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Artificial Pancreas Shows Promise In Diabetes Test

samzenpus posted about 4 months ago | from the no-more-needles dept.

Medicine 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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Marketing hype (-1)

Anonymous Coward | about 4 months ago | (#47248085)

my wife had this and it was near deadly with its incorrect readings and suggested delivery.

Be warned it's marketing hype.

Google it.

Re:Marketing hype (1)

i kan reed (749298) | about 4 months ago | (#47248163)

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 (5, Informative)

jvp (27996) | about 4 months ago | (#47248175)

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.

Marketing hype costs money (0)

Anonymous Coward | about 4 months ago | (#47248357)

And those marketeering people need paid, along with the other medical middlemen. A diabetic needs insulin, most advances of the last 20 years make it easier to dispense, but not cheaper. I can't afford insulin this month, but yay! there's a new pump on the way. Modern insulin is fermented from yeast like beer, so why is it 1000 times more expensive than beer? Because manufacturing cost savings get passed along to the stock holders not the patient.

see Hicks - go kill yourselves...

Re:Marketing hype (2)

DoofusOfDeath (636671) | about 4 months ago | (#47248479)

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.

Re:Marketing hype (1)

Anonymous Coward | about 4 months ago | (#47248819)

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 that interstitial fluid can't be trusted, however. It's not a trivial thing to do right (or Medtronic and everybody else would've made it work a long time ago), 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.

Re:Marketing hype (2)

jvp (27996) | about 4 months ago | (#47249099)

]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.

Re:Marketing hype (0)

Anonymous Coward | about 4 months ago | (#47249387)

Oh, and when you provide said data, don't be an "Anonymous Coward" about it, either.

Why? Data is either valid or it isn't; whether he has a cute little username at the top of his post has no bearing on that.

Re:Marketing hype (1)

mtxmorph (669251) | about 4 months ago | (#47255731)

JVP, I'm not the same person as the AC, but I have been on both MiniMed and Decom CGMs. I've also done some CGM medical trials for MiniMed.

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 / dropping, don't calibrate more often than every 8 hours, etc., etc. I stuck with it mainly because of the convenience factor of having only one device to carry around.

My doctor convinced me to try a Dexcom because of the issues I was having, and I can tell you that it's a world of difference. The Dexcom has been so damn accurate, and a hell of a lot more comfortable than any of the MiniMed CGMs I have used. I can let it run past calibration (>12 hours) and it still gives readings. When I go to calibrate it (even if it's been >12 hours) it's very rarely off by more than 20 mg/dL unless my blood sugar is shooting up like crazy.

Maybe you have tried it, and maybe it didn't work for you.. but don't write off all CGMs. They do work. The only thing that sort of sucks is having to carry around another device.. For what it's worth, last time I saw the study in TFA, they were using a Dexcom CGM.

Re:Marketing hype (0)

Anonymous Coward | about 4 months ago | (#47249303)

I'm guessing you're talking about the medtronic CGM/pump... the CGM is worthless (plus the sensor is frankly a harpoon). Dexcom's recent models however have been pleasantly accurate- in particular, I've gotten quite good readings via using the arms for it.

Re:Marketing hype (1)

pepty (1976012) | about 4 months ago | (#47249677)

This is the first trial of an experimental device. It's years away from the market. So far:

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.

Re:Marketing hype (1)

dens (98172) | about 4 months ago | (#47252219)

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 tennis or racquetball, but full court basketball or weight lifting can lower my sugar so fast, I even don't always get adjusting for it (by lowering my basal rate and eating proteins and carbs ahead and keeping my basal lower for the next 24 hours) right, even after 36 years of practice.

Re:Marketing hype (0)

Anonymous Coward | about 4 months ago | (#47305743)

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.

I concur ... even the pumps are failure prone even if it is hidden in the press when they kill people. So, how can you trust two electronic devices and a scientific algorithm PLUS $160 a day glucagon (stupid stupid stupid) that takes control out of our hands.

Isn't this why we have Mexicans? (0, Funny)

Anonymous Coward | about 4 months ago | (#47248171)

Why are we screwing around with artificial organs when we can have the real deal?

Re:Isn't this why we have Mexicans? (2)

jvp (27996) | about 4 months ago | (#47248203)

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.

Re:Isn't this why we have Mexicans? (1)

Shakrai (717556) | about 4 months ago | (#47248329)

Anti rejection drugs > death.

Re:Isn't this why we have Mexicans? (1)

jvp (27996) | about 4 months ago | (#47248405)

Anti rejection drugs > death.

Yeah. Maybe. But probably not, depending on whether you happen to get sick one day...

Re:Isn't this why we have Mexicans? (1)

Shakrai (717556) | about 4 months ago | (#47248419)

You have to be alive to get sick.....

Re:Isn't this why we have Mexicans? (1)

compro01 (777531) | about 4 months ago | (#47248539)

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.

Re:Isn't this why we have Mexicans? (0)

Anonymous Coward | about 4 months ago | (#47249619)

The anti-rejection drugs interfere with the insulin. That's why transplants have never worked well.

Look up the "Edmonton Protocol" for a capsule history of a "this limited test case worked in the lab, *of course* it will work in actual humans!!! Oh, wait, it doesn't."

Re:Isn't this why we have Mexicans? (1)

ThatsDrDangerToYou (3480047) | about 4 months ago | (#47248337)

As long as he ain't got the diabeetus it's cool.

Re:Isn't this why we have Mexicans? (0)

Anonymous Coward | about 4 months ago | (#47248391)

Joking aside, I know someone who actually did get a pancreas transplant, and his Type-1 was *essentially* cured.

After hearing about this [naturalnews.com] , it makes me wonder how many cases could be corrected with a minor capsaicin injection instead of transplants or manual insulin micromanagement.

I know I'd rather get stabbed once (or maybe even a couple times if it comes back) with an extract from one of my favorite cooking ingredients than cut open, stitched together, and having to scarf down immunosuppressants like hummingbirds sip nectar. (and even then, transplant sounds better than having to stab myself 50-900 times a day)

Re:Isn't this why we have Mexicans? (1)

Shatrat (855151) | about 4 months ago | (#47248509)

it makes me wonder how many cases could be corrected with a minor capsaicin injection

Off hand I would guess zero cases.

Re:Isn't this why we have Mexicans? (1)

fractoid (1076465) | about 4 months ago | (#47252841)

"We have a name for alternative medicine that has been proven to work. We call it... medicine." - Tim Minchin

Re:Isn't this why we have Mexicans? (1)

geekoid (135745) | about 4 months ago | (#47248423)

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.

Re:Isn't this why we have Mexicans? (1)

jcochran (309950) | about 4 months ago | (#47248601)

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.

Re:Isn't this why we have Mexicans? (1)

pepty (1976012) | about 4 months ago | (#47249697)

How about implants of pancreatic cells encased so as to be protected from the immune system?

Re:Isn't this why we have Mexicans? (1)

fractoid (1076465) | about 4 months ago | (#47252851)

When I first heard about "artificial pancreas" being tested it was exactly this; a device comprising pancreatic cells (not even necessarily biocompatible with the host) contained within some osmotic-type membrane which could pass chemicals through it but was impermeable to anything bigger (such as cells). I believe there may have been proof-of-concept type things constructed in a lab but haven't heard of anything futher.

Re:Isn't this why we have Mexicans? (-1)

Anonymous Coward | about 4 months ago | (#47248377)

Who would want part of a Mexican inside them?

Type 1 Diabetic here (0)

Anonymous Coward | about 4 months ago | (#47248185)

FTFA:

The system consists of an iPhone 4S with an attached glucose monitoring device, two pumps, and reservoirs for insulin and glucagon.

How is this in any way an improvement over the continuous monitoring setup that multiple pump suppliers already offer? All you're doing is adding an additional pump with glucagon. Nothing about this even remotely resembles what anyone would fairly call an "artificial pancreas."

Click bait. Move along.

Re:Type 1 Diabetic here (1)

pepty (1976012) | about 4 months ago | (#47249771)

The other improvement is in the algorithm used to calculate glucose levels and hormone dosages. For one thing, it allows the user to input information about the meals they are about to eat. It's not click bait; it's the results of the first outpatient trial.

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).

Considering how much money Republicans... (-1)

Anonymous Coward | about 4 months ago | (#47248191)

make off of diabetes, expect them to kill this. Diabetes might just be the most profitable health issue for them so they support it with everything they have. Their kind gets filthy rich off of our suffering. Just look at how much money they steal from us to give to corn farmers to make that horrible HCFS. They are killing us.

Heard the NPR story (0)

Anonymous Coward | about 4 months ago | (#47248205)

Dude's kid is a certified loser. At 15, with 14 years of T1 diabetes, you should be able to remember your fucking insulin pump. Kudos to the father for doing the work but, damn, that's one helicopter parent who has seriously removed all sense of responsibility from his son's upbringing.

Re:Heard the NPR story (1)

bradgoodman (964302) | about 4 months ago | (#47248351)

I heard the story. My son is only 10 (he was T1D) - and I don't "baby" him as much. Seemed as though the "fear" factor was really trumped-up a lot in the story.

This will need better advances in CGM Technology (5, Informative)

OSULugan (3529543) | about 4 months ago | (#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)?

Re:This will need better advances in CGM Technolog (2)

Major Blud (789630) | about 4 months ago | (#47248461)

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-pocket after my insurance fees. When these need to be changed every 3-6 days, that adds up pretty quickly.

I believe that these devices will eventually reach the point of convenience where you'll seldom need to think about type 1 diabetes (outside of filling the pump and changing sensors), but the price is a huge barrier to entry.

Re:This will need better advances in CGM Technolog (0)

Anonymous Coward | about 4 months ago | (#47248729)

When you say "the CGM device", which one do you mean? There are several, and most especially they've *all* become more accurate over the last couple of years. The one that my son is wearing, the Dexcom G4 (I have ZERO affilication with them except that my son uses one), is leaps and bounds more accurate than anything you could've been using two years ago. I don't say that to invalidate your experience, but technology has progressed in the interim. We rarely see inaccuracies that aren't explained by the time lag between blood glucose levels and interstitial fluid levels (which is actually what a CGM measures), and calibration is usually only required every other day. That said, it's still important for people with T1D to test their BG at every meal due to the physiological limitations of CGMs.

For us, the most important aspect of CGM usage is the ability to see trends during the day and based on activity levels. It's huge to know in advance that my son's BG is trending toward low *before* it happens and give him additional carbohydrates to prevent him from doing so. This, in effect, is the information that the 'bionic pancreas' research is basing its dosage of insulin and glucagon (which, in turn, is essentially how a non-T1D pancreas works).

Re:This will need better advances in CGM Technolog (1)

Major Blud (789630) | about 4 months ago | (#47248863)

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 :-).

Re:This will need better advances in CGM Technolog (1)

tagous (1066492) | about 4 months ago | (#47248675)

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.

Re:This will need better advances in CGM Technolog (1)

kwiecmmm (1527631) | about 4 months ago | (#47248711)

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 have seen numbers jump to be about a 100 point difference, but this is normally followed by a calibration failure. This causes me to have to recheck my blood glucose (I agree this is annoying, but at least it recognizes it is off). Currently the sensor lasts 6 days (I can normally get it to go a 7th day before the battery dies). I still normally test my blood glucose 3-4 times a day, but that is better than my previous 8-12 times a day.

I think I do better with the CGM, but then again I am just happy not to have to go back to using constant needle injections and finger pricks.

Re:This will need better advances in CGM Technolog (0)

Anonymous Coward | about 4 months ago | (#47248871)

Why do you assume the finger stick is "truth?" It also has a standard deviation. You don't usually do many finger sticks in a row, and therefore don't notice. But if you read the literature, you'll find it does. Further, if you burn some test strips doing a bunch of finger sticks in a row, on different fingers and hands, you'll find it's not just a disclaimer. It really does deviate quite a bit, as expected.

Their "algorithm" doesn't take your stated "truth" as truth, because it's not truth. Which is correct.

Does their "algorithm" do the right thing? Or a good thing? Or a better thing? Well, there are studies you should read to determine that. But your stated criticism is false.

Re:This will need better advances in CGM Technolog (1)

Major Blud (789630) | about 4 months ago | (#47248975)

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 (1)

amchugh (116330) | about 4 months ago | (#47252875)

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 except maybe for pump integration. It seems like there's a ton of different ways to put the sensors in that affect accuracy too. Some people have scarred up areas that get bad readings, some have to change the angle of insertion to get better results, and a few of us put in the new sensor a few hours to a day before the old sensor is done because the early hours of sensor use seem less accurate. Almost everyone seems to be using the sensors at least six days and some up to three weeks. For me, ten sensors can last about 3 months.

Re:This will need better advances in CGM Technolog (1)

pepty (1976012) | about 4 months ago | (#47249817)

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

Drop everything to avoid Diabetes II (0)

Anonymous Coward | about 4 months ago | (#47248319)

In a very long list titled - Stupid Things I Have Done ---- ignoring my doctors warnings on my blood sugar levels ranks right around #1. To be sure at this time we had really bad family things going on along with the usual work BS and financial issues. But once you cross that line there is no going back to a normal life.

Pretty much if you are facing pre-diabetes this is what you must do:
- Stop eating fast food and high carb foods
- Drop around 40lbs
- start moderate exercise

The 40lbs sounds hard and it is - but with a healthy(er) diet and modest exercise the weight will come off. My doctor was not quite this clear or blunt with me but I wish he had.been.

Re:Drop everything to avoid Diabetes II (1)

Shakrai (717556) | about 4 months ago | (#47248375)

The 40lbs sounds hard and it is

A 500/day calorie deficit will drop that in 40 weeks. Sooner if exercise is added to the equation. 500 calories a day is about as high as I would recommend for a deficit, from my experiences the people who shoot for more than that are the most likely to end up in a losing battle of yo-yo dieting. Weight loss is all about long term lifestyle changes, not short term extremes.

FWIW my family has a history of heart disease and diabetes.... my blood test results (fasting sugar and cholesterol) follow my weight more than my diet. Healthy weight equals good test results, irrespective of what my diet consists of at the time. Everybody is different, but personally I didn't really change the foods I eat. I just ate less of them. Seeing my long cousins who are all Type 2 in their 20s (no wonder, their BMIs are all >40) was quite the wake up call....

Re:Drop everything to avoid Diabetes II (1)

jvp (27996) | about 4 months ago | (#47248401)

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.

Re:Drop everything to avoid Diabetes II (0)

Anonymous Coward | about 4 months ago | (#47248515)

there are type 2's that are insulin dependent and would potentially benefit from this.

or in other words type 2's can essentially become type 1's. it isn't caused by an auto immune disorder, it is because their pancreas can't keep up and eventually gives up..

Warning: Snarky comment (2)

Lucas123 (935744) | about 4 months ago | (#47248321)

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.

Re:Warning: Snarky comment (1)

geekoid (135745) | about 4 months ago | (#47248409)

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.

Re:Warning: Snarky comment (1)

jvp (27996) | about 4 months ago | (#47248441)

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.

Re:Warning: Snarky comment (0)

Anonymous Coward | about 4 months ago | (#47248425)

I totally agree - if this is the national epidemic I keep hearing it is we are barely keeping pace with it. And indeed insulin and other diabetic meds are profitable and the audience is captive.

Re:Warning: Snarky comment (1)

kwiecmmm (1527631) | about 4 months ago | (#47248431)

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.

Re:Warning: Snarky comment (0)

Anonymous Coward | about 4 months ago | (#47248537)

type 2's can also require insulin

Re:Warning: Snarky comment (1)

demonlapin (527802) | about 4 months ago | (#47249599)

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

Stop eating digestible carbohydrates.

Re:Warning: Snarky comment (1)

Skiffkl (3696317) | about 4 months ago | (#47251239)

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.

Re:Warning: Snarky comment (1)

demonlapin (527802) | about 4 months ago | (#47251709)

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.

Re:Warning: Snarky comment (1)

Skiffkl (3696317) | about 4 months ago | (#47252781)

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 options for type !.

Re:Warning: Snarky comment (0)

Anonymous Coward | about 4 months ago | (#47248573)

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.

Re:Warning: Snarky comment (1)

pepty (1976012) | about 4 months ago | (#47249979)

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.

Re:Warning: Snarky comment (1)

pepty (1976012) | about 4 months ago | (#47249935)

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 (0)

geekoid (135745) | about 4 months ago | (#47248403)

Doughnuts aren't going to eat the selves.

Re:Pease hurry (1)

jvp (27996) | about 4 months ago | (#47248451)

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

Re:Pease hurry (0)

Anonymous Coward | about 4 months ago | (#47249109)

2 words in subject + 1 sentence fragment = 2 spelling errors.

golf clap

No "Magic" cure (1)

bradgoodman (964302) | about 4 months ago | (#47248433)

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 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).

4. There are devices now (by Medtronic) that will shut OFF your Insulin supply if your CGM says your blood glucose is too low - but aside from problems with poor CGM readings, this could be too late. (Furthermore, it's a minor firmware tweak on an existing pump). 5. There have been other project out there for years in which pumps can inject glucogon when BG levels are low. In fact, I credit my 8 year-old daughter for first coming up with the idea a few years ago - at least that't the first time that I personally heard it! Either way - no novily there.

So in short - nothing spectacular here, but I bet if they made a snazzy "solar roadways" type video, made it on a 3D printer and accepted BitCoins for payments, they'd monopolize the front-page headlines for weeks to come!

Re:No "Magic" cure (1)

pepty (1976012) | about 4 months ago | (#47250045)

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 (1)

bradgoodman (964302) | about 4 months ago | (#47250107)

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".

Measure blood directly (1)

Dimwit (36756) | about 4 months ago | (#47248851)

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.

Re:Measure blood directly (1)

jvp (27996) | about 4 months ago | (#47249225)

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 need a power source. 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.

Re:Measure blood directly (1)

jcochran (309950) | about 4 months ago | (#47249691)

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 (1)

cinnamon colbert (732724) | about 4 months ago | (#47249137)

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

Re:so much for the stem cell hype wagon (1)

jvp (27996) | about 4 months ago | (#47249239)

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.

Re:so much for the stem cell hype wagon (0)

Anonymous Coward | about 4 months ago | (#47250429)

I have a PhD in molecular biology
I have 20+ years experience in biotech
yes, in theory a stem cell solution is better, but people need help today, not next year
bionic pancreas is available now - or soon; stem cells are still a long long way off

Type 1 cure alredy in human testing (1)

Anonymous Coward | about 4 months ago | (#47249475)

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 for Phase 2 of human trials at Mass. General Hospital, in Dr. Faustmann's lab.

                    http://www.faustmanlab.org/

The BCG vaccine, used worldwide for tuburculois for millions of people, is applied in small daily doses for one month while the diabetic maintains strict blood sugar control. This allows adult stem cells, not implanted tissue, to transform to insulin producing cells and cure the diabetes. This is the first fundamentally new treatment for Type 1 diabetes, one that's actually worked in test subjects, since insulin was refined and tested.

Why does it dispense glucagon? (1)

Antique Geekmeister (740220) | about 4 months ago | (#47249583)

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 relevant alpha cells, and my colleague would expect the glucagon sensitivity to recover with otherwise good diabetes control from manipulating the insulin alone..

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