How technology has changed diabetes management and what it has failed to achieve

Tremendous improvements have modified diabetes management from pure clinical diagnosis and the discovery of insulin to continuous subcutaneous insulin infusion (CSII) coupled with continuous glucose monitoring (CGM) to allow patients to adapt insulin delivery to glycaemia on a virtually "real-time" basis. Insulin was first discovered in 1923 and, in less than a century, it has been purified, humanized and now synthesized by genetically modified microorganisms. Insulin analogue, kinetics and reproducibility now allow near-normal glycaemia to be targeted without increasing hypoglycaemia, thus allowing greater flexibility in the patient's day-to-day life. In addition, advances have been made over the past few decades in the development of the necessary and complementary technologies for insulin infusion, glucose measurement, glucose insulin interaction and telemedicine. The major remaining limitations are the lack of glycaemic regulation on insulin administration and the burden of parenteral delivery. Thus, the dream of both patients and diabetologists is to close the loop and to build an artificial pancreas. (C) 2011 Elsevier Masson SAS. All rights reserved.