A Focus on Diabetes Technology for Families
The latest on using technology in your daily life.
By Margeret Nguyen, diaTribe
On February 1-2, we attended the Children with Diabetes (CWD) Focus on Technology Conference in Crystal City, Virginia. It was an enormously enjoyable and educational weekend. There was a fantastic line-up of speakers on topics including the artificial pancreas and the practical uses and incorporation of diabetes technology into daily life. Parents, children, and adults with type 1 diabetes who have grown up with the "CWD family" were also able to connect and share stories of difficulties and how they worked past those struggles. The following are highlights of what was discussed at the sessions.
Dr. Edward Damiano's Quest to Develop an Artificial Pancreas
Dr. Edward Damiano of Boston University discussed his exciting research on the artificial pancreas (also called the "closed loop") and explained the experiments that have helped him and his colleagues progress to their current closed-loop system. His newest system uses an iPhone running a control algorithm, two Tandem t:slim insulin pumps (dosing insulin and glucagon), and a Dexcom G4 continuous glucose monitor.
Dr. Damiano began his talk by discussing his inspiration for building an artificial pancreas: his son who has type 1 diabetes. His goal is to build a system that could regulate his son's blood glucose levels automatically and with minimal user intervention. Dr. Damiano and the Boston-based Bionic Pancreas research group first tested their insulin and glucagon algorithm in pigs without functional beta cells and have continued their research all the way to humans. In his last published study, the algorithm, which only needed information about the subject's weight for initialization, was able to control blood glucose levels even when the participants were exercising on stationary bicycles. These initial studies helped the research group improve the algorithm so that it could better control blood sugars.
Algorithms Learning for a Lifetime
After reviewing previous studies, Dr. Damiano discussed an unpublished bihormonal closed-loop study with adolescents and adults. He explained that adolescents require two to three times more insulin for their size than adults because of puberty and that they are physiologically very different from adults. But even with this fact, he wanted to build a single type of device with one algorithm that someone could ostensibly use their entire life. A CGM provides 288 blood glucose values every day (one value every five minutes); with the data collected over days and weeks, their adaptive algorithm automatically adjusts insulin dosing to the person's needs and responds to even the most challenging of cases. In the unpublished adolescents and adult study, the algorithm controlled the blood glucose levels of adolescents and adults extremely well. When a user gave a single automatically adaptive insulin bolus before meals, the results were somewhat better in adolescents, but only marginally better in the adults. This convinced the Bionic Pancreas group that a fully reactive system in adults is entirely practical, but the occasional pre-meal bolus in adolescents might be justified for optimal care.
Future Studies: At Home Trials of the Artificial Pancreas
Dr. Damiano and his colleagues plan to test the prototype closed-loop system in subjects outside of the hospital, and investigate if the device is safe to use when people are living their everyday lives. Each study tests the adaptive algorithm and device in a new way and involves less in-person surveillance. The first study, called the Beacon Hill Study, will have subjects remaining within three square miles of the hospital, staying overnight at a hotel for five days, and eating and exercising as often as they'd like while using the device; the second study will include adolescents at diabetes camp for eleven days (five days on the device and five days under their usual care); and the third will involve hospital employees who go about their normal routine (including going home after work) for two weeks. The research group hopes to conduct a pivotal six-month study that tests the final version of their system in 2015. Dr. Damiano explained that his goal is to have a commercial launch for the closed loop system by 2017, which is when his son would start college.
Parents Session on Helping Their Teens Manage Diabetes
In the evening, Dr. Jill Weissberg-Benchell, from Northwestern University, and certified diabetes educator and registered nurse Natalie Bellini spoke to parents about how to talk to their teens and work with them as partners. They asked parents to place themselves in their children's shoes, and recall what their interests and emotional states were when they were teenagers. Then they asked parents to imagine what it is like to be a teen and have the added responsibility of managing diabetes.
One of the online diabetes groups I belong to (but don't frequently post to) is geared towards "frum" (Orthodox or "observant") Jewish people with (mostly type 1) diabetes. Most of the chat on the mailing list centers around people needing last-minute supplies before Shabbat or a holiday, where to acquire supplies and get medical help when visiting Israel, and advice on which pump is best for one's type 1 child — in other words, the usual sort of diabetes chatter, but...