This talk was presented by Aaron Kowalski, from the Juvenile Diabetes Research Foundation (JDRF). Dr. Kowalski oversees JDRF-funded research aimed at accelerating the delivery and development of artificial pancreas systems.
He is also a person with type 1 diabetes and was diagnosed at the age of 13 in 1984. Prior to that, in 1977 at the age of three, Dr. Kowalski's brother was diagnosed with T1D.
This talk was the most EXCITING and positive that I attended over the 2 days because I came away from it with a solid belief that the next best thing to a cure (either the Artificial Pancreas or Beta Cell encapsulation) is only a couple of years away.
Artificial Pancreas (also known as a Bionic Pancreas or the closed loop system);
What is it?
There are two types of Artificial Pancreas, which confused me for a time. One Artificial Pancreas is a combination of an insulin pump containing rapid acting insulin, a Continuous Glucose Monitor (CGM), and a device such as a tablet or smartphone, which runs the software that communicates with both the pump and CGM.
The other type of Artificial Pancreas is two pumps, one pump contains insulin and the other contains glucagon, a different hormone that raises blood sugar when it gets too low. This system has an app that runs on an iPhone, which is connected wirelessly to CGM. This Artificial Pancreas was developed by Ed Damiano, an associate professor of biomedical engineering at Boston University.
Both Artificial Pancreases have successfully completed clinical trials and are very close to being “available”. In fact, we had a parent attending the talk who's daughter is participating in the overnight closed loop trials. She showed us a tablet with her daughter's overnight readings presented in a graph. It was such a straight line!
Why are people excited?
- Both of these systems will take the guess work out of diabetes management.
- There is minimum input from the user.
- The Artificial Pancreas uses a pump that will shut off the supply on insulin if bloods glucose is trending low and will switch back on when BG’s come back into range.
- Ed Damiano’s Artificial Pancreas releases glucagon to raise BG’s when they drop.
- And it’s close to being widely available. Dr. Kowalski said that people would have it in two years and if you factor in the “builder’s estimate” calibration, I would estimate 4 years.
My concern, now, is how far behind in diabetes technology Ireland is in relation to providing insulin pumps for all. When the Artificial Pancreas becomes widely available and people start demanding it; there will be trouble.
Beta Cell Encapsulation;
What is it?
About a decade ago there was considerable excitement in the T1D community about islet cell transplants–the transplantation of insulin producing cells back into the body. But islet transplants have a big downside: high doses of potentially toxic immunosuppressive drugs are needed to block the same autoimmune attack that initially triggered T1D.
Encapsulation describes a therapy where a pouch composed of beta cells or islet cells, surrounded by a protective barrier, is implanted into the body. The barrier hides the islet cells from the immune system, providing a safe environment where they can function normally. The cells constantly assess the amount of glucose in the blood and release exactly the correct amount of insulin. And unlike islet transplants, no immunosuppressive drugs are required.
Why am I excited about this?
I'm excited about this because in my opinion its very close to a cure. There are no gadgets to wear. You would have to have them re-implanted every two years but that’s nothing compared to all the tasks I do daily to manage my diabetes.
Encapsulation is still a ways off but I'm really hopeful to see it in my lifetime.
Smart Insulin/Glucose Responsive Insulin;
What is it?
Smart Insulin is an insulin that would only activate when glucose if present in the blood. One of the problems in today’s diabetes management is that we can sometimes have too much insulin causing low blood sugars/hypos or too little insulin causing high blood sugars.
I’m sitting on the fence with this one; I don’t think I know enough about it.
Afrezza inhaled insulin;
What is it?
I will have to admit that when I heard the scientists were having another go at the Inhaled insulin I rolled my eyes. But having someone explain what it is and be excited about it got me interested. Not excited though;-)
Yes, it’s an insulin you inhale but it has a peak of 12 minutes. it works extremely fast and has been used instead of boluses, by Dr. Kowalsky himself. It works so fast that you can use it after meals and still avoid the after meal spike.
Diaport;
What is it?
This is not a new treatment option; it’s actually something that is available but isn’t very popular. I'm including it because I had never heard of it before.
The Diaport is a cannula that is surgically inserted into the stomach cavity, so the insulin works much faster than being infused with a pump cannula. Dr. Kowalski said that one of the problems with the current insulins is that they're too slow and can’t deal with the post meal spikes in blood sugars. Someone in the audience then spoke about the Diaport.
I love learning new information but this treatment option seemed like a last resort to me.
Regeneration;
Did you know that people with Type 1 Diabetes still make beta cells, no matter how long they have had it, but the immune system kills them before they can get making insulin. Regeneration is trying to find a way to protect them or fix the glitch in our immune system that takes them out.
Another one to watch but too far away to get excited about yet.
Round up.
As I mentioned earlier this was the most exciting talk that I attended. It was difficult not to be infected with Dr. Kowalski’s enthusiasm and excitement. But also being in the same room as someone who was using the Artificial Pancreas was electric. I feel that being so close to the technology was a signal to me that it is close and that we are actually talking about a couple of years.
Ireland better get it’s skates on!