Artificial Pancreas Shows Promise In Diabetes Test 75
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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While I appreciate healthy skepticism about medical advances, "google it" is a phrase I associate more with pseudoskepticism than the real deal.
Re:Marketing hype (Score:5, Informative)
Yep. I'm a *big* fan of my insulin pump, but the included "Constant Glucose Monitoring" device that the pump's company touts as "FDA-approved artificial pancreas!!one11eleven!!" is anything but. It's measuring interstitial fluid, which is *randomly* accurate in *random* people at *random* times. It can neither be trusted, nor should be. And I've since stopped using the CGM side of the pump.
The tech that they're talking about in this article is the same idea: measure interstitial fluid and make insulin decisions based on that. Bad. Ju. Ju.
We need some way of measuring blood glucose levels from, ya know, actual *blood*, without the risk of causing infections. Until we get that, no bueno. Just pass on it.
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Funny, I was about to write the same thing. My wife has a pump + a continuous monitor, and her experience is just like yours.
It's an interesting idea, but the implementation isn't quite there yet.
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Based on your pump + cgm statement, I'm going to assume you have one of the generations of Medtronic devices. The CGM functionality in these, even the newer 530G with Enlite sensors, simply isn't very good at all. If you ask any of the (credible) researchers in the field about them they will either stay entirely silent so as not to piss Medtronic off or they will drop enough data on you about them to scare you off from CGMs generally forever. They simply aren't very good. I do contest any assertions tha
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]but when done right the results really are quite useful.
All I ask is that you don't judge the entirety of an approach based on your experience with one flawed implementation.
Show me it "done right" with years(!) of lab evidence, trials including hundreds (if not thousands) of individuals, and perhaps I'll believe you. Oh, and when you provide said data, don't be an "Anonymous Coward" about it, either.
No, blood tests aren't 100% accurate. They are, however, a far, *FAR* more accurate way to get an idea of levels than using interstitial fluid. And, as it turns out in this case: accuracy counts. A lot.
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Without a doubt, I can agree with you that MiniMed CGMs absolutely suck and that the "artificial pancreas" marketing from MiniMed is crap. I used the MiniMed CGM on my pump for about 2 years and it was often way off my actual blood sugar. I talked with MiniMed reps several times and they would tell me the same crap: don't calibrate when your blood sugar is rising /
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The developers tested the device over five days in two groups of patients, 20 adults and 32 adolescents, comparing the results with readings obtained with conventional insulin pumps that the participants were using.
The artificial pancreas performed better than the conventional pump on several measures. Among the adolescents, the average number of interventions for hypoglycemia was 0.8 a day with the experimental pump, compared with 1.6 a day with the insulin pumps. Among adults, the device significantly reduced the amount of time that glucose levels fell too low.
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Mine is extremely accurate when I'm at my desk working or sleeping, usually within 1 or 2 points (mg/dL).
The trouble is when I am active. When I play basketball, the lag between blood sugar and the interstitial fluid the CGM monitors can be extreme, like my blood sugar could be 40 when the CGM thinks it's still 120. The other problems is that in cases like this, I'm not sure how fast either insulin or glucagon can be injected. I mean, it's usually easy to deal with if I play moderately intense sports like t
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Why are we screwing around with artificial organs when we can have the real deal?
He. Joking aside, I know someone who actually did get a pancreas transplant, and his Type-1 was *essentially* cured. However. He eats massive handfuls of anti-rej drugs with every meal, all to keep that pancreas functioning. IMHO, not a good trade. At all.
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Anti rejection drugs > death.
Yeah. Maybe. But probably not, depending on whether you happen to get sick one day...
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Yes, but the question is whether having to take insulin is better or worse than having to take anti-rejection drugs.
I believe the insulin is generally considered the better option unless you're needing the anti-rejection drugs for something else anyway.
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it makes me wonder how many cases could be corrected with a minor capsaicin injection
Off hand I would guess zero cases.
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It's a step. Next will be growing them with your own cells; which will remove rejection risk.
About a year after that it will be an outpatient surgery.
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Unfortunately, that isn't likely to be true. A lot of Type I diabetes is, at its root, an autoimmune disease. The immune system goes crazy and kills off the islets of langerhans. So let's say you do get a grown pancreas from your own cells and have it transplanted. Well, your immune system then proceeds to kill of the islets of langerhans and you're back at square one.
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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).
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This will need better advances in CGM Technology (Score:5, Informative)
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)?
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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
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I had a Medtronic Paradigm. My pump is made by Medtronic (which I'm very happy with), so this CGM was designed to be used in conjunction with it.
Thanks for the advice, you're the second person in this thread to recommend the Dexcom. Looks like I will need to talk to my endocronologist :-).
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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
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I usually don't respond to AC's but what you are saying is absolutely true. My experience is completely anecdotal, but when the CGM would show a fluctuation of 100 within an hour and the test strips show a deviation of 10 during the same time frame when checked every 15 minutes, it definitely made me question the CGM.
I'd love to read some studies about the accuracy of different brands of test strips and CGM devices, as long as they weren't tainted by the manufactures and vendors of said devices.
Re: This will need better advances in CGM Technolo (Score:1)
I've been using the medtronic CGM & pump for four years, and going to insulin pump support group meetings for slightly longer. The reps have been pretty honest about the CGMs being neither accurate nor precise, as one would expect from a system that's calibrated via another inaccurate system. Still, most of the group most of the time gets at least enough accuracy to determine the direction glucose is trending or if it's stable. Everyone agrees that the Dexcom CGMS beats Medtronic's CGMS on most metrics
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http://www.nejm.org/doi/full/10.1056/NEJMoa1314474#Results=&t=articleResults
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In a very long list titled - Stupid Things I Have Done ---- ignoring my doctors warnings on my blood sugar levels ranks right around #1.
While your contribution to the thread is admirable, it's centered around Type-2. We're discussing the genetic, auto-immune disease known as Type-1.
Warning: Snarky comment (Score:3)
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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.
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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.
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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.
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Stop eating digestible carbohydrates.
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Test strips. ~$1 each. 4x per day. 25 million diabetics in the US alone. Its a large recurring, renewable revenue stream that the insurance industry can swing around like a fire hose right now to their favorite phara company.
Any solution that doesn't require test strips will die before industry lets it exist.
Hell no. It's a recurring revenue stream for medical device/diagnostic companies, for the insurance companies It's a large recurring EXPENSE that they would love to be rid of. If strips cost $4 per day and new tech costs $3.75, insurance companies will be all over it. If the new tech costs $8 per day but cuts down complications by $2k per year insurance companies will be all over it.
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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.
Pease hurry (Score:1)
Doughnuts aren't going to eat the selves.
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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
No "Magic" cure (Score:2)
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
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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.
Re: No "Magic" cure (Score:2)
Measure blood directly (Score:2)
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.
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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
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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.
so much for the stem cell hype wagon (Score:2)
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
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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.
Type 1 cure alredy in human testing (Score:1)
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
Why does it dispense glucagon? (Score:2)
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