A future of glucose-responsive insulin secretion: bionics versus nature

people with diabetes constantly walk a tight rope between strict glucose control to prevent complications and hypoglycaemia. Too often, slight miscalculations result in hypoglycaemia, which can be at best embarrassing and irritating, and may cause injury or even death. new drugs for diabetes and new ways of measuring blood glucose bring hope of easing the burdens of diabetes but the dream for many (and for the researchers trying to help them) is a treatment that restores glucose-responsive insulin secretion so that normal blood glucose concentrations can be achieved with no risk of hypoglycaemia – and perhaps even with no need to think about diabetes all the time. There are two obvious routes towards this holy grail: one, for the pure scientist, is the development of the perfect insulin delivery device, driven by the perfect biochemical glucose sensor – the artificial pancreas or ‘bionic solution’; the other accepts that nature got it right the first time and that all we need to do is restore the beta-cells in the islet structures that diabetes destroyed. a group of authors from the UK take a look at the new technologies in diabetes that are bringing us, step by step, closer to one or both of these goals.