I remember being told at a lecture for patients at the Joslin’s Clinic in 1966 that we should try to maintain strict blood sugar control for just five years, since by then there would be a closed-loop, portable insulin machine that would guarantee perfect blood sugars for everyone all the time. Ha!
I was encouraged in 1984 when I noticed the first degree programs in bioengineering were developed, since I thought this would surely bring some progress in diabetes management, but nothing truly significant has come of it.
Generally, there is so much evidence that diabetic complications may be due, at least in part, to genetic factors or the continuing influence of the autoimmunity that initially destroyed the beta cells and never goes away, that I worry that better blood sugar management may still not really solve the problem of diabetes. Also, studies in type 2 diabetics are starting to show surprisingly limited benefits from blood sugar control, and in patients who have had periods of hyperglycemia in the past, no amount of blood sugar control seems able to reduce the development of complications now, so some elaborate machine to control blood sugar may not really answer all the problems we face.
Whatever is designed to help diabetics should be patient-centered, as almost all treatments for diabetes are not. That means it should be easy to use, should not be plagued by its own complications, and should be miniaturized to the point that it does not announce to the world, ‘This person is a diabetic, so don’t hire him, fall in love with him, or do anything except get him a chair, because he is sick and frail.’
I would have thought, though, that if you are interested in the ‘hows’ and ‘whys’ of diabetes you would have signed up for a course in physiology rather than biomedical engineering, since the mechanical treatment of diabetes need not necessarily have anything to do with how diabetes develops or what mechanisms underlie it, since any superficial suppression of its effects would answer the problem, in the same way a pump doesn’t need to understand what caused the flood.