Transcript of Interview with Luigi Meneghini, M.D., M.B.A.
Narrator:
The Diabetes Research Institute presents a series of reports on the latest progress in cure-focused research – promising discoveries aimed at restoring natural insulin production in those living with diabetes.
Reporter:
For many years, the search for the “holy grail” in diabetes treatment has focused on a so-called “closed loop” system.
With a closed loop, a device would continuously measure a person’s blood sugar level and, based on those readings, would release the correct amount of insulin back into the bloodstream.
In effect, acting a lot like the pancreas. And, while scientists have not yet discovered that holy grail, they’re getting closer.
Dr. Luigi Meneghini, Director of the Kosow Diabetes Treatment Center at the Diabetes Research Institute in Miami, says recent advances in technology are making possible the first part of that closed loop system -- continuous glucose monitoring.
Meneghini:
“In terms of clinical application, it’s the most exciting thing that we’ve seen.”
Reporter:
The glucose monitor works by inserting a small catheter under the skin. That catheter is connected to a sensor that continually measures glucose in the skin tissues. A meter displays the levels continuously.
Meneghini:
“It’s wonderful, because instead of having four or five blood glucose values over a period of a day, or 24 hours, to guide your therapy, you now have continuous glucose patterns that you can use to see if your blood sugars are going up, coming down, how fast they’re going up, how fast they’re going down, whether you’re likely to need some correction, either with carbohydrates because you’re hypoglycemic or with insulin because you’re hyperglycemic.”
Reporter:
You can set alarms on these sensors to alert you if your blood sugar is going very low or very high. What’s more – if the person with diabetes uses an insulin pump, the sensors can send that data to the pump.
Meneghini:
“So that when you do a blood glucose with the meter that value is transmitted directly to the pump, and based on some settings that you and your physician have programmed in the pump, it will actually calculate the bolus that you need to deliver.”
Reporter:
Bolus is a fast-acting type of insulin.
But, Meneghini says, the patient still must make the treatment decision of how much insulin the pump should release.
The glucose sensor does not trigger the pump. So, the closed loop is not here, yet.
Meneghini:
“I think the next step will be to build algorithms that you can use in a pump that will use the information that comes from a continuous glucose sensor and make a treatment decision.
“The big challenge will be how do we deal with meals, because outside of meals I think a closed loop, with a subcutaneous glucose sensor, and subcutaneous insulin delivery through a pump can very well take care of blood sugars outside of meals, fasting blood sugars, hyperglycemic correction, but it doesn’t really respond to meal-related needs. And I’m not sure how we’re going to get around that other than say, listen, if you’re going to eat a meal and you know what meal you’re going to eat, just take what you think you need for the meal and let technology do the rest.”
Reporter:
Right now, Meneghini cautions that the continuous glucose monitor is not foolproof.
He warns, if you’re blood sugar is rising or falling quickly, the sensor might not catch that immediately.
So, he says, the DRI is still advising patients to test their blood glucose levels with more traditional monitors and make treatment decisions based on those readings, but…
Meneghini:
“I think in a few years the technology’s going to be such that you can rely on these continuous glucose sensors to guide therapy, which means less bloodletting and hopefully, not only a lot more data that patients can use in an appropriate manner, but a lot less intrusion in a patient’s lifestyle, because they don’t have to stop to pinch their finger, get blood out and all the implications that go along with testing blood glucose.”
Reporter:
Meneghini says the new technology is encouraging.
Meneghini:
“I think we are much closer to that closed loop and I think it’s much better than what we had 10 to 15 years ago.”
Reporter:
But even with all the progress, he says, technology does not solve all of the problems of managing diabetes.
Meneghini:
“However good it is…if you had diabetes you’d wish for something that was entirely better.”
Narrator:
This has been a production of the Diabetes Research Institute Foundation. For more information, or to show your support for the Diabetes Research Institute, call 1-800-321-3437.
You also may donate online at diabetesresearch.org.