COULD TYPE 1 DIABETES BE CAUSED BY A VIRUS?
Research has suggested that there could in fact be a connection between enterovirus and the development of type 1 diabetes. In studies involving over 4400 patients with diabetes (most of whom were children and recently diagnosed) a significant amount of the participants had detectable enterovirus leading researchers to form an association between this virus and diabetes related islet cell auto-immunity and therefore type 1 diabetes.
The development of type 1 diabetes involves complex interactions between viruses, pancreatic islet cells and the immune system but the identifying of specific viral triggers could eventually lead to new treatment strategies being adopted for this condition. Yeung W-CG et al. Enterovirus infection and type 1 diabetes mellitus: Systematic review and meta-analysis of observational molecular studies. BMJ 2011 Feb 3; 342:d35. (http://dx.doi.org/10.1136/bmj.d35)
The Artificial Pancreas and Glucose Control
Automated closed- loop insulin delivery systems ( or 'artificial pancreas') control blood glucose by linking continuous subcutaneous glucose monitoring with subcutaneous insulin pump delivery.
Investigators wanted to compare the safety and effectiveness of overnight closed-loop insulin delivery with standard insulin pump delivery and, with this in mind, selected a test group of 24 adults with type 1 diabetes.
The group was tested under two different conditions:
Overnight closed - loop insulin delivery was compared with conventional insulin pump delivery following the consumption of evening meals containing 60g carbohydrates.
Overnight closed - loop insulin delivery was compared to conventional insulin pump delivery following consumption of larger meals containing 100g carbohydrates as well as wine.
When it came to closed-loop insulin delivery there was a significant rise in the time where plasma glucose levels were in the target range (70-144mg/dL). This was 15% after moderate carbohydrate meals (60g) and 28% after larger meals when compared with the traditional pump delivery.
Pulling data from both studies the closed -loop delivery method was found to keep glucose levels in the target range for longer and significantly lower the variability of plasma glucose and hypoglycemic time. Leading to the hope that the 'artificial pancreas' may provide hope for those with type 1 diabetes when it comes to obtaining better glucose control.
This technology is still in its infancy and will undoubtedly improve and be made available for clinical use - though no doubt at a substantial cost. Hovorka R et al. Overnight closed loop insulin delivery (artificial pancreas) in adults with type 1 diabetes: Crossover randomised controlled studies. BMJ 2011 Apr 14; 342:d1855. (http://dx.doi.org/10.1136/bmj.d1855)
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