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Artificial Pancreas Shows Promise In Diabetes Test 75

Posted by samzenpus
from the no-more-needles dept.
An anonymous reader writes A cure for Type 1 diabetes is still far from sight, but new research suggests an artificial "bionic pancreas" holds promise for making it much more easily manageable. From the article: "Currently about one-third of people with Type 1 diabetes rely on insulin pumps to regulate blood sugar. They eliminate the need for injections and can be programmed to mimic the natural release of insulin by dispensing small doses regularly. But these pumps do not automatically adjust to the patient's variable insulin needs, and they do not dispense glucagon. The new device, described in a report in The New England Journal of Medicine, dispenses both hormones, and it does so with little intervention from the patient."
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Artificial Pancreas Shows Promise In Diabetes Test

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  • by OSULugan (3529543) on Monday June 16, 2014 @02:15PM (#47248219)

    To be successful, this kind of a device will need substantial improvements in Continuous Glucose Monitoring (CGM) devices. I used one of these 2 to 3 years ago, and it required a finger-stick reading to "calibrate" it at a minimum once every 12 hours, but recommended 4 times a day. Even with this calibration, the algorithm in their software didn't adjust to this as truth data, and would continue to read quite different values. Many times this was in the 60-80 point (mg/dL) range. When you're trying to control blood glucose into a range of 80-120 mg/dL, having an error so great is a significant challenge. Granted, this was likely 1 generation old technology, but from what my endocrinologist (who's also a pump wearing diabetic) tells me, the newest generation isn't much better.

    I can't imagine what the device would do when you factor this error in along with the algorithm trying to account for situations such as eating, without having additional input from the user.

    Oh, and one last hurdle: A newly placed sensor for the CGM devices generally take a period of 1 to 2 hours to acclimate, then need a "calibration", before the data is useful. What does a diabetic do during this time period (which needs to occur once every 3 days)?

    • Ditto. I'm a type 1 who has used a pump for the past 7 years. I tried the CGM device for a few months about two years ago, and was really disappointed. The readings were widely inaccurate (sometimes over 100 mg/dl). I also didn't see much point in it if I still had to manually check my blood sugar levels at least 4 times a day to calibrate it. Having an additional piece of equipment stuck in your body all day was also another turn-off.

      But the biggest downside? The $35 that each sensor cost out-of-pocke

    • by tagous (1066492)
      My daughter has been using the DexcomG4 for a year (off and on) and it is more accurate then 60-80. I've been very pleased with the results. Early models were certainly used for trends rather then reads. I look forward to the joining of CGM and pump with limits (just like pumps have now). Now if they could just fix the adhesive. Too many hours in the pool and the tape starts to peel off.
    • by kwiecmmm (1527631)

      I currently have the CGM and I understand some of what you are saying but I believe things have improved a lot since then. Currently my CGM gives me a calibration within about 10-15% of my blood glucose. This is normally good enough to monitor trends and keep my blood glucose in the proper range without finger pricks. The one huge advantage of it is the fact that when I am hungry I can look at it and see if I am hungry because of low blood sugar or just being hungry.

      About your complaints with the CGM, I

    • by pepty (1976012)
      Read the NEJM article. It details how the algorithm and data inputs differ from previous systems.

      http://www.nejm.org/doi/full/10.1056/NEJMoa1314474#Results=&t=articleResults

  • by Lucas123 (935744) on Monday June 16, 2014 @02:34PM (#47248321) Homepage
    Over the past four decades, we've seen squat in the form of treatment for diabetes other than improving the delivery of insulin delivery for diabetics, which has been around since the 1920s. Honestly, it almost seems as if the insulin market is just too lucrative to allow a real cure for Type 1 diabetes. We march on continuing to watch little children struggle with this disease through adulthood and often succumb to an early death because of it. C'mon scientific community. Get your collective heads our of your arses and curse this.
    • by geekoid (135745)

      Three are large amount of dollars going into this issue. It's almost like its hard and has taken several leaps in computer power and medical knowledge.
      The first company to cure diabetes is going to make a shit ton of money.

      • by jvp (27996)

        The first company to cure diabetes is going to make a shit ton of money.

        My prediction regarding Type-1 is this: The computer geeks are going to come up with a pretty damned good solution before the geneticists do (the tech in the aforementioned article is *not* that). But ultimately, it'll be the geneticists that figure out how to cram new Islets of Langerhans into the pancreas and keep them protected from the immune system without the anti-rej drugs.

        The former solution will be an acceptable stop-gap measure for however long it takes the geneticists to cook up the latter.

    • by kwiecmmm (1527631)

      I completely agree. The problem is Type 1 is such a small section of diabetics (about 5% at the moment) that most people don't even think of this, and when you tell someone you are diabetic they automatically assume it is Type 2. If they actually put the time and effort into finding a cure for this it would probably cure or at least lead to better treatments for Type 2 as well, but that might actually cost drug companies money in the long run.

      • Type 2 is actually fairly easy to cure if you want to get rid of it.

        Stop eating digestible carbohydrates.
        • by Skiffkl (3696317)
          It may be manageable but I disagree it's not fairly easy to cure. Some type II patients make less insulin than others. When I was pregnant my perfect A1C scores were destroyed and I ate minimal carbs. I was on 7 shots of insulin a day. The placenta steers the boat like a Drunk Kennedy. Does anyone have any study information about how many Diabetics both types were cured by RNY surgery? It is a lot less risky than an organ transplant and costs a lot less.
          • Roux-en-Y is a weight loss surgery, so there's no reason to believe it would do anything for a type I. Just out of curiosity - obviously, your experience is your experience - how low was "minimal" carbs? I generally aim for under 20 g/day.
            • by Skiffkl (3696317)
              My carb intake varies depending how active I am. Between 30 and 60 grams a day. Actually Researchers have a huge interest in learning how to cure type I by studying RNY patients who have type II Diabetes. These patients show normal blood sugar levels within days of the surgery, before any weight loss has occurred. The research around this is referred to as the foregut hypotheses of diabetes remission. Even non obese Type II diabetics can benefit from this surgery. Hopefully it will lead to more treatment o
    • by pepty (1976012)

      Honestly, it almost seems as if the insulin market is just too lucrative to allow a real cure for Type 1 diabetes.

      Novo Nordisk insulin is available from Walmart at a heavy discount, and biosimilar versions (generic, more or less) will be on the market soon. The insulin market isn't going to be very lucrative for much longer, at least when it isn't attached to a proprietary delivery system.

      Over the past four decades, we've seen squat in the form of treatment for diabetes other than improving the delivery of insulin delivery for diabetics, which has been around since the 1920s.

      Lots of drugs have been developed for type II and there are always plenty more in development. Pharmas like money and there is always plenty of it for a new diabetes drug.

  • Doughnuts aren't going to eat the selves.

    • by jvp (27996)

      Doughnuts aren't going to eat the selves(sic).

      Is it bad that I know that a Dunkin Donuts Boston Kreme donut has about 32g of carbs? ... :-D

  • Like everything on the Internet - a glitzy story doesn't always equate to reality. (I'm looking at you, Solar Roadways!)

    Let me count the issues here:

    1. This device seems to "do a bit better" than conventional treatments. How much better? A lot or almost none at all?

    3. When you eat - it can take (minimum 20 minutes, maximum much longer) for the carbohydrates you eat to be broken down into glucose, detectable by a CGM. This can be MUCH longer for fatty foods which can often result in the liver secreting

    • by pepty (1976012)

      Let me count the issues here:

      1. This device seems to "do a bit better" than conventional treatments. How much better? A lot or almost none at all?

      You can read the full research article by going through OP's links, but here you go:

      Among the adults, the mean plasma glucose level over the 5-day bionic-pancreas period was 138 mg per deciliter (7.7 mmol per liter), and the mean percentage of time with a low glucose level (less than 70 mg per deciliter [3.9 mmol per liter]) was 4.8%. After 1 day of automatic adaptation by the bionic pancreas, the mean (±SD) glucose level on continuous monitoring was lower than the mean level during the control period (133±13 vs. 159±30 mg per deciliter [7.4±0.7 vs. 8.8±1.7 mmol per liter], P less than 0.001) and the percentage of time with a low glucose reading was lower (4.1% vs. 7.3%, P=0.01). Among the adolescents, the mean plasma glucose level was also lower during the bionic-pancreas period than during the control period (138±18 vs. 157±27 mg per deciliter [7.7±1.0 vs. 8.7±1.5 mmol per liter], P=0.004), but the percentage of time with a low plasma glucose reading was similar during the two periods (6.1% and 7.6%, respectively; P=0.23). The mean frequency of interventions for hypoglycemia among the adolescents was lower during the bionic-pancreas period than during the control period (one per 1.6 days vs. one per 0.8 days, P less than 0.001).

      This is the first outpatient trial of an experimental device. Check back when they are ready to send it to the FDA for approval.

      3. When you eat - it can take (minimum 20 minutes, maximum much longer) for the carbohydrates you eat to be broken down into glucose, detectable by a CGM. This can be MUCH longer for fatty foods which can often result in the liver secreting Glucose. Commercially available insulin can take up to 2 ours to reach peak affect. This means that by the time you eat and your CGM begins to notice it - it is too late to take any meaningful affect and keep your blood sugar under reasonabily control (for the next several ours).

      The device allows the patient to input info about their upcoming meal so that the algorithm can attempt to anticipate this problem.

      • I can "input data on upcoming meals" with a current pump. And it's only as good as the data I put in (which may be VERY wrong at times). This is far from the fully-automated "closed loop" systems described as "bionic pancriuses".
  • It seems as though the big problem with this technology is that it's not measuring blood directly. What are the barriers to placing a sensor more-or-less permanantly inside the body that can test blood directly and the send, via radio or whatever, commands to an external insulin pump to dispense insulin?

    I'm guessing "blood clots" is the problem here, but I don't know.

    • by jvp (27996)

      It seems as though the big problem with this technology is that it's not measuring blood directly. What are the barriers to placing a sensor more-or-less permanantly inside the body that can test blood directly and the send, via radio or whatever, commands to an external insulin pump to dispense insulin?

      Fun problems that aren't insurmountable, but expensive and very challenging. You have the issue of potential infections and rejection, first and foremost. Any insulin pump wearer knows that the site he or she is using needs to be ripped out and replaced every 3 days or so. Why? The body will muck it up via its internal self-defense mechanisms. The same thing would happen to a foreign body fully immersed inside the body.

      Power supply. Something that's transmitting constantly or regularly is going to nee

      • by jcochran (309950)

        Do you make it something that attaches to the outside of the skin for power (ie: a small battery)? Or cut the person open whenever the battery starts flaking out? If the latter, we have new members of the zipper club instantly.

        Seems that such a device would be an ideal candidate for inductive coupling. Both for charging and data transmission. The device would consist of two parts. One part implanted into the body, and a second part held on the skin over the implant. That would avoid a semi-permanent skin penetration acting as an infection risk.

  • for years, we have been pouring billions (literaly) into stem cells, without a whole lot to show for it
    A few tens of millions, and a bionic pancreas is nearing usability

    tell me again why the bandwagon for stem cells

    • by jvp (27996)

      A few tens of millions, and a bionic pancreas is nearing usability

      tell me again why the bandwagon for stem cells

      A child growing up with Type-1 is going to fare a lot better in life with a completely internal, biological solution to the problem versus having a device attached or implanted. So too will adults. Your thought process is a bit short-sighted, it seems.

  • by Anonymous Coward

    The artifical pancreas has been "just around the corner since before I became diabetic, 40 years ago. There has been no notable advancement except to make the electronics smaller, and to make insulin more pure. The sensors have *never, never, never* worked reliably, they always involve consuming chemical reagents or just don't *work*. I participated in artifical pancreas research several times, as subject and later as investigator.

    Fortunately, a genuine "cure" for most Type 1 diabetes is gathering funding f

  • This is confusing: From my diabetic colleague: glucagon is dispensed in response to low blood sugar by the alpha cells of the pancreas, which apparently remain intact, not by the destroyed beta cells that are missing form the pancreas. If the diabetes is being treated well with insulin, why wouldn't the patient's normal glucagon response work well?

    From my colleague reading over my shoulder: many diabetics lose their glucagon sensitivity, but apparently due to overall blood sugar control. They still have the

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