Nanotechnology: Revolution In Diabetes Care

Diabetes mellitus has reached epidemic scale these days - it is expected to affect 366 million people by 2030. The impact of this medical condition extends beyond its effects on the body, such as blindness, as its increasing prevalence strongly influences health expenditure and represents a huge economic burden, as translated into loss of productivity and foregone economic growth.

Nowadays, patients have at their disposal a myriad of therapeutics and disease management devices, allowing diabetic people to live a relatively long and healthy life. With this we are starting to see the long term consequences of disease that did not exist in the past because most diabetics did not live beyond their 60^th year. At the same time, our knowledge of disease mechanisms and pathophysiology is gradually increasing. As a result of these developments, newer, revolutionary approaches to disease treatment and management have emerged in recent years.

Investigations in the field of nanomedicine (which involves the manufacture, measurement and clinical application of very small (nano)-scale structures), in particular, have yielded very promising results. There are two kinds of great treatment opportunities offered by nanomedicine. One is the miniaturization of existing drug systemsaimed at improving of the biocompatibility and bioavailability of the drug products. The other is more ground-breaking.

This was simply impossible in the recent past.

Nanotechnology may provide better insulin-delivering systems

The first kind includes the nanotechnologies developed for the administration of insulin. Insulin becomes standard therapy for thousands of diabetic patients which do not respond to pills any longer. The invasive multiple injections of precisely calculated amounts of insulin present a significant deterioration of the life quality of diabetic patients. With the aim of addressing this problem, nanomedicine-based alternative routes of administration have been developed. More precisely, nanoparticles, regardless of being produced from natural or synthetic materials, have been shown to effectively pass the inherent barriers for insulin stability, biodegradation, and absorption across gastrointestinal tract and other mucosal membranes, and which, presently, cause the need to administer insulin through injection.

Studies with these new methods of insulin delivery have been conducted with animals and human beings, with a focus on oral and inhaling technologies. However, there are still many obstacles to be surpassed and a lot more research to be done before any of these technologies are available for everyday use by any patient.

Non-insulin-based treatments for pancreatogenic disease

One very specific example of improved delivery of a product for the treatment of diabetes that is not insulin is the one of the pancreatic polypeptide. Pancreatogenic diabetes is a potentially fatal disease that develops subsequently to other pancreatic diseases.

Administration of the pancreatic polypeptide has been shown to be a promising therapeutic option, as this substance improves insulin sensitivity and decreases insulin requirements in pancreatogenic diabetes patients.

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However, the peptide suffers from the problem of short biological half-life that necessitates continuous administration of the peptide for obtaining therapeutic. Moreover, pancreatic polypeptide has the propensity to aggregate in aqueous media that further complicates effective delivery of this drug. To circumvent this obstacle, a group of researchers of the University of Illinois at Chicago attempted to address the delivery problems of pancreatic polypeptide by associating the peptide with sterically stabilized micelles. Sterically stabilized micelles are polyethylene glycolated  (PEGylated) phospholipid micelles that have been shown to increase the half-life  of several peptides in vivo, prevent their aggregation in aqueous media and  deliver them specifically to desired sites of action in their most active  conformation for interaction with cellular targets. A test in diabetic animals revealed that, because of the sterically stabilized micelles, pancreatic polypeptide was delivered to its site of action, effectively improving glucose tolerance and insulin sensitivity.

New Nanotechnological Approaches Might Target Genes and Cells Malfunctioning In Diabetes

The second kind of treatment options which might be made possible by the advances in nanomedicine is the targeted delivery of RNA (siRNA or microRNA) to inhibit a disease pathway in the body. Good evidences for this come from clinical trials with so-called nanoparticulated RNA delivery systems for other diseases. These specific types of RNA can directly influence the work of certain genes in the body. Some preliminary testing that has been carried out in the diabetes treatment was done mainly for the delivery of viral microRNA, but no tangible products are available yet. This is still a very experimental approach, although an extremely promising one.

Nanotechnology might help in simplifying the management of diabetes

With regards to the management of diabetes, the influence of nanotechnology is equally starting to get noticed in the medical community.

This is a very important problem, as it may lead to disease complications and often to subsequent hospitalizations, poor clinical outcomes and increased healthcare costs. Again, the knowledge, techniques and processes of the nanosciences can be used to overcome this issue.

For instances, it is generally accepted that conventional finger prick capillary blood glucose self-monitoring is associated with major problems. Not only it can be painful, but it has many limitations (e.g., it cannot be done if the person is driving or asleep, etc.). One idea that is likely to meet the need for improved non-invasive glucose monitoring is a “smart tattoo”, which is composed  of glucose responsive, fluorescence-based  nanosensors implanted under the skin but  manipulated from outside. Research is still being conducted to rectify the biocompatibility  and behavior of this non-invasive device. Other possibilities have been investigated too, but the “smart tattoo” concept has gathered the most attention in the recent years.

Artificial nanopancreas is being developed

Another curious and widely studied concept is that of the artificial nanopancreas. First described in 1974, the idea was based on a simple principle: a sensor electrode would repeatedly measure blood glucose levels and any deviation would be fed back into a small computer that energizes an infusion pump, which would release the required amount of insulin into the bloodstream. Nanotechnology researchers are relentlessly working towards producing a device of this nature. 

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In conclusion, while many of technologies described above will require rigorous testing before being marketed, it is not hard to foresee the revolutionary approach that is likely to be adopted in the management of diabetes – perhaps only comparable to the one that took place after the discovery of insulin by Banting and Best.