Artificial Pancreas Shows Promise in Diabetes Test

Artificial Pancreas

A portable artificial pancreas built with a modified iPhone successfully regulated blood sugar levels in a trial with people who have Type 1 diabetes, researchers reported Sunday.

Type 1 diabetes, which usually starts in childhood or young adulthood, is a chronic condition in which the pancreas produces little or no insulin, the hormone that lowers blood sugar levels. Insulin works in conjunction with glucagon, a hormone that raises blood sugar. Together, they keep blood sugar in a healthy range.

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.

“The data address some of the most difficult problems in diabetes management,” said Dr. Kevan Herold, director of the Yale Diabetes Center, who was not involved in the study. “I’d say that the effects are quite significant and noteworthy.”

Dr. Fredric E. Wondisford, director of the diabetes institute at Johns Hopkins, also found the results encouraging. “To me, it’s a clear advance,” he said. But he cautioned that the effectiveness and practicality of the device had still not been tested in large numbers of patients over long periods of time. He also raised the issue of cost and insurance coverage.

Treatment of Type 1 diabetes is complicated. Patients not using pumps need two or more insulin injections a day, and all have to monitor blood sugar several times a day by pricking their skin and testing their blood.

Maintaining safe blood sugar levels requires precise adjustments, especially to prevent hypoglycemia, or extremely low blood sugar. Hypoglycemia can occur quickly, without the patient’s awareness, and can be a life-threatening emergency.

For patients with adequate treatment, elevated blood sugar is usually not an emergency, but can cause vascular damage over time that can lead to eye problems and amputations.

The artificial pancreas is the latest version of a device that researchers have been refining for several years. The system consists of an iPhone 4S with an attached glucose monitoring device, two pumps, and reservoirs for insulin and glucagon.

A sensor implanted under the skin on one side of the patient’s abdomen measures the glucose in the fluid between the cells, which corresponds closely to blood glucose levels. The sensor delivers the reading to the smartphone, and the phone’s software calculates a dose of insulin and glucagon every five minutes.

The medicine is then pumped through thin tubes to two tiny infusion points embedded just under the skin on the other side of the patient’s abdomen.

The phone also has an app with which a patient can enter information immediately before eating, indicating whether the meal is breakfast, lunch or dinner, and whether the carbohydrate content will be small, large or typical. The device then calculates and dispenses the proper dosages.

Continue reading the main storyContinue reading the main storyContinue reading the main story
The device still requires a finger stick twice a day to get an accurate blood reading, which the patient enters into the phone.

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 adults in the trial each had the constant attention of a nurse, and they lived in a hotel for the five-day study. Most of the time they were free to travel around and pursue normal activities.

The adolescents, 16 boys and 16 girls, lived under supervision in a summer camp for youths with diabetes.

“We need to do a true home-use study, give people the device and send them home,” said the lead author, Dr. Steven J. Russell, an assistant professor of medicine at Massachusetts General Hospital. “Let them do whatever it is they’re going to do without supervision.”

Several authors of the new report have received payments from medical device companies and hold patents on blood sugar monitoring technology.

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.

And the artificial pancreas worked well at calculating mealtime doses without the patient having to use (often inaccurate) estimates and correct a too high or too low reading after eating.

Much more work needs to be done before the device can be marketed, Dr. Russell said. The senior author, Edward R. Damiano, an associate professor of biomechanical engineering at Boston University, has a 15-year-old son with Type 1 diabetes. He said he was determined to get the new device working and approved in time for his son to go off to college carrying one.

Source: nytimes

Skipping meds linked to more hospital visits for kids

Skipping meds linked to more hospital visits for kids

Kids and teens with asthma and type 1 diabetes often don`t take their medication as prescribed, and those that skip doses are more likely to end up in the emergency room, according to a new review.

More than half of children with a chronic illness are put on medication, but past studies have found anywhere from 50 percent to 88 percent don`t take their drugs as prescribed.

“In our experience, most patients and families are surprised to learn how prevalent this problem is, and many clinicians are as well,” lead author Meghan McGrady of the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children`s Hospital Medical Center, said.

She and co-author Kevin Hommel set out to gauge the long-term healthcare utilization consequences of children with chronic illnesses not taking their medicine.

Their review included 10 past studies, nine of which found a link between skipping medication and more hospital visits.

Nine of the studies included children with asthma and the tenth focused on those with type 1 diabetes. Most studies looked at kids between two and 18 years old; one included young adults up to age 29.

Studies tracked children`s medication use through pharmacy refill records, family questionnaires and electronic monitors.

On average, kids with asthma whose families did not fill any of their prescriptions were more likely to go to the ER than children with at least one filled prescription. Likewise, those who rarely refilled their drugs had more ER trips than children who got at least half of their prescribed refills.

For example, one 2007 study of close to 1,500 children found those with no filled prescriptions for an inhaled corticosteroid, compared to one or two, were over 10 times more likely to have an ER visit for asthma.

But the opposite seemed to be true for outpatient and primary care visits. Two studies included outpatient visits and found that the fewer prescriptions a child with asthma had filled, the less likely it was that the child would have an asthma-related primary care visit.

Taking medication as prescribed and regularly scheduling checkups are both part of proper management of chronic conditions, so a child who lags in one category might logically lag in the other, the authors write in the journal Pediatrics.

“It could be that these findings capture the profile of families who have difficulties not only taking their medications, but also attending regularly scheduled follow-up clinic visits,” McGrady told Reuters Health.

According to the American Lung Association, about 7.1 million U.S. children and teens have asthma, and in 2009, there were approximately 774,000 asthma-related ER visits for kids under 15.

Children and teens who don`t take their prescribed medications regularly are at an increased risk of health complications, and also cost the healthcare system more money in the long run, researchers said.

It`s hard to say for sure how much money kids skipping their medication costs the U.S., but estimates suggest non-adherence in general accounts for $100 to $300 billion in healthcare costs each year, Kimberly Driscoll, a pediatric psychologist who studies type 1 diabetes treatment adherence at Florida State University College of Medicine in Tallahassee, said.

“More emergency department visits means more school absences, more hospitalizations and more unnecessary medical expenses,” said Michael Rapoff, who studies pediatric adherence to medication at the University of Kansas Medical Center in Kansas City.

For conditions such as asthma, long-acting medications reduce inflammation but don`t appear to have an immediate effect on symptoms, so some kids are more likely to skip them, Rapoff, who wasn`t involved in the new research, told Reuters Health.

The review did not differentiate between necessary and unnecessary ER visits, but there are acute incidents when kids with asthma or diabetes really do need to go to the hospital, whether they take their medicine properly or not, he said.

“The results of this study have implications for children, their parents and their health care providers,” McGrady said. “In all, multi-disciplinary approaches to adherence promotion are an important part of providing optimal medical care.”

Source: Zee News