'Bionic' diabetics could just need to change batteries

A NEW drug made from lizard saliva was revealed last week, as Glasgow played host to the Diabetes UK conference.

Diabetes, perhaps the fastest-growing disease in the Western world, is linked to rising obesity and longevity: one in three Americans born after 2000 may develop diabetes in their lifetime. Against an overall declining mortality, diabetes deaths continue to rise rapidly. Many people aren't aware they have diabetes but new government strategies should help diagnose the "missing millions". In some US states, free-of-charge screening, public surveillance campaigns and compulsory database registration has made diabetes a reportable disease.

Diabetes is characterised by high glucose (sugar) in the blood. It can be divided into type one, occurring mainly in young people resulting from deficiency in the hormone insulin, and type two, occurring later in life, often associated with obesity. Diabetes dramatically increases the risk of heart attacks and strokes. Preventing and treating this growing epidemic is costing the NHS millions of pounds.

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In 1922, insulin extracted from animal pancreas tissue was administered for the first time in the UK to a diabetic patient. This historic event in the old Royal Infirmary of Edinburgh marked a huge turning point. To this day, insulin, a hormone that lowers blood glucose, is the main treatment for all type one and some type two diabetic patients.

During the 1990s, there was great anticipation of a potential "cure" for diabetes, through transplantation of insulin-secreting cells from deceased donors to patients. Today, very few patients have benefited mainly because of scarcity of donor organs. An alternative tissue source may come from pigs. Initial concerns about pig virus transmission halted this research but, with safety concerns resolved, this field looks promising once more.

In the meantime, type one diabetes is treated using insulin injections, administered by pocket-sized pen-like devices. Very recently, inhaled insulin arrived on the market, taken using an asthma-type puffer device. For patients with needle phobia, this could be a revolution. Concerns about effectiveness and declining lung function may prevent its widespread use though.

Robotics, technology and gadgetry lend themselves well to the diabetes field. Pocket-held devices allowing patients to monitor blood glucose levels are widely used but require blood letting by finger prick several times a day. New continuous glucose monitors, some worn like wrist watches, are in development. They perform automatic glucose checks at intervals, removing the need for pricking and bleeding. Electronic "pumps" to deliver insulin are emerging. These small devices, worn on a belt, deliver insulin continuously throughout the day. In the future, small computerised personal treatment systems may relay information wirelessly from glucose sensing watches to insulin pumps. This will allow automatic "around the clock" insulin adjustment, effortlessly achieving near perfect blood glucose levels. The new "bionic" patient will just have to remember to change the batteries!

In type two diabetes, dietary change, weight loss and tablet medication may be advised, with some individuals ultimately requiring insulin. A new treatment for these patients, awaiting NHS approval, has exotic roots: a drug based on a compound called GLP-1 found in the venom of the hela-monster lizard from Arizona. This compound mimics a chemical found naturally in the human gut. Exactly how it works is debated but it seems to stimulate natural insulin production, reduce appetite and sugar absorption and also helps weight loss. Unfortunately, it has to be given by injection and is currently very expensive.

• Dr Debbie Wake is a specialist registrar and researcher at the Western General Hospital, Edinburgh, and presents health podcasts at www.drpod.co.uk