Slowly but surely, a fully integrated “closed loop” or “artificial pancreas” system doesn’t seem so pie-in-the-sky anymore.
By that I mean: the real diabetes device news coming out of this week’s annual ADA Conference was not any product launch in particular, but what I view as a “clear and present” push towards a more automated diabetes management system.
For starters, see the new pre-conference special edition of Diabetes Technology & Therapeutics, all about “accelerating the availability of an artificial pancreas.” And also the recent Journal of JAMA (American Medical Association) article on how the artificial pancreas may soon be a reality.
Then take a look at the study announced yesterday: UC Santa Barbara researchers paired the OmniPod and the Dexcom Seven with a customized insulin delivery algorithm and tested it on Type 1 patients (albeit only four). “Without any outside intervention, the system restored normal blood glucose levels following both induced high levels (hyperglycemia) and unanticipated meals, while avoiding hypoglycemia.”
Medtronic also was all about “making steps towards a closed loop” at the ADA event. First, they presented data touting improved outcomes for patients using their pumps paired with the Guardian CGM system (improved A1c levels). As mentioned, they also released a new combo model in Europe this week with an automated insulin suspension feature (key to safe implementation of a closed loop), and they recently announced acquisition of a second, entirely new type of CGM technology that the company will develop in parallel with its Guardian system.
All told, there were at least a dozen sessions/ abstracts /posters at this year’s event focusing on the uses and value of CGM in conjunction with insulin therapy. One reason for this is that not only researchers, but practicing physicians, now have access to patients using CGM in the real world. They’ve been busy gathering data and observing the effects in various groups: young adults, athletes, pregnant women, Type 2s starting on insulin… And guess what? It’s making a big impact. According to the data presented here, patients generally tighten their control by leaps and bounds within weeks of starting a CGM – “because they can finally see what’s going on.”
But it was reassuring to see experts here admit that CGM, in its current far-from-perfect form, can also be very tough to live with. In a talk titled, “The Psychological Side of Using CGM” (an unusual touchy-feely session for this deep science conference), Dr. William Polonsky quoted a patient saying:
“Using the CGM, I know I’ll be warned if I’m going low. So I can relax during the day with it. But at night it’s like having a newborn!”
Here, here. The calibrations, persistent and often unnecessary alarms, and uncomfortable adhesives aren’t making our lives too much easier at the moment: baby steps towards a more perfect mousetrap mode of constant monitoring.
On the insulin delivery side, there was much buzz about new patch pumps – both OmniPod knock-offs, and simpler, disposable models being designed for the needs of Type 2 diabetics. According to specialist Dr. Bruce Bode, there are 4.5 million Type 2s on insulin, but only 37,000 currently use pumps. Studies show that putting them on pumps yields an average 1.2-pt drop in A1c, and patients say their quality of life improves. (I hear that)
To this end, check out the Valeritas V-Go pump, the Altea Passport pump, and the Tolea pump model, for example. Eli Lilly and Amylin are even experimenting with putting Byetta in this type of “dumbed down” insulin pump (minus basal programs and all the fancy features) – which would mean that a Closed Loop System could soon be a boon to ALL of us PWDs.