Research Pharmacy

Diabetes and the difficulties of medication

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Diabetes is a common condition for which treatments are available but not always optimal. The therapeutic aim, using insulin, tablets, diet and physical activity, is to keep blood glucose within the normal limits. This is because the high glucose levels associated with diabetes may eventually lead to ill health with outcomes such as heart disease, stroke, pain and poor blood supply to lower limbs, kidney disease and blindness, although these problems may take years to emerge. These are the well-known complications of both the common forms of diabetes (types 1 and 2) and can develop even when a person with diabetes does their best to comply with their recommended treatment.

The problem that some people with diabetes face is that it can be very hard to control blood glucose levels perfectly with their medication. This is just as true for those who vary their dose according to their measured glucose readings (for example those people on DAFNE or DESMOND programmes) as it is for people on a treatment programme where they take a prescribed constant dose daily. The fact is that the chances are high for finding glucose levels in the blood that are greater than they should be. This is partly because the levels change constantly depending on the timing and content of meals but also on how much energy is expended, among other factors, all of which are liable to differ day to day. In people without diabetes, the pancreas releases insulin on a continually accommodating basis and this adjusts blood glucose levels to near-normal all the time.

For people with diabetes their glucose-controlling medication is usually taken twice to three times daily and such a regimen cannot be expected to achieve the fine adjustments necessary for perfect glucose control. Understandably, most people with diabetes tend to err on the side of under-dose. This gives no immediate symptoms, whereas medication overdose (in an effort to stop glucose peaks) can produce what is known as a “hypo”. A hypo is unpleasant and potentially unsafe, making the person perspire and possibly feel faint. While avoiding this acute symptom is obviously wise, the slow onset of the long-term complications of raised blood glucose levels masks the risks of chronically under-treated diabetes. The consequence is that many people with diabetes eventually develop health problems.

The artificial pancreas

For these reasons, it would be useful if the guesswork could be taken out of the medication problem by having a system that would make the automatic adjustments needed. This would have the role of an “artificial pancreas”, otherwise known as a “closed loop” insulin delivery system. Many attempts have been made to achieve this, including pancreas transplants and electronic sensor-linked insulin pumps but there are no routine methods. At present, for insulin users, non-automatic insulin pumps are available, although not common in the UK. While not ideal, for many people, they might represent an improvement on injection and in concept, they could be thought of as a good stepping-stone to an automated system.

Researchers at De Montfort University’s Leicester School of Pharmacy have for some time been researching a novel automated system and have recently received funding to develop it further. The stated aim of the project is to develop a cost-effective, safe, implantable and refillable device that will hold several weeks’ insulin supply at a time and make automatic adjustments for the insulin dose needed to control blood glucose levels. The device will not be ready for patient use for some years to come but this stage is focused on getting the design right and the performance proved to make sure that the device is a feasible and attractive alternative to conventional treatment.

The survey

Part of this process is to understand the views of potential users. The De Montfort University team is therefore seeking the opinions of people with diabetes to help in the design of this new implantable insulin pump. The researchers have developed a survey to collect the ideas of people with Type 1 and Type 2 diabetes who manage their diabetes using conventional insulin treatment. A second survey will collect opinions from those who presently use insulin pumps to inject their insulin continuously. The research, led by Prof Joan Taylor, is aimed at understanding potential attitudes of people with diabetes towards their condition and their current medication (including any difficulties they have). However, more than this, it is also hoped to gauge opinions on the proposed implantable, automated pump and, since it would require surgery to install it, what factors might influence people with diabetes to consider using one if it should become available.

The participation in these surveys will remain anonymous and will be used alongside information in a related part of this project, gained from meetings with other people with diabetes, diabetologists, specialist GPs, nurses and surgeons, medical researchers and insulin formulators.

The surveys (from people with diabetes and insulin pump users) will likely take between 30 and 60 minutes to complete due to their detailed nature. You will not be asked for any identifiable personal information and so we will not know the sources of completed surveys. Similarly, completing it will not lead you into any further contact with us. The information the survey provides will be extremely useful and we are grateful to you for considering completing it. In due course, you will be able to view outcomes of the survey on this website. The study, including the further part directed towards the design and testing of the device itself, is funded by the National Institute for Health Research, which is NHS-linked.

Online

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Pump users survey

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PDF

Click here for the De Montfort University Insulin Pump Users Survey