Written by Jill M. Paulson, M.D., ECNU
September 6, 2014
‘Bionic Pancreas’, ‘Google Contact Lens’, and ‘Inhaled Insulin’ are just some of the futuristic-sounding diabetes technology that has filled the news recently. Below is information about them:
Bionic Pancreas
This is truly exciting. Not only in an I’m-An-Endocrinologist exciting way, but for everyone who has diabetes or who knows someone with diabetes. Almost everyone reading this will fall into one of those two categories.
While most patients in this country have type 2 diabetes (formerly called Adult Onset Diabetes), at least 5-10% have type 1 diabetes, formerly called Juvenile Diabetes. This disease is distinct in that the patient’s pancreas produces no insulin whatsoever and they are reliant on injectable insulin to live. With all types of diabetes, good control of blood sugar, but without low blood sugars, is vital to reduce the risk of long-term complications, short-term complications, and to improve one’s quality of life.
A New England Journal of Medicine article published in July of this year gives hope for a ‘bionic pancreas’ in the not-too-distant future. In two studies over 5 days, a ‘bionic pancreas’ was tested. All participants wore a small sensor (continuous glucose monitor) in which a small needle constantly monitored the study subject’s glucose level in real-time, through tissue fluid. Additionally, a pump in the form of an iPhone was worn. The sensor was connected to the iPhone and two hormones were automatically injected in to the patients based on an algorithm pre-programmed in to the iPhone. Insulin was infused, as was a hormone called glucagon, which increases blood sugar and works to counter the effect of insulin. This hormone is deficient in patients with type 1 diabetes but is not normally given as part of the treatment.
In one study, 20 adults wore this device for 5 days around Boston. In another study, 32 adolescents at a camp for diabetes wore the device for the same amount of time. They still had to check their finger stick blood sugars to calibrate the continuous glucose monitor a few times a day. Additionally, they were allowed to eat and exercise as they wished. The results of both studies showed that the mean glucose level was lower in both groups compared to a control period when they wore their usual insulin pumps.
Importantly, the researchers found a 37% reduction in interventions for low blood sugar (hypoglycemia) in adults wearing the device and also a decrease in interventions for hypoglycemia in the adolescent population. Avoiding hypoglycemia is crucial because prolonged episodes can lead to complications including impairment of functioning, loss of consciousness and rarely, even death.
Larger trials are underway for this wearable technology. I believe that we will all see a device like this come to market in our lifetime. This also serves as a great base, as the technology may be extractable to all patients with diabetes, not just those with Type 1.
Google Contact Lens
Google and Novartis are teaming together to develop a prototype of a smart contact lens that will continually measure glucose in tears through a miniaturized glucose sensor built in the lens. One of the huge barriers for diabetic control in people who need to check their blood glucose is actually checking it. Many find it painful, inconvenient, or forget to do it. Others may wear a continuous glucose monitor that has a needle under the skin that continually samples tissue fluid for glucose levels.
However, a less invasive method has always been sought. While this is years away, the Google and Novartis technology is promising.
The press release with a link to the explanation of the technology can be found:
Inhaled Insulin
An inhaled insulin, Afrezza, became FDA approved this summer. It is the first inhaled insulin to come to market since Exubera, another inhaled insulin that was only available from August 2006-October 2007. Afrezza is a dry-powder formulation of human regular insulin. It is indicated for adults over the age of 18, with type 1 or type 2 diabetes who require insulin at meal times. It should not be used in children, pregnant women, women who are breastfeeding, or patients in diabetic emergency called ketoacidosis. There is an FDA warning not to use this medication in patients with lung disease or those who smoke. In fact, it is recommended that all patients be evaluated with a history, physical examination and lung function testing prior to initiating this medication. Lung function testing will need to be continued at set intervals.
Excitement for inhaled insulin has not been high amongst endocrinologists and internists. Though short term studies have shown inhaled insulin to be non-inferior to subcutaneous insulin, the risk of side effects, delivery route, and other suspicions are still out there. With the ease of insulin delivery in commonly used insulin pens, known efficacy of the current insulins, and willingness for patients to inject themselves after a trial period, time will tell whether this different modality of inhaled insulin will be adopted. Or, will it meet a similar fate to the prior inhaled insulin on the market?
Other References:
Russell SJ, El-Khatib FH, Sinha M, et al. Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes. NEJM July 2014. 371: 313-325.
Novartis to license Google “smart lens”
http://multimediacapsule.thomsonone.com/novartis/alcon-announcement
FDA approves Afrezza to treat diabetes
http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm403122.htm
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