Eda Cengiz

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  Diabetes Treatment: One Size does not Fit All
  Eda Cengiz

  Diabetes has become the epidemic of the 21st century affecting more than 300 million people globally. Treatment regimens and medication dosing for diabetes have relied on weight based formulas or non-customized dosing regimens for decades, and not surprisingly, treatment outcomes have been far from satisfactory. The individualization of diabetes pharmacotherapy to address the variability in response to medications and side effects has been introduced to improve diabetes treatment, however has been unattainable until the advances in technology made it a possibility.

  
  

  The development of the closed-loop (CL) systems has become one of the most striking examples of customized insulin treatment for people with type 1 diabetes. The CL, commonly referred to as the Artificial Pancreas systems, consist of a continuous glucose monitor (CGM), insulin delivery algorithm and an insulin pump that work in tandem to automate insulin treatment based on real-time CGM values. The CL systems’ key innovative factor has been the continuous adjustment of insulin delivery based on individual patient’s blood glucose response as opposed to standard of care treatment by quarterly insulin dose adjustments during clinic visits. The findings from diabetes technology trials have demonstrated the benefit of better fitting treatments that are achieved using increased computational power, technological insulin delivery tools and the advent of mobile and wireless capability. While these systems are not completely customized for each patient, they provided the platform to advance personalized diabetes management and generated more questions to overcome barriers in implementing individualized diabetes treatment.

  
  

  The first-generation diabetes technology systems will evolve as we gain more experience in designing customized diabetes treatment regimens with skillful application of individualized insulin action profiles, continue to incorporate new technology into current systems and collaboratively work to improve diabetes management for an ultimate goal of keeping people with diabetes complication and burden-free until a diabetes cure becomes a reality.