I want you to meet Molly. She’s a CDE and clinical nurse trial coordinator at the Center for Diabetes Technology at the University of Virginia School Of Medicine. She’s a type 1 herself who works with the famous Dr. Boris Kovatchev running cutting-edge Artificial Pancreas trials.
Earlier this year, before you ” met ” Molly — she almost became a statistic. Molly almost died in the early morning hours from a “SH event,” a Severe Hypoglycemic seizure that required EMS intervention and help from a fast-acting spouse. Instead of me trying to retell the story, here’s a link to Molly finally telling her story in her own words in DiabetesMine this August. If you or someone you know lives with Type 1 diabetes, you must read this. Of course, you’ve probably had this happen. My wife has called EMS for me but I have avoided a seizure or trip to the ER.
Here’s a life-and-death detail of Type 1 diabetes: 1 in 20 people, an estimated 2-4 percent and 6 percent in patients younger than 40 years old, will die from severe hypoglycemia. That’s having a low blood sugar that produces seizures, coma and death. Of the estimated 3 million people in the U.S. with type 1 diabetes, that’s approximately 150,000 people. That’s like wiping out Chattanooga, Tenn. or Rockford, Ill. — wiping them right off the map.
The prevention of a ” hypo event” is a deadly serious issue for T1Ds who strive for tight blood glucose control. That’s the catch-22: The better your control is and the lower your A1cs number is, the better chance you have of avoiding the serious, medical consequences of diabetes ( amputation, heart attack, stokes, and blindness to name a few).
The better your control, however, the higher the likelihood of low-blood sugar events (hypoglycemia). Wearing Insulin pumps and continuous glucose monitors (CGMs) all serve as valuable tools for T1Ds in the quest for tight control. However, reading Molly’s near-fatal “bedtime story” makes it clear to me: even the best informed and compliant PWDs ( persons with diabetes) will experience severe lows and their insulin pumps will continue to infuse insulin until the patient or an attending EMS tech turns it off manually.
That’s where the Artificial Pancreas and its Safety Supervision System can provide real technology solutions. And that’s why the AP must be available and soon.
The figure ( reprinted with permission from Molly) shows the course of her near-death experience and how the system would have intervened. Sixty minutes before the ” severe hypo” event the safety system would have alerted the patient and stopped insulin. This alert — think of it as your home’s monitoring system — can send a signal to the patient. And if the patient is sleeping or in what I call a ” diabetes fog — unaware of the pending crash.” it could send an alert to a caregiver or spouse via the system’s remote monitoring capability.
I first met Molly in the summer of 2010 when I enrolled in my first AP clinical trial at UVA. Molly, and her trials colleague Mary, are bright, engaging and positive people. Thanks to Molly and Mary, I’ve enjoyed every minute I’ve spent in the UVA trials — as an in-patient and out-patient. And even though Molly reminds me, gleefully, that her alma mater James Madison beat my alma mater, Virginia Tech, in a football game recently in Blacksburg — I can’t imagine going back to UVA in the future and not seeing her smiling face.
Molly gets ” the need” for more clinical trials and why the Artificial Pancreas is so critical to our long-term health. For all T1Ds who wake up at 2 or 3 AM to treat a low blood sugar and sit in the kitchen wondering what happens the next time our sugar drops below 40, we know why the AP and better technology must be available in the United States. The safety shutoff is available to insulin pump and CGM wearers NOW — in Great Britain. It’s time for the United States to stop leading from behind and move to the front on diabetes technology and research.
Our lives — and Molly’s life — hang in the balance.
Have Artificial Pancreas; Will Travel.
That’s the word today from Daniel Cherñavvsky, MD, CRC with the University of Virginia Health System. “Yes, we completed the trial in Santa Barbara and the following article published in Diabetesmine.com talks about it.,” Dr. Daniel tells me. “We are ready to do the trial overseas” in France and Italy next.
Yes! The AP outpatient trial was done with participants in California in April and provided more details and data. For Daniel, the next stop on the road trip is to bring the technology to his research colleagues in France and Italy. This is all building toward home trials — yes, home trials in the real world in 2014 — by PWDs ( persons with diabetes) while being closely monitored by doctors and researchers via remote technology!
Here is a brief excerpt from the Diabetesmine.com article.
“This is all very exciting! Although when you think about it, 48 hours is a pretty short timeframe to get a realistic read on any PWD’s ongoing patterns of glucose swings. I wondered how realistic the algorithm patterns were…
“We’re just dipping our toes in the stream right now,” Dr. Howard Zisser said. “We’re going with our ‘best guess’ until we can do week-long studies.” Meanwhile, patient Jim wasn’t complaining a bit over 48 hours of long-awaited freedom. “It’s soooo nice — I don’t have to do anything!” he crooned, with his eyes all a’twinkle. Dr. Zisser just grinned. “We’re learning and developing things along the way,” he said. “It’s like the space program. We’re going to the moon, and along the way we get Tang, and who knows what other innovations that come out of the process?”
First, my apologies to followers or readers of We R the Cure — I’ve owed you a follow up to my experience wearing the actual Artificial Pancreas in a clinical trial at UVA since late March. Here is part 2.
Second, the headline of this post could have been written by thousands of Americans who are living with Type 1 diabetes and keeping ” Hope Alive ” that a solution like the AP is coming. Of course, solutions and “cures” have been promised by doctors, researchers, fundraisers and good-hearted volunteers for decades. I don’t believe in the tooth fairy either.
So rather than bore you with my prediction of when the AP will be built, approved and commercially available, I suggest you Google or Bing the topic and take a deep dive into the facts and the promises surrounding ” WHEN ?”
Here are some of the things I learned from my 24 hour period with Dr. Boris Kovatchev and his amazingly talented team of doctors, nurses, researchers and technology pioneers at the UVA Center of Diabetes Technology in Charlottesville, VA. Hopefully, you’ll see something here that gives you a dose of optimism for our future. A future filled with less daily stress and better diabetic health.
- Dr. Boris said he’s having ongoing talks with insulin pump companies, smartphone technology providers and other manufacturers. His message is: the AP worldwide consortium needs better high tech equipment — to get the AP prototype to the finish line faster. If the human clinical trials continue to meet and surpass expectations, there is an expectation that manufacturers will remain fully engaged.
- Attachments. I was wearing a 3 ring circus of “stuff” during my AP clinical trial: A) basic Tandem t:slim insulin pump, B) Two, yes 2, Dexcom 4 CGMs, and C) A Sony droid smartphone and CGM receiver with a “brain” — an algorithm designed to react to my blood sugar readings every 5 minutes and make adjustments if needed to keep my levels as close to ” a control or flat line” reading. Being a human pin cushion is the downside of participating in a diabetes human clinical trial. In the future, the technology must evolve so Type 1 Ds will feel more like ” IRON MAN ” — wearing the coolest technology — and less like ” FRANKENSTEIN” with bolts in my neck. Despite the tubing, monitors and fanny pack, I did not look like the patients who wore their insulin pump strapped to their back like a Jet Pack in the early days of diabetes research.
- Attachments, Part 2. The good news is : The smartphone and CGM technology is working and all happens via Wi-Fi and Bluetooth. Very Cool. Very Exciting. You can carry it with you and walk without an IV or extension cord when you go out for lunch and dinner. I felt kinda like a lab rat walking free. That is what the AP offers Type 1′s – a dose of freedom from diabetes management.
- The new power/hardware design appeared to work well in my trial. Next step for the UVA team: Repeat the software and hardware clinical trials performed at UVA at the University of California at Santa Barbara in May with 5 participants. If it works well there then the next step is to take the AP prototype to the consortium partners in France and Italy and repeat the same trials overseas.
- Gather the research evidence from all of the 2013 trials and present it to the FDA and others who are involved in the AP project. Report the findings and set up the 2014 human clinical trial test agenda: AP home trials. Yes, home trials with remote 24/7 monitoring of patients who are wearing the AP prototype as they go about their normal daily routines ” OUTSIDE ” of the research hospital settings.
- Finally, as I was wearing the AP for 24 hours — Dr. Boris and his research team was montoring my glucouse control from the hotel room adjoining my room, or from their UVA office on Main Street or — better yet — from their laptop while sitting in the Atlanta airport waiting for a flight back to Charlottesville. The device is capable of 24/7 remote monitoring access. Amazing.
I’ve got renewed hope and excitement about the AP. How long before we’re all able to wear one? I’m hoping for three to five years. It’s going to take
more time, brains, private sector investment and more research dollars to make this a reality. As many Type 1 Ds or Diabetes Online Community members have said before me: ” the solution is coming; it’s my job to keep myself in the best possible shape — to closely monitor and control my sugar levels — so I’ll be healthy enough to benefit from the AP when it arrives.”
It’s not a cure for diabetes. That’s still our goal. But, the AP ship is sailing on the horizon and is about to dock. I want to be ready when our ship finally comes in.
OK, so the headline might be a little bit over the top. My apologies. However, I was wearing the ” Future ” of high tech diabetes self-management, and it was amazing, incredible and a breath of fresh air.
I was blessed to actually plug in and wear the Artificial Pancreas in a human clinical trial at UVa on March 14 and 15. The AP is not exactly like clicking the Arc Reactor into your chest, but the two devices are similar. It is a new, high-tech device that brings the promise of: better health; less daily stress for you and your family, and the powerful hope of fewer long-term medical complications from diabetes such as blindness, heart attacks, strokes and amputations.
For 24 wonderful hours, I felt like Iron Man — without the cool cars, the ability to fly, the Malibu mansion or the lifestyle of Robert Downey, Jr. But the experience was still “Super Hero-like” for someone like me who has battled the ” Super Villan” Type 1D for 14 years and been unable to achieve consistent glucose control. The AP is not a cure for diabetes, but it does offer a solution or pathway to better health outcomes for the 3 million Americans living with Type 1 diabetes.
After missing an opportunity to participate in the last AP trial, this time I passed the FDA’s strict health screening ( done May 11) and was invited by the research team at the UVA Center for Diabetes Technology to participate in a shortened outpatient trial. Recently, the UVA team successfully completed a 48-hour pilot study with 5 individuals — to prove that a ” wearable AP is feasible and safe; therefore its continued testing and refinement for outpatient use is warranted,” according to Boris P. Kovatchev, Ph.D., the lead investigator and Director of the center.
In the prior study, the AP participants led a ” normal ” life and were able to eat and sleep without the constant finger pricks and mental burden of ” how’s my sugar doing now?” Check out Tom Brobson’s video story of his UVa trial experience. This was the first out-patient study done in the United States.
As a follow-up to this clinical trial, my one-person study was not designed to test the AP algorithm or to determine if the software worked. We know the AP works — and it worked again for me in this trial! The UVa team called me for a ” dry run” test to see if a new hardware solution — a fix to provide an uninterrupted source of power to the AP and the CGM — would prevent the battery ” burn out” that happened during the previous trials. This is where ” BRICK 1 ” comes in. The researchers designed a new power and communication system to be combined within one unit. The good news: the ” Brick” designed appeared to work exactly as the researchers expected during my 24-hour test, providing consistent data reporting with no gaps!
The team put the AP SmartPhone, CGM, Bluetooth wireless communication equipment all together in ” Brick 1″ — this is what I carried with me and how I communicated with my insulin pump. And instead of staying put in a hospital or hotel room, I was able to carry the AP/CGM Brick with me as I walked to dinner at the College Inn on ” The Corner” across from campus and again for lunch on Friday. As Dr. Boris joked with the local NBC TV reporter, “this is the first time ever anyone with the artificial pancreas has been outside walking in a parking lot.” One small step for man, one giant leap for AP research!
Dr. Boris, Dr. Daniel and Benton Mize, the computer engineer working on the AP design, said the Federal Drug Administration (FDA) — which is regulating and monitoring all human clinical trials performed in Charlottesville and the 4 other AP consortium universities in the USA, France and Italy — needs clinical proof the technology works and that patients in non-hospital trials will be safe from low glucose episodes. The technology must give researchers uninterrupted remote monitoring capability of participants on a 24/7 basis when AP home trials start in 2014.
My bottom line — the AP worked as advertised. I was involved in determining my meal boluses and counting my carbs ( the control factor). The AP was able to operate in ” safe mode ” while I slept and ” closed loop” mode while I ate dinner or exercised. It essentially acted like a normal pancreas does providing sugar control automatically. The CGMs and the AP monitored my sugar every 5 minutes and adjusted by basal rates ( baseline insulin dose) up or down to help me achieve the best possible glucose control with the least amount of work.
And thanks to the AP and the awesome team at UVa, I had the freedom to go to bed and sleep all night with no 2 am lows. I maintained a Flat Line sugar reading overnight and woke up the same — and that’s a “Super Hero” result and the promise of a bright future for everyone living with Type 1 diabetes.
Next post: I’ll add a few more observations from my clinical trial; Dr. Daniel’s trip to the University of California for a new outpatient clinical trial with the AP and “BRICK 1″; and Dr. Boris’ talks with manufacturers to get better quality technology for the AP.
A few years ago, a child under the age of 9 years presented this to a room full of adults at a JDRF fundraiser in Richmond, VA. Her concise and beautiful talk captivated the room. It says a lot about the daily grind of a child, a parent caring for a child, or an adult living with Type 1 diabetes. More than 3 million Americans face this daily Type 1 D drama in order to stay alive.
As 2012 ends and 2013 begins, it’s time to energize We R the Cure. Here’s my starting point.
I encourage you to try this simple yet realistic “day in the life” of a person living with diabetes. To feel what it’s like to test your blood sugar like me, put a rubber band around your wrist and snap it each time you see my handprint or needle. Eight times or more a day.
- I woke up low at 2 AM. Mom had to check me. