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ADVOCATE: n. [ad-vuh-kit, -keyt]: a person who speaks or writes in support or defense of a person, cause, etc.

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21th Annual Shooting Stars JDRF Walk to Cure Diabetes Sunday, October 23, 2016 in Newport Beach, CA at The Waffle House

For a contribution of $50 (or MORE!), walkers will receive a VERY COOL Shooting Stars Team T-Shirt while supplies last. Contact Joanne if you are interested in attending the event. joanne@TheSavvyDiabetic.com. To donate on-line, please go to: http://tinyurl.com/z5c2x8e.

Savvy Updates 3.27.2017: Immune Response, 2 Types of Beta Cells, Wearable CGMs, Health Apps, Twins

children and twins concept – two identical twin girls in red dresses looking somewhere

As always, lots of news in the T1d community.  Here goes!

Preventing the Immune Response to Implanted Diabetes Devices was reported by Jessica Apple on ASweetLife.org last week. 
JDRF announced a report of one of the first studies to deeply examine the fundamentals of how the immune system interacts with implantable biomaterials. The study was conducted by researchers at MIT and Boston Children’s Hospital and was reported in the journal Nature Materials.
According to JDRF’s press release, tens of millions of people in the United States are living with implanted biomedical devices or devices that penetrate the skin. “By understanding how to target and prevent unnecessary immune responses to the materials used in medical devices, we can provide therapies that work more effectively and with fewer negative side effects,” said Aaron Kowalski, Ph.D., JDRF Chief Mission Officer. The new report, “Colony stimulating factor-1 receptor is a central component of the foreign body response to biomaterial implants in rodents and non-human primates,” could influence the future ability to prevent immune rejection of devices that treat type 1 diabetes.
Read more:
Preventing the Immune Response to Implanted Diabetes Devices
New Research Identifies Novel Target for Controlling Immune Response to Implanted Materials
Colony stimulating factor-1 receptor is a central component of the foreign body response to biomaterial implants in rodents and non-human primates
 
There are Two Types of Beta Cells and One Resists Immune System Attacks, according to a new study published in Cell Metabolism, 7 March 2017, which details a subpopulation of insulin-making beta cells that can resist immune system attacks while type 1 diabetes is developing.
In type 1 diabetes, the immune system attacks the insulin producing beta cells, which over time […]

Savvy Updates 3.12.17: Alexa, Live Stem Cell Imaging, New Cause of T1

Wow, some really neat stuff in the news!
Merck aims to put Amazon’s Alexa to work on voice-enabled diabetes tools, according to a post on FiercePharma.com by Beth Snyder Bulik, 8 March 2017 … thanks to Mike Hoskins for the heads up.
Using Amazon Lex, the brains behind the Amazon Echo device and its well-known voice-enabled assistant Alexa, Merck & Co, in a new partnership with Amazon Web Services, plans to initially work on diabetes. Its first initiative will be a call to entrepreneurs, techies and industry types for an innovation challenge expected to begin within the next month.
The yet-to-be-named challenge will be run by strategy and innovation consultancy Luminary Labs. While specifics haven’t been released, the call to action will “be open to solutions broadly enough that innovators of all stripes can come up with really novel ideas but being narrow enough to provide guidance and carefully evaluate submissions,” said Sara Holoubek, founder and CEO of Luminary Labs.
Read more: Merck aims to put Amazon’s Alexa to work on voice-enabled diabetes tools
 

Live stem cell imaging technique opens new windows into pancreatic regeneration, as posted on www.diabetes.co.uk, by Camille Bienvenu, 3 March 2017. 
Richard Tan, a PhD student from the Heart Research Institute, in Sydney, Australia, has developed so called “bioluminescent” (that emit a light signal in order to track their fate in real time once injected into the body) stem cells as a non-invasive way to give scientists immediate feedback on whether organ tissue regeneration is actually working.
In type 1 diabetes, stem cell-based therapies hold promise to regenerate cells of the pancreas. The goal is to have the stem cells transform into insulin-producing cells.
Read more: Live stem cell imaging technique opens new windows into pancreatic regeneration
Stem cells are […]

T1D Exchange and their First Annual Diabetes Innovation Challenge

This is exciting!

 

 

 

 

 

T1D Exchange and M2D2, a joint venture of the University of Massachusetts Lowell and Worcester campuses that incubates medical device start-ups,  have announced the first annual Diabetes Innovation Challenge (2016).

 

The Diabetes Innovation Challenge will provide up to two awards of up to $150,000 in cash or in-kind services provided by T1D Exchange, M2D2, and Challenge sponsors, including the American Diabetes Association and JDRF.

For this year’s innovation Challenge, nearly 60 innovators submitted their applications for consideration. T1D Exchange has narrowed the list down to 26 semi-finalists.

Now, semi-finalists will pitch their innovations in one of two competitions in front of a panel of esteemed judges (think Shark Tank) with the hopes of advancing to our finals event.

Who We Selected

Semi-finalists were chosen based on a few criteria, including what stage of development their innovation was (either early stage or translational) and whether their solution fit into one of our four innovation categories (a device, diagnostic, therapeutic or technology).

Here’s a quick look at just a few semi-finalists:

from Enable Biosciences, an ultrasensitive auto-antibody test to detect diabetes sooner than what’s possible today

from CamMed, a thin, flexible patch pump for one or multiple injectable medications

from Dibatech, a portable and re-chargeable device that can keep insulin stable at unfavorable temperatures in areas with erratic power supply (focused on third-world countries)

from Sproutel, a smart teddy bear teaching tool that helps young helps children gain hands-on skills in diabetes management (through play)

from Clinitech, an electronic band-aid for noninvasive glucose monitoring

What’s next?

T1D Exchange will host two semi-finals events in late September and early October. From there, finalists will be selected who will present their solutions in late October to another panel of esteemed judges. While award winners will receive […]

Clinical Trial OPEN: Liver-Targeted Insulin More Effective than Insulin?

Trial name: Study of HDV Insulin Versus Insulin in Type 1 Diabetes Subjects

Diabetes type: Type 1 diabetes

What the trial is testing: This six-month study will test the safety and efficacy of HDV insulin, a new technology that directs meal-time rapid-acting insulin toward the liver.

What the trial is measuring: The trial will test HDV insulin’s effect on A1c, fasting blood glucose levels, frequency of low blood sugar (hypoglycemia), body weight, and insulin dose.

Why this is new/important: HDV (“Hepatocyte Directed Vesicle”) technology consists of small molecules that attach to insulin and deliver it to the liver. In people without diabetes, the liver uses up to 80% of the pancreas’ entire insulin production, storing glucose for later release to counteract low blood sugar. The liver houses the only cells in the body that can both store and release glucose; cells in other tissues can use glucose in response to pancreatic or injected insulin, but because they are not exposed to the liver’s glucose-releasing hormone, glucagon, they are unable to release stored glucose to counteract low blood sugar. In contrast, only a fraction of injected insulin reaches the liver, leaving most to act on other tissues.

Targeting insulin specifically to the liver at meal-time is an exciting improvement because it more closely mimics the body’s natural insulin production. Some believe it will bring a lower risk of hypoglycemia and less weight gain.

Safety concerns impeded the testing of an earlier version of liver-targeted insulin called peglispro. This new form of basal insulin was made by Lilly Diabetes for use in people with type 2 diabetes, but issues with liver enzymes halted development. With a different liver delivery mechanism and pre-meal instead of basal insulin, Diasome hopes its HDV technology will […]

Savvy Updates 8/20/2016: Gut Microbiome, Glucagon, UCI’s Dr. Lakey, 3-Drug Combo for Control

Relationship between the composition of the gut microbiome and diabetes is being demonstrated repeated in studies, as reported in Endocrinology Advisor by Tori Rodriguez, August 11, 2016.

In a twin study by researchers at Harvard Medical School, MIT and Seoul National University in South Korea, published in 2016, there is an altered function and composition of the gut microbiome with biomarkers of subclinical T2 diabetes.  Among other systems and processes, microbiota has effects on the immune system, which indicates that it alters inflammatory markets and T cell subset regulation.  A shift in immune response is significant as it applies to T1 diabetes and may be of particular interest for T2 diabetes.  Indeed, as previous research has shown, “while the microbiome of healthy infants becomes more stable and diverse as they approach toddlerhood, the microbiome of those at high risk of autoimmunity become less stable and diverse, which could result in distinct differences in the autoimmune microbiome between healthy children and those with type 1 diabetes.”

The gut microbiome may increase understanding  of the pathogenesis of type 1 and type 2 diabetes.
“The development of type 1 diabetes seems to be associated with a reduced bacterial diversity in the gut, and this phenomenon appears after seroconversion to positivity for diabetes-associated autoantibodies,” says study co-author Mikael Knip, MD, PhD, professor of pediatrics at the University of Helsinki in Finland. “This indicates that the dysbiosis may be involved in the progression from autoantibody positivity to overt disease but not with the initiation of beta-cell autoimmunity,” he said. Additionally, those who progress to type 1 diabetes show a reduced number of beneficial bacteria and an increased number of bacteria with pathogenic potential.”

Read more: Role of the Gut Microbiome in Diabetes

 

Glucagon – […]

Savvy Updates 7/21/2016: CGM Benefits Shot Takers, Sleep & Diabetes Risk, Human Gut Microbiome, Intensive BG Control and Kidneys

CGM Benefits Injection Users, according to the results from Dexcom’s DIaMonD Study, presented at the ADA Scientific Sessions in June, 2016 and reported by www.diaTribe.org, 6/28/2016.  According to Dr. Howard Wolpert of the Joslin Diabetes Center, healthcare providers should consider recommending CGM to ALL patients with Type 1 diabetes who have not attained their glucose goals, not just those on insulin pumps.  Currently only about 7% of MDI users with Type 1 use CGM.

DIaMonD adds to the evidence that CGM improves time-in-range, reduces highs and lows, and improves A1c. This does not come as a surprise since glucose value and trend can be observed every five minutes and alarms sound for lows and highs, allowing people to recognize patterns, tighten the feedback loop, and take action to improve.
I’ve always said that if I were forced to choose between using a pump or using CGM, hands down, I’d choose my CGM.  Even though it is not perfect and you have to make sure not to overreact and overcorrect with such instantaneous data, it gives me trends and patters as well as annoying but necessary alerts.
By the way, DIaMonD stands for Daily Injections and continuous glucose Monitoring in Diabetes.
Read more: Does CGM Benefit Injection Users? Yes!
 

Men Who Sleep Too Much OR Too Little May Have Impaired Insulin Sensitivity … BUT NOT WOMEN, according to a study published on June 29, 2016 in the Journal of Clinical Endocrinology & Metabolism, and reported in EndocrinologyAdvisor.com.
Really?!?!?  Wow, that’s wild!
Compared with men who slept about 7 hours a night, the men who slept the most or the least were more likely to have impaired insulin sensitivity and beta-cell function, putting them at increased risk for diabetes.
However, the researchers found that compared with […]

Savvy Updates: 5/30/2016: T1 and Bacteria, 90-day CGM, Lab Beta Cells, & MORE

Type 1 Diabetes May Be Triggered by Bacteria

Reported by Honor Whiteman, MedicalNewsToday.com, 5/17/2016
A study by researchers from Cardiff University in the UK suggests that a part of a bacterium that activates killer T cells may cause them to bind to beta cells and kill them.
“Killer T cells sense their environment using cell surface receptors that act like highly sensitive fingertips, scanning for germs,” explains Dr. David Cole of the School of Medicine at Cardiff.
“However, sometimes these sensors recognize the wrong target, and the killer T cells attack our own tissue. We, and others, have shown this is what happens during type 1 diabetes when killer T cells target and destroy beta cells.”
Once these beta cells are destroyed, insulin is no longer produced, meaning patients will require lifelong insulin therapy in order to control blood glucose levels.
In other words, Killer T cells go “a little crazy” and kill the wrong guys!
Read more: Type 1 Diabetes May Be Triggered by Bacteria7
 

Eversense 90-day Implantable CGM Receives CE Mark Approval

diaTribe 5/20/2016
Senseonics recently announced CE Mark approval in Europe for its Eversense 90-day implantable CGM sensor, body-worn transmitter (worn over the sensor), and mobile app for viewing real-time glucose data.
Eversense is being positioned as the “world’s first long-term wear sensor,” as current glucose sensors from Abbott (FreeStyle Libre), Dexcom (G4, G5), and Medtronic (Enlite, Enlite 2) require a new insertion every 7-14 days. Eversense uses a 90-day implanted sensor (a bit larger than a pill) that is placed in the upper arm in a 5-10 minute in-office procedure. A rechargeable transmitter device is worn on top of the skin, directly over the sensor, which powers the implant and sends the current glucose value and trend arrow to a smartphone. […]

Savvy Diabetic Update, 1 May 2016: Salk Beta Cells, 5th Autoantigen, Victoza & more

♦ Study produces fully functional beta cells from artificial embryonic stem cells, according to a report in the San Diego Union-Tribune by Bradley Fikes, 4/15/2016 (and also sent to me by 3 different friends living in San Diego!).
Salk Institute scientists say they’ve discovered a key ingredient needed to make functional insulin-producing beta cells.  If these replacement cells can be implanted and protected, they will make insulin as the body needs, just as the original cells do. That means type 1 diabetes would, for the first time ever, be curable.

