The treatment of diabetes could be transformed by using nanotechnology to create a 'smart delivery' system that regulates glucose levels from within the body – effectively replicating the work of the pancreatic cells that produce insulin

Nanomedicine is booming. And where better to focus research efforts than on a disease that affects the lives of more than 350 million people around the world – nearly 4 million in the UK alone – and which is on the increase: diabetes.

People with both type 1 and type 2 diabetes face a constant battle to manage their condition, caused when the pancreas is no longer able to make insulin, or when the body cannot make efficient use of the insulin it does produce. Daily self-management is vital and demanding, requiring regular checking of blood glucose levels. In addition, the long-term effects of high glucose levels can affect the whole body, leading to complications such as cardiovascular disease, and causing retinal, kidney and nerve damage.

It is widely agreed by patients and medical professionals that traditional methods of determining blood glucose levels are insufficient. The typical finger-prick test can be painful, cannot be performed when the patient is sleeping and, most importantly, often misses dangerous and sudden spikes and troughs in blood glucose. So what if glucose monitoring could be made easier and more accurate? Advances in nanotechnology may be the answer.

Scientists at Western New England University are developing a non-invasive monitoring device, which would look and work like a breathalyser. Their prototype uses nanotechnology to detect acetone in the breath – a marker that many say correlates accurately to blood-glucose levels, although more research into this is required.

"The benefits to patients would be astronomical," says researcher Ronny Priefer. "Instead of having to prick your finger six to 10 times a day, every day, for the rest of your life, you would only need to exhale into a device."

The patient breathes into a chamber containing a one-use test slide. The slides are coated with a nanometre-thick film, which consists of two polymers that react with acetone. The slide is then read and the data converted to give a reading of the level of acetone present. The patent-pending device uses nanotechnology to make it entirely selective to acetone alone.

"We are currently fine-tuning the surfaces to optimise the signal-to-noise ratio," explains Priefer. They will be using the first prototype – the size of a book, but soon to be miniaturised – in clinics from 2014 to get real-time, supervised results from patients. "When we have completed the miniaturisation of the device to be a hand-held model, we will then be doing an eight-month study where patients take the device home and record their breath acetone and blood glucose levels."

But could blood glucose monitoring be made even easier than exhaling into a device? And adjust glucose levels at the same time? A team at North Carolina State University believes so. Prof Zhen Gu and his team are working on a couple of different systems which may achieve this ideal – effectively creating an artificial replacement to the beta cells in the islets of the pancreas, which would normally release insulin to counter high glucose levels.

"Our overall aim is to create 'smart delivery' systems for insulin provision," says Gu. "What I mean by that is that insulin is delivered at the right time, via a safe approach – avoiding too much or not enough dosage – and in a way which requires only small formulations."

One of the team's ideas in development is an injectable nanoscale sensory network, announcing earlier this year that such a system maintained normal blood sugar levels for up to 10 days in type 1 diabetic mice. The "nano-network" degrades to release insulin when glucose levels are high and the researchers are currently trying to optimise it to respond as quickly as pancreatic islet cells do naturally in the body, and to make it more biocompatible with human tissue.

The nano-network's core is formed of dextran nanoparticles loaded with insulin and glucose-specific enzymes. High glucose levels activate these enzymes to convert glucose into gluconic acid, breaking down the dextran and releasing the insulin to bring glucose levels under control. Each nanoparticle is coated with either a negatively or positively charged film, which, once they have been injected under the skin, makes them cling together to form the solid network.

Gu's team is also experimenting with using ultrasound to remotely trigger insulin release from the same implanted network. Their concepts – and the many others in development – could not only remove the need for people with diabetes to self-monitor blood glucose with finger prick tests or a pump, but make this process more accurate while also alleviating the need for patients to regularly inject themselves with insulin.