Inspiration And Expert Advice: Expert Columns
Technology Conference Highlights the Future of Diabetes Care
By Daniel Trecroci
On October 25-27, 2007, the brightest minds in diabetes technology descended upon the Bay Area for a three-day conference.
Here are some of the highlights:
Measuring Glucose with Infrared Technology
At an October 25th workshop, Orna Amir, Ph.D. of OrSense Ltd. did a presentation on “Noninvasive Continuous Glucose Monitoring Based on Occlusion Spectroscopy.” OrSense’s device uses transmission-based, red-near infrared light to continuously monitor blood glucose. Data were presented supporting the potential use of OrSense’s device as a noninvasive sensor for continuous blood glucose monitoring. In addition to showing acceptable accuracy, the device was safe, painless, and well tolerated.
Measuring Glucose in the Eye
On the same day, Brent Cameron, Ph.D. from the Department of Bioengineering at the University of Toledo in Toledo, Ohio, presented “Advances in Optical Polarimetry for Noninvasive Glucose Sensing.” Cameron discussed possibilities for the eventual development of a non-invasive testing device that measures glucose by shining a light in the eye. Cameron’s theory is that the glucose can be measured in the liquid aqueous humor portion of the eye.
Working Toward an Artificial Pancreas
On October 26th, Robert Mah, Ph.D. of NASA Ames Research Center in Mountain View, California, presented “Closed Loop Control: Is It Rocket Science?” According to Amy Tenderich, a closed-loop device (or “artificial pancreas) is one that combines continuous blood-glucose sensing and insulin delivery. Mimicking the function of the human pancreas, a "closed-loop" system monitors glucose levels and, in response, delivers an appropriate amount of insulin. In his presentation, Mah specified that closed-loop control for insulin delivery can be quite sophisticated to improve performance. In any case, he states, good sensors are the key to its effectiveness.
Computerized Safety for ICU Patients
The same day, Geoffrey Chase, Ph.D. of the University of Canterbury in Christchurch, New Zealand, discussed “Intensive Insulin Therapy and the Artificial Pancreas in Critical Care: Pitfalls, Practicalities and Performance.” Chase presented the results of his team’s SPRINT Glycemic Control protocol, which uses a simple algorithm based on more complex, computerized methods to balance insulin and nutritional inputs to ICU patients on a one to two-hour basis. The goal is to ensure tight control to within a 72-110 mg/dL (4-6.1 mmol/L) range for the patient’s entire stay, which is typically 100+ hours.
“Overall, mortality was reduced 20 to 35 percent for patients in ICU for longer than three to five days—over 50 percent in our cohort—in a 1.5-year trial compared to retrospective patients,” says Chase.
System Keeps Diabetes Professionals on Task
On October 27th, COL Robert Vigersky, M.D. U.S. Army, Walter Reed Army Medical Center talked about “Computer Assisted Decision Support (CADS) for Primary Care of Diabetes.” Vigerksy says that the explosive growth in the number of diabetes therapies makes it extremely difficult for diabetes professionals to maintain familiarity with available options and algorithms. Vigersky says that a CADS system using data from memory meters, current medications and clinical practice guidelines would be expected to improve quality of care. Vigersky’s team has developed a CADS system prototype, which automatically interprets glucose profiles, prioritizes problem areas, and recommends changes in existing treatments. The CADS system receives input from:
- An on-line patient module in which glucose data are uploaded, and medication history, schedule for glucose monitoring, and meal times are verified.
- A customizable administrator module, which includes formulary information, a set of regimens, and rules for warnings.
- A customizable provider module, which sets treatment goals, target glucose ranges and glucose-monitoring schedules. This module displays the data analysis and recommended changes in treatment.
Rapid-Acting Insulin Mimics Insulin Production of Nondiabetics
Also on the 27th, Andreas Pfützner, M.D., Ph.D. from the Institute of Clinical Research and Development in Mainz, Germany, presented data from “Mealtime Glycemic Control Comparing VIAject™ to Lispro.” VIAject™ is a very rapid-acting form of injectable human insulin for meal-time use by patients with type 1 or type 2 diabetes. VIAject™ is made up of regular human insulin and a formulation of other ingredients that are “generally regarded as safe” by the Food and Drug Administration. The insulin is more rapidly absorbed to mimic the effects of naturally produced insulin in people without diabetes. Viaject™ is presently in Phase II clinical studies.
For a complete listing of all of the topics from the Diabetes Technology Meeting, log on to http://www.diabetestechnology.org.