type-2 diabetes include:

• Being overweight or obese
• Having a large waist measurement (central obesity)
• A family history of type-2 diabetes
• Being physically inactive
• High blood pressure
• Increasing age (being over 25 if you are South Asian, African Caribbean or Black African, and being over 45 if you are white).

Diabetes UK lists other risk factors including smoking; a history of gestational diabetes (a type of diabetes that happens only during pregnancy); a history of heart attack or stroke; some medical conditions such as polycystic ovary syndrome (PCOS), a hormone disorder which affects the ovaries; and some mental illnesses such as bipolar, schizophrenia, or depression.

“One myth is that developing type-2 diabetes is related to eating too much sugar, but this is not the case,” says Dr De.

“It’s all about your overall diet, how active you are, and how you metabolise sugar and whether your body has enough insulin to dispose of that excess sugar adequately, as well as insulin resistance where the insulin your body produces doesn’t work as well.”

How is type-2 diabetes treated?

Lifestyle changes for managing type-2 diabetes include increasing activity to at least 2.5 hours a week of moderate intensity, eating a healthy diet, limiting alcohol to within safe limits, quitting smoking, and managing weight.

Drugs prescribed for type-2 diabetes include metformin which lowers blood sugar by improving the way your body handles insulin, as well as sulfonylureas (e.g. gliclazide) to stimulate insulin production, and DPP-4 inhibitors (known as gliptins), which promote more insulin production.

Earlier this year the National Institute of Health and Care Excellence (NICE) recommended a group of drugs called sodium glucose co-transporter 2 inhibitors (SGLT-2 inhibitors) which not only lower blood sugar by helping the kidneys reduce excess sugar in the body, but also protect against heart failure and heart attacks. NICE advised that these should be prescribed as a first line treatment for all people with diabetes, not just those with heart disease. Research had shown that older people, women and Black people were less likely to be prescribed these.

Other drugs for type-2 diabetes include GLP-1 injectable drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro) to manage blood sugar but which also aid weight loss. Semaglutide also comes in tablet form (Rybelsus).

Can you “cure” type-2 diabetes by losing weight?

“The answer to that is yes, there is evidence from several high-quality trials that losing 10% to 20% of your bodyweight can lower your Hba1c levels and put the disease into remission,” says Dr De.

“This seems to work best in the first six years after diagnosis.”

The DIRECT trial which followed patients who were given a very low calorie meal replacement “soups and shakes” diet for three months, found that 46% were in remission from type-2 diabetes after one year, and 36% after two years. At five years, the original DIRECT intervention group still had an average weight loss of 6kg and 25% of those who were in remission at two years were still in remission at five years. This approach is now available on the NHS Path to Remission Programme.

• Dr Michael Mosley spoke to Saga Magazine in 2023 to explain how to prevent and reverse type-2 diabetes.

How is diabetes diagnosed?

“These days diabetes can be diagnosed with a straightforward non-fasting blood test called HbA1c,” says Dr De.

“HbA1c is a measure of the percentage of haemoglobin in your red blood cells that have glucose attached to it and can give you an average blood sugar figure over the past two to three months.”

Your blood sugar is normal if your HbA1c result is less than 42 mmol/mol, you are in the prediabetes zone if your reading is between 42 to 47, and have diabetes if your reading is 48 or above on two or more occasions over a two-week period.

What are the complications of diabetes?

Every week diabetes leads to more than 930 strokes, 660 heart attacks and almost 2,990 cases of heart failure.

“Diabetes can damage small and large blood vessels throughout the body, raising the risk of heart attacks, strokes and peripheral vascular disease where the arteries in the legs become clogged, which can lead to amputation,” says Dr De.

“It can also damage small blood vessels behind the eyes leading to diabetic retinopathy, (where the retina at the back of the eyes is damaged), those supplying the kidneys (diabetic nephropathy) and nerves, leading to nerve damage (neuropathy).

“This is why early diagnosis and good control of blood glucose levels with lifestyle changes and medication if needed, is so important.”

https://www.saga.co.uk/magazine/health-and-wellbeing/am-i-at-risk-of-diabetes

Type 2 diabetes can be naturally reversed after diagnosis with 4 daily habits

From msn.com/en-us

While there's no cure or method to completely eradicate diabetes, health experts have offered strategies for individuals to reverse their symptoms and manage their health.

Approximately one in 10 Americans has diabetes, with the majority having type 2 diabetes. This is a condition that arises when the body's cells don't respond properly to insulin, leading to elevated blood sugar levels.

Typically, type 2 diabetes develops most often in adults aged 45 and older; however, in recent years, more children, teens, and young adults are developing type 2 diabetes, which is raising alarm among health professionals. According to the CDC, most cases of diabetes can be prevented through proven lifestyle changes, including losing weight, eating a healthy diet, and engaging in regular physical activity.

But, can diabetes be reversed after you've already been diagnosed?

"If you reverse insulin resistance, you reverse type 2 diabetes," Gerald I. Shulman, MD, PhD, told the Yale School of Medicine.

Indeed, a landmark study supports that lifestyle changes can reverse insulin resistance, finding that even a weight reduction of 10% can help.

"The best way to reverse type 2 diabetes is to decrease your body's resistance to the actions of the insulin made by the pancreas," said Patricia Peter, MD, assistant professor of medicine (endocrinology) at YSM. "For most people, this means trying to attain a healthy weight, exercising regularly, and minimizing sugars and excessive carbohydrates in your diet."

Here are four lifestyle modifications that can help you reverse your diabetes symptoms:

Nutritious and well-balanced eating

Diet plays a crucial role in diabetes management, serving as a vital approach for regulating blood sugar levels and decreasing your body's insulin resistance.

The American Diabetes Association recommends that foods rich in protein, beneficial fats, vitamins, minerals, antioxidants, and fibre are "superstar" foods for a healthy diabetes meal plan. 

Non-starchy options like dark leafy greens and avocado should comprise half of your plate. Protein sources such as beans, dried peas, and legumes offer nutrient-dense advantages.

Fish rich in omega-3 fats, nuts, berries, citrus fruits, whole grains, and milk and yogurt are other outstanding nutritional sources.

                                                                                                                                                        © Getty

Work out consistently

Prioritizing regular physical activity can boost insulin sensitivity and fat metabolism, according to a 2018 study.

The CDC also suggests at least 150 minutes of moderate-intensity physical activity each week. Even a basic stroll can help decrease your blood sugar.

                                                                                                                             © Getty

Control your stress

The CDC emphasizes that stress can complicate diabetes management, suggesting conversations with your physician and diabetes educator to find effective stress reduction techniques.

Mindfulness approaches like deep breathing, yoga, and meditation can assist in lowering stress levels, thus helping you manage both your emotions and blood sugar levels.

Prioritise good sleep

Make quality sleep a priority Studies show that inconsistent or poor-quality sleep can disrupt your hormonal balance and significantly affect glucose metabolism.

Securing quality rest can also reduce your stress levels and boost your mood, further bolstering your overall lifestyle goals.

https://www.msn.com/en-us/health/other/type-2-diabetes-can-be-naturally-reversed-after-diagnosis-with-4-daily-habits/ar-AA1RQlR0

From Painful Pricks to Automated Medication: How Diabetes Devices Have Evolved to Help Patients

From news.cuanschutz.edu

Diabetes specialist and leader Cecilia Low Wang, MD, explains how diabetes devices like continuous glucose monitors and automated insulin delivery systems continue to evolve to help improve health outcomes for patients with diabetes

For years, a painful prick of the finger multiple times a day was the go-to method for a patient with type 1 diabetes to monitor their glucose levels — a key component to managing their health. However, in recent decades, technological advancements have led to the development of wearable continuous glucose monitors that offer less pain and more data collection. Physicians and scientists have taken it a step further to innovate devices that aim to not only monitor glucose levels but also use the glucose data to deliver insulin automatically when needed.

Despite these important advances, not all health care providers are familiar with these devices — including what their benefits and limitations are. To raise more awareness, Cecilia Low Wang, MD, a nationally recognized leader in the field of diabetes, explained this technology during a University of Colorado Anschutz Department of Medicine Grand Rounds presentation. As director of the glucose management team at the University of Colorado Hospital, program director for the Diabetes Fellowship Training Program, and a professor of endocrinology, metabolism, and diabetes at CU Anschutz, she has witnessed first-hand the value — and need — for these devices.

“Diabetes technologies have been advancing rapidly,” she said. “At the same time, the prevalence of diabetes has risen dramatically over the past few decades.”

According to the American Diabetes Association, 38.4 million Americans had diabetes as of 2021. That number is predicted to increase in the upcoming years, she explained. It’s a pressing issue given that with diabetes treatment comes the risk of hypoglycaemia — a condition where the body shuts down due to low blood sugar (glucose) levels — and an increased risk of microvascular complications such as eye disease, nerve damage, and kidney disease, and cardiovascular conditions such as heart failure, heart attacks, strokes, and peripheral artery disease.

“When people develop microvascular complications, their quality of life can go downhill and their lifespan and health span are cut short,” Low Wang said. “We want to monitor glucose because it helps us reduce these risks for patients.”

A risk continuum

A person’s risk of hypoglycaemia and microvascular complications depends on the type of diabetes they have and how advanced it is, also known as a risk continuum, Low Wang explained. The people with the highest risk are those with type 1 diabetes and those with more advanced stages of type 2 diabetes. The lowest risk is among people with prediabetes — either pre-type 1 diabetes (also called “stage 2 type 1 diabetes”) or pre-type 2 diabetes — but even those with pre-type 2 diabetes are “already at double the risk for macrovascular complications,” she said. Macrovascular complications include strokes, coronary heart disease, and peripheral artery disease.

Nearly all individuals with type 1 diabetes will require insulin therapy, whereas about 25% of individuals with type 2 diabetes are on insulin therapy.

“Insulin has a very narrow therapeutic window. When we’re trying to get toward normal glucose levels, that increases the risk for hypoglycemia,” she said, explaining that administering more insulin than a person needs in any given moment can result in too much glucose being removed from the bloodstream. “This is why we need to monitor glucose levels.”

Finger pricks to wearable monitors

From 1983 to 1993, the Diabetes Control and Complications Trial — a pivotal national research program — was conducted. It demonstrated that individuals with type 1 diabetes who achieved intensive control of their glucose levels experienced a vast decrease in the risk of eye disease, kidney disease, and nerve damage, underscoring the value of monitoring glucose levels in order to improve health outcomes.

In 1999, the U.S. Food and Drug Administration (FDA) approved the first continuous glucose monitoring system, but the data was not visible to the person using it. A patient would still have to prick their finger several times over the course of three days before then taking the device to a clinic to have a physician tell them the data.

“One of the problems is that finger sticks are incredibly painful,” Low Wang said. “This was the impetus for scientists to try to think of other ways to monitor glucose.”

Over the years, there have been many improvements in continuous glucose monitoring, Low Wang explained. Today, there are wearable devices that people can place on their arm to measure their glucose levels 24 hours a day and deliver real-time information.

“In these wearable devices, the device will measure glucose every minute or every five minutes,” she said. “The glucose data are then sent either to a separate reader or to an application on a smartphone or smartwatch.” 

Overall, these devices have proven valuable in several ways, such as by decreasing the need for finger sticks to measure blood glucose levels, showing the glucose trend, increasing patient satisfaction, helping patients and providers collect more data to understand a patient’s glucose trends over time, and alerting patients when they are in danger of hypoglycemia, Low Wang explained. 

“Continuous glucose monitoring has revolutionized the self-management of type 1 diabetes,” she said. “Patients have less hypoglycaemia, better glucose control, and better patient-reported and clinical outcomes.”

Automating insulin delivery 

Although continuous glucose monitoring systems have been useful in helping alert patients when they need insulin or to treat a low glucose level, adhering to a complex regimen — particularly remembering to take an injected medication every day, at the correct dose, multiple times a day — is incredibly difficult, Low Wang said. It’s common for patients to miss doses of insulin, which is concerning because a single missed insulin dose can have a negative effect on their glucose control.

In the past decade, a key technological advancement has been the development of automated insulin delivery systems that combine continuous glucose monitoring and insulin pumps using a “control algorithm.”

Low Wang noted that a benefit of automated insulin delivery systems (also called “hybrid closed-loop systems”) is that the devices are able to deliver different amounts of insulin according to glucose values, trends, and predicted glucose, allowing for more customized and personalized care.

“Automated insulin delivery has revolutionized the management of type 1 diabetes,” she said. “What our patients tell us is that they can sleep through the night and live their lives without constantly thinking about their diabetes. Parents of children with diabetes are able to breathe a little easier.”

However, there are several limitations to these devices. For instance, there is a time lag in sensor glucose values, delayed action of insulin since it is being delivered subcutaneously instead of through the portal system, and many potential technical issues such as sensor connectivity, missing sensor data, problems with tubing, and so on. Other barriers can include the cost of the device and being able to access it depending on insurance coverage. The overall accuracy of continuous glucose monitoring is also an issue, Low Wang noted.

“Despite the limitations, for the most part, automated insulin delivery systems increase the amount of time that patients are in an optimal glycemic range and decrease the burden of diabetes care,” she said.

Who these devices can help

Low Wang explained that automated insulin delivery systems should be considered as a potential tool for all patients with type 1 diabetes and those with insulin-deficient diabetes. Among patients with type 2 diabetes, automated insulin delivery is now FDA-approved. Low Wang recommends that physicians consider these devices for all type 2 diabetes patients who are on multiple daily injections of insulin — while continuous glucose monitoring should be considered in anyone who requires at least one injection of insulin a day — or those who are using the medications in the sulfonylurea or glinide class.

The FDA has approved over-the-counter continuous glucose monitors, making some devices available to people without the need for a prescription. Although these direct-to-consumer devices may be useful for some patients, Low Wang cautioned that there could be issues with getting accurate readings and interpreting the glucose data, so patients should consult their physician before purchasing one.

“The first minimally-invasive and non-invasive continuous glucose monitoring systems are on the horizon,” she said. “Recently, the FDA approved the first fully autonomous, needle-free glucose sensor. It’s not on the market yet, so stay tuned. We’ll see more exciting advances in the coming months and years.”

https://news.cuanschutz.edu/department-of-medicine/diabetes-devices-insulin-glucose