Salk scientists have created successful patient-derived pancreatic beta cells able to respond to glucagon (red) and produce insulin (green) accordingly. These cells (nuclei, blue) could be transplanted back into patients for a potential new diabetes therapy.
The ingredient is a protein called ERR-gamma that turns up energy production in the beta cells, said Ron Evans, a Salk researcher who co-led the study with colleague Michael Downes.

From left: Salk Researchers Michael Downes, Ron Evans and Eiji Yoshihara
These cells are made from artificial embryonic stem cells, called induced pluripotent stem cells that are typically produced from skin.
Read more: Salk makes step toward cellular diabetes treatment
 
♦ A Major Diabetes Mystery Solved, as reported on the Huffpost Science by Jacqueline Howard, 4/25/2016 and BBC News by James Gallagher, 4/24/2016.
Scientists have previously known that the chronic autoimmune disease involves the immune system attacking four molecules, called autoantigens, in the pancreas. However, diabetes experts have long speculated that a fifth molecule must also be under attack — but they hadn’t been able to identify it until now.
Researchers in the U.K. and Italy have discovered the fifth and final molecule, called tetraspanin-7. Their work could improve diabetes prediction and treatment, said Dr. Michael Christie, […]

Savvy Updates 4/2/2016: Insulin Variability Overnight, Designing for Diabetes, and More …

  What Improves My Healthcare Experience
by Kerri Sparling, 26 January, 2016
Kerri Morrone Sparling has had T1 almost 30 years.  She writes a blog website called Six Until Me, which she started because “I was tired of Googling “diabetes” and coming up with little more than a list of complications and frightening stories.” Back then, Kerri was one of four or five diabetes bloggers … and she writes beautifully and speaks with great passion and a fabulous sense of humor.
This blog is excellent and very worth sharing.  In her closing paragraph, she says, “Life with chronic illness has taught me that the medical system is gross and broken.” Amen, Kerri.  I’m sure we could all contribute our experiences to her thoughts.
Read More from Kerri: What Improves My Healthcare Experience?
 

A New Era in Diabetes Design

Last November, I had the opportunity to attend the DiabetesMine Innovation Summit at Stanford University, with leaders in the diabetes world (product executives, FDA and government directors, user interface researchers and more).  To say the least, it was exciting and so very interesting.
I met Sara Krugman (a T1 since age 5) who is currently lead designer at Tidepool as well as the new iLet/Bionic Pancreas … and Katie McCurdy, lead designer at Open mHealth, user experience strategy consultant at UVM Medical Center and a Stanford Medicine X e-patient scholar.  These are 2 gangbuster amazing women!
They spoke of “good design” which understands and respects the context of its end users … and I felt instantly optimistic that perhaps finally product developers might listen to users and actually learn what is really important to us, as end users.
Thank you DiabetesMine … this is great reading.  A New Era in Diabetes Design
 

Overnight Insulin Requirements […]

The Savvy Diabetic Research Update: 9 March 2016

Senseonics’ Eversense: 90-day Implanted CGM Enters US Pivotal Trial
www.DiaTribe.org, 2/26/2016

This pivotal trial will evaluate the accuracy and safety of the Senseonics’ implantable, 90-day Eversense CGM system. Eversense CGM measurements will be compared to a laboratory reference device at several in-clinic visits over the 90-day wear period.

Current CGM offerings (Medtronic and Dexcom) in the US involve a sensor inserted through the skin and a transmitter that is attached externally to the body; these sensors last only seven days before they need to be replaced (though some people wear them slightly longer). Eversense uses a longer-term, 90-day implanted sensor, which is placed in the upper arm in a simple 5-10 minute in-office procedure. Since the sensor doesn’t contain a battery, a transmitter device is worn externally over the sensor to power the sensor and send the data to a smartphone. Both the smartphone and transmitter will alert the user of a high or low. Even if the phone is out of range, the transmitter will provide on-body vibe alert to indicate a high or low. Senseonics has completed a pivotal trial in Europe, where Eversense is still awaiting approval. If this new US trial finds the Eversense system is safe and effective, it opens the door for a US FDA submission.

For more information about the trial, please contact Emily Gades at 925-930-7267 or egades@diabloclinical.com, or from ClinicalTrials.gov, go to http://tinyurl.com/zlnrqxq

 
CU scientists identify factor that may trigger type 1 diabetes
Aurora, Colorado, 11 February 2016
A team of researchers, led by investigators at the University of Colorado School of Medicine, have identified a new class of antigens that may be a contributing factor to type 1 diabetes, according to an article published in the 12 February 2016 issue of […]