Type 1 diabetes glycemic management: Insulin therapy, glucose monitoring, and automation.

Bruce A Perkins, Jennifer L Sherr, Chantal Mathieu

Journal: Science (New York, N.Y.) 2021;373(6554):522-527

PMID: 34326234

Abstract

Despite innovations in insulin therapy since its discovery, most patients living with type 1 diabetes do not achieve sufficient glycemic control to prevent complications, and they experience hypoglycemia, weight gain, and major self-care burden. Promising pharmacological advances in insulin therapy include the refinement of extremely rapid insulin analogs, alternate insulin-delivery routes, liver-selective insulins, add-on drugs that enhance insulin effect, and glucose-responsive insulin molecules. The greatest future impact will come from combining these pharmacological solutions with existing automated insulin delivery methods that integrate insulin pumps and glucose sensors. These systems will use algorithms enhanced by machine learning, supplemented by technologies that include activity monitors and sensors for other key metabolites such as ketones. The future challenges facing clinicians and researchers will be those of access and broad clinical implementation.

Address: Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada. [email protected].; Department of Pediatrics (Endocrinology), Yale School of Medicine, Yale University, New Haven, CT, USA.; Department of Endocrinology, UZ Gasthuisberg, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium.

DOI: 10.1126/science.abg4502

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MeSH Terms: Absorption, Physiological, Algorithms, Automation, Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Glycemic Control, Humans, Hypoglycemic Agents, Insulin Infusion Systems, Insulins, Meals