Advanced clinical practice of diabetes

Although, new drugs and new devices for the treatment of diabetes are available, patients with diabetes and patients with severe diabetic complications are increasing. It is important to develop the technique to assess the pathophysiology of diabetes to select the appropriate medication and assess the risk of vascular complication, and early diagnosis, and utilize updated medicine. We introduce here the representative updated medicine in our clinical practice.

 

1.The assessment of pathophysiology of diabetes using artificial pancreas

The cause of type 2 diabetes is decreased insulin secretion and/ or insulin sensitivity. We utilize artificial pancreas system, STG55 (Nikkiso, Tokyo, Japan) (Fig. 1), to assess insulin secretion and insulin sensitivity, which enables us to assess more precisely than usual oral glucose tolerance test. Kuroda et al. evaluated the clinical accuracy of the continuous glucose monitoring using STG55 system and reported in J Diabetes Sci Technol. 11:1096-1100, 2017.

 


Artificial pancreas system, STG55 (Nikkiso, Tokyo, Japan)

 

2.Optimization of insulin pump therapy

Insulin therapy is consisted of long acting insulin for basal insulin replacement and rapid acting insulin for bolus insulin replacement. However, long acting insulin cannot meet basal insulin requirement, because basal insulin requirement changes with time, especially the requirement changes drastically during dawn time and during exercise. Insulin pump therapy can meet these needs. Rapid acting insulin is used in insulin pump and basal insulin rate is programmed to maintain blood glucose. We have experienced more than 100 patients who are using insulin pump and reported that basal insulin requirement is approximately 28% of total daily dose of insulin (TDD) (Kuroda et al. Diabetes Care 34:1089-90, 2011). Moreover, we reported that each mealtime insulin requirement is calculated from TDD (Kuroda et al. Diabetes Technol Ther 14:1077-80, 2012). We introduce sensor-augmented insulin pump therapy and flash glucose monitoring systems aggressively to the patients with type 1 diabetes.

 

3.The detection of cell free DNA derived from pancreatic beta cells

Kuroda et al. reported that CpG islands in the insulin gene is uniquely unmethylated in the pancreatic beta cell and CpG islants in the other cell types are all methylated (PLoS One. 4: e6953, 2009). Type 1 diabetes is the result of beta cell destruction by the autoimmune system. We established a new technique to detect pancreatic beta cell DNA in the circulation using this characteristic. We hope to predict type 1 diabetes using this technique and beta cell injury after pancreas and pancreatic islet transplantation.

 

 

Thus, we will break through the plateau of clinical practice of diabetes.