The “Who and What” For the Future of Artificial Pancreases was shared by Alex Parrott for TheSugarScience.org, 14 March 2021.
Artificial pancreas development is constantly being studied and improved upon. The more intuitive the pump, the easier the life of the pump-dependent person will be. The two most impactful times on a diabetic’s hemoglobin A1C levels (HbA1c) are after meals and during physical exercise. Postprandial spikes are a major cause in hyperglycemic spikes and are typically caused by missed meal boluses or a delayed bolus. On the other side, not compensating for physically demanding activities is the main cause of hypoglycemic drops.
Dr. Garcia-Tirado and the Center for Diabetes Technology at UVA have made groundbreaking developments in the world of artificial pancreases. The Center for Diabetes Technology also has the PADOVA Simulator which is an FDA-approved in silica way of testing and studying all aspects and variables that affect insulin delivery and artificial pancreas developments. They have developed two APs; The first is Rocket AP that can intuitively predict when someone is about to eat, and the second is an exercised informed closed-loop system AP that can predict when physical activity is imminent and suspend insulin delivery.
The Rocket AP has many technological elements that come together to achieve the goal of predicting meals, but one of the more important elements is the bolus staging system. Since this is a closed-loop AP, meaning the glucose monitor and the artificial pancreas are able to communicate directly, as the CGM reports a trend of higher glucose readings the pump primes a bolus for delivery. It can prime a bolus and then deliver fractional amounts of that bolus instead of all at once. This allows it to keep incrementally delivering more insulin until the CGM reports blood sugars returning to a normal range. The system can also back off on the delivery if it thinks the person may not be eating or is just having a small snack.
The APEX system went through thorough testing by combining the algorithm with commercially available monitoring devices such as a Dexcom G6 CGM and a Sony Smartband. When the system is informed of exercise during a set time frame it can plan ahead to suspend an insulin bolus. Their studies showed about 90 minutes before exercising is the optimal time to suspend the insulin bolus for the proper glycemic control. The results showed a significant decrease in subjects exposed to hypoglycemia.
Digital diabetes management developer Glooko has raised $30 million to continue its growth, fueled by rising demands for telehealth programs plus multiple partnerships maintained with health systems and biopharma industry companies over the past year.
Its software collects data from glucose meters and continuous monitors as well as from insulin pumps, pens and wearable activity trackers—which Glooko began offering for free in early 2019. The company currently lists more than 3 million users in 27 countries.
“This is an unprecedented time in healthcare and technology,” said Glooko CEO Russ Johannesson. “Now more than ever, the healthcare industry is seeking new and smarter technologies, whether it’s for patient care or researching new therapies.”
Clinical Trial Tests Stem Cell Therapy to Cure People with Type 1 Diabetes was reported by Matthew Garza for diaTribe.org, 15 March 2021. Vertex’s new cell therapy, made from stem cells, aims to replace insulin-producing cells in people with type 1 diabetes. The therapy will soon begin testing in clinical trials to determine its safety and efficacy.
Dr. Doug Melton founded Semma Therapeutics, a biotechnology company that pioneered the use of stem cell-derived human islets as a potentially curative treatment for type 1 diabetes. They made several major scientific advances, including the ability to produce large quantities of working human beta cells that restore insulin secretion, and they were acquired by Vertex in 2019.
Vertex Pharmaceuticals has since built on all of this groundbreaking and foundational work that began in Dr. Melton’s lab and Semma Therapeutics. Vertex recently announced that it will soon launch a clinical trial for VX-880, a therapy for type 1 diabetes. VX-880 is the first “fully differentiated stem cell-derived islet cell therapy.”
Type 1 diabetes occurs when the immune system, a complex network of cells and proteins that defend the body against infection and keep you healthy, attacks the beta cells in the islets of the pancreas that produce insulin, called islet cells. Researchers believe that it is possible to replace the damaged islet cells with new healthy cells, but this might also require a way to prevent your body’s immune system from attacking and destroying these new cells. This would essentially be a possible cure for type 1 diabetes. This is where stem cells come in.
Stem cells have not yet developed into the mature cells that make up our organs and tissues, such as the cells in the bones, heart, brain, and essentially every part of the body. Stem cells form the pool of cells in the body that can turn into one or another of these specialized cells, but to do this they must receive specialized instructions. For example, a stem cell can become a new blood cell under the right conditions and with the right biological instructions. To make cell therapies, like VX-880, stem cells are grown in a lab and instructed to become islet cells that are able to produce insulin. They can then be transplanted into someone with type 1 diabetes. Type 1 diabetes is not the only disease in which stem cells might be a cure, whether they become specialized in a lab or inside a person.
Trial location: Sites currently include the University of Miami Health System, the University of Pennsylvania, and Massachusetts General Hospital. More sites may be added.
You may be eligible to join the study if you are 18-65 years old, have been diagnosed with type 1 diabetes for at least five years, have had at least two episodes of documented severe hypoglycemia in the past year, are on a stable diabetes treatment plan, have used a continuous glucose monitor (CGM) consistently for at least three months prior to screening for the trial, and are willing to use the CGM during the trial, and have not had any prior islet cell transplant, organ transplant, or cell therapy
Read more: Clinical Trial Tests Stem Cell Therapy
Joslin Investigators Join New, Regional Center of Excellence Focused On Research Towards a Cure for Type 1 Diabetes was reported by Joslin Communications for Joslin.org, 1 March 2021.
Joslin Diabetes Center is excited to be a part of the new Juvenile Diabetes Research Foundation (JDRF) Center of Excellence in New England. This new center will be a cross-collaboration among Joslin, the Harvard Stem Cell Institute, the UMass Diabetes Center of Excellence at UMass Medical School and The Jackson Laboratory.
Research experts from each institution, including Drs. Stephan Kissler, Jason Gaglia and Peng Yi from Joslin Diabetes Center, will focus on examining how insulin-producing beta cells generated from stem cells may be able to bring us closer to a cure for type 1 diabetes.
“We are extremely excited that the JDRF has decided to support a Center of Excellence in New England. The Center will solidify our ongoing collaboration with the Melton lab at Harvard and will help forge strong new ties with outstanding type 1 diabetes researchers at the University of Massachusetts Medical School, whose expertise perfectly complements our own. As a group, and with JDRF’s support, we will try to tackle some of the most difficult challenges in working towards a cure for type 1 diabetes,” said Stephan Kissler, PhD, Joslin Investigator and Associate Professor of Medicine at Harvard Medical School.
Here’s an interesting read from TheSugarScience.org’s Monthly Woven Spotlight: The Orchestra of the Pancreas: Cellular Neighborhood, by James LeFevre.
Like an orchestra, there are a multitude of cells in the pancreatic islets playing together in a symphony to maintain glucose homeostasis—alpha, beta, delta, pancreatic polypeptide, and epsilon cells. As it turns out, we’ve had our ear plugs in too far and haven’t been able to hear the whole beta cell section until recently. Evidence has shown that beta cells are not a homogenous population, but instead heterogeneous with four different types. So, let’s turn up the volume some more and try listening to the melodies of the beta cell section.
Read more: The Orchestra of the Pancreas