“This cake tastes like diabetes.” Often, in statements such as the former, society associates obesity and sugary foods with diabetes, but a correlation does not always exist between the two. Essentially, diabetes is a disease in where an individual is unable to produce one’s own insulin or their cells are unable to use insulin effectively, thus leading to a chronic high blood glucose level, also known as hyperglycemia. Insulin is a hormone secreted by the islet cells in the pancreas, acting as a signal for the cells to take in and use glucose as a source of energy. Persistent and severe hyperglycemia may lead to serious health consequences, such as kidney disease, cardiovascular disease, retina damage, brain damage, and in severe consequences, death. For this reason, diabetes lies within the top ten of the contributing causes to death in America. The current standard for a diabetes diagnosis is a plasma glucose level of at least 7 mmol/L after an intake of 75 grams of sugar, followed by an 8 hour period of fasting.6 To diagnose an individual for prediabetes, or someone who is at risk of developing diabetes in the near future, the fasting plasma glucose level must be at an interval of 6.1-6.9 mmol/L.
Diabetes mainly occurs in two phenotypes, called type 1 diabetes and type 2 diabetes respectively. Albeit less common, type 1 diabetes is mostly caused by environmental factors, such as genetic predisposition. The chance of being diagnosed with type 2 diabetes, however, is heavily impacted by one’s lifestyle choices, such as diet, exercise, etc. Nevertheless, not all who are diagnosed with type 2 diabetes are obese, but obesity has a strong association with diabetes. Type 2 diabetes accounts for about 90% of the diabetes diagnoses, usually diagnosed in middle aged adults, although this type of diabetes may be preventable with a healthy lifestyle.5 Both forms of diabetes are predominant in some ethnicities over others, which suggests a genetic role within the disease itself.
In that sense, type 1 diabetes is also known to be a genetic disorder, thus irreversible. Type 1 diabetes is the result of the body’s defense mechanism, in which the body mistakes the insulin-secreting beta cells of the pancreas to be foreign. The body then triggers an autoimmune response, destroying the pancreatic cells, rendering the pancreas unable to release insulin effectively. For adolescents and adults, the result is detrimental, as the beta cells are usually unable to regenerate themselves.2 Therefore, patients must take insulin treatments to make up for the lack of insulin. Patients who have had type 1 diabetes for a prolonged period of time usually suffer from little to no effective islet cells. Type 2 diabetes differs from Type 1 in that Type 2 diabetes is due to insulin resistance, in which the glucose transporter proteins, such as GLUT4, within the tissues in the body become less sensitive to insulin, unable to make a proper response even with high levels of insulin in the blood stream. The beta cells within the pancreas continue to release insulin to stimulate a response, however, the cell receptors get desensitized to the hormone signal.1 As a result, cells take in less glucose, which leads to hyperglycemia and hemoglobin being saturated with glucose. This also causes a feedback loop in where the hyperglycemia may lead to glucotoxicity and lipotoxicity, eventually causing a decrease in insulin secretion by the beta cells, which may then cause even less receptors to process the insulin signal.1 Type 2 diabetes is also known to cause an increase in glucagon, a hormone that counteracts insulin by increasing the blood glucose levels, which could cause even more strain on the already high plasma glucose levels.
Around 9.4% of the U.S. population had diabetes in 2015, including those who were not diagnosed. A total of 7.2% of the U.S. population were diagnosed with diabetes by the year 2015. These statistics suggest that there is about a 2.2% deficit in those who were not diagnosed with diabetes, which may be due to the inaccessibility of proper healthcare and resources. These numbers are continuously on the rise, with an estimated additional 1.5 million people diagnosed with diabetes every year in America alone.4 In addition, while usually only type 1 diabetes was observed in adolescents, in developed countries where obesity is an issue, now type 2 diabetes is almost as prevalent.10 In addition, researchers estimate about 33.9% of adults in the Unites States to be prediabetic, which suggests that about a third of the adults in the U.S.A. to be at risk of getting the disease.
As of now, in the market there are currently treatments in the form of insulin pens and pumps. The pen’s advantages include cost-effectiveness and convenience; however, the treatment must be hand-administered often, and tissues in the areas where the injections are repeated often may develop resistance to the insulin. For those who have type 2 diabetes who require insulin treatments, the pen may cause more harm than good.9 The pen may also cause a rapid insulin spike and a drop in blood glucose that could potentially be dangerous. In regards to the pump, the pump constantly pumps insulin into the body, therefore keeping blood glucose levels somewhat consistent and accurate. Yet, the pump is more expensive and bulky for patients to carry. For those with type 2 diabetes, usually an oral medication is prescribed to counteract hyperglycemia, such as metformin, to increase the tissues’ sensitivity to insulin and inhibits glucagon.3
Although people with diabetes seem to live out normal lives, diabetes is a major economic burden to both the individual and the nation. People diagnosed with diabetes are required to spend around $9,600 per year for treatment related to diabetes, which increases the cost of their medical bill by about 230%.8 The price of the treatments have only been increasing over the past decade and is predicted to continue to elevate. The diabetes market consists of treatments of glucagon-like peptide-1 agonist, dipeptidyl-peptidase-4 inhibitors, sodium glucose co-transporter 2 inhibitors, and insulin, with insulin bringing the greatest revenue. In terms of the nationwide economy, a quarter of the finances from the healthcare of the United States, about 327 billion dollars, goes to treatment for diabetes. Globally, for adults the estimated health expenditure for diabetes near about 850 billion dollars and is expected to reach 958 billion dollars by 2045, disregarding the increase in the cost of treatment.5 The sheer number of people who are affected by diabetes also affects the economy in decreasing productivity because of the absences people working with the disease must take, which emphasizes the impact diabetes has beyond the people who are directly affected, such as the economy and workplace. Statistically, the cost of lost productivity due to absences amount to about 3.3 billion dollars, and the reduction in productivity due to the early passing of workers due to diabetes is even more costly.
Currently, although still in the stage of testing, researchers are developing a “microneedle patch” that would deliver insulin to the body painlessly and efficiently. Unlike other current solutions mentioned afore, such as the pump or the injection, this treatment would be more efficient in that the patch was designed to simultaneously test for blood glucose levels while administering the insulin treatment with nanoparticles that detect the level of blood glucose. The patch consists of tiny microneedles which act as vesicles that hold the insulin; the microneedles consist of a molecule created from combining the hydrophobic 2-nitroimidazole and hydrophilic hyaluronic acid, resulting in a molecule with both hydrophilic and hydrophobic ends. High blood glucose content would deprive the area around the patch of oxygen, thus triggering a reaction in which the molecules of the microneedles become completely hydrophilic and dissolve into the bloodstr
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sadvantage to using the pump and the pen is that there is no guarantee in how much insulin the patient needs at that given time. Usually, patients would use the method of pricking their fingers to test the blood glucose levels, then proceeding to use the insulin pen for the appropriate dosage, but this method is highly susceptible to human error. Although the pump was designed to minimize human error, the pump can cause buildup of scar tissue, which can potentially block the delivery of insulin to the body. However, this patch would be highly accurate and efficient in releasing the amount of insulin needed depending on the blood glucose detected. The microneedle patch would also be more durable and time efficient, allowing the patient to not have to administer the treatment as frequently as before. Although the focus of this treatment is on type 1 diabetes, this treatment may also be administered to those with type 2 diabetes who need insulin treatments as well.
Diabetes is a worldwide issue, not just concerning countries that thrive on fast food chains. In Africa, over 70% of the deaths before the age of 60 could be attributed to diabetes.5 In third world countries, many people don’t have access to diagnostic tests, nor do they have the resources to receive treatment for diabetes. As a result, an estimated 50% of those who have diabetes are undiagnosed, therefore putting lives in peril. With a durable and economical solution such as the microneedle patch, the estimated number of deaths due to diabetes is undoubtedly bound to decrease. Bioengineers and researchers must continue to search for cost-effective, safe, and reliable treatments, not only for the nation’s economy and people, but for those who can’t afford or access the existing treatments.