First Day of Class: Diabetes Technology

Yesterday was the first day of class for my course: The Race for the Artificial Pancreas. The course is offered to exceptional undergraduate students at the University of Alabama at Birmingham. The course was offered for the first time last year. As the rapid development of diabetes technology continues to turn the field on its head, the students in this class will compare and evaluate the different iterations of closed-loop insulin pumps that are controlled by algorithms linked to data from continuous glucose monitors. The so-called artificial pancreas is ultimately designed to make minute-by-minute adjustments in the rate of insulin delivery to achieve nearly normal blood glucose levels and minimize time spent in either hyperglycemia or hypoglycemia.

The class will feature a month of "Diabetes 101" information, including discussions of carbohydrate chemistry, cell membrane structure and function, ion gradients, glucose transporters, insulin secretion, the chemistry of insulin and insulin analogs, artificial sweeteners, hemoglobin A1c formation, obesity, comparison of Types 1 and 2 diabetes mellitus, ethnicity associated with T1D and T2D incidence, the process of eating and absorbing food, gut microbiota and their role in glycemic balance and appetite, fecal transplants, post-prandial glucose excursions, glycemic index, oxidative metabolism of glucose, alcohol, fasting, starvation, ketone bodies, bariatric surgery, incretins, pancreatic alpha and beta cell function, hormonal influences on glycemic excursions, treatment of hypoglycemia and hyperglycemia, drug therapy for T2D, low-dose glucagon therapy, nasal glucagon, stem cell and beta cell therapy for T1D, the role of concentrated insulin formulations, inhaled and oral insulins, the use of a dual insulin-glucagon pump system, and a discussion of current standards of care for T1D.

The course will then focus on the development of insulin pumps and glucose monitors in the past five years, data sharing with cell phones, and algorithms for optimal glucose control, with a discussion focused on efficacy, convenience, compliance and cost of devices currently in use, as well as a look at the people involved in pushing the field forward.

Finally the course will culminate with a debate over the devices and companies most likely to dominate the field in 2020.

Once again, the course promises to be dynamic and the continuous stream of new technology releases, corporate acquisitions and improved cell phone capability will make it necessary to update our discussions continuously. By December of 2018, at the end of the course, the field will have moved forward and we hope to capture that progress.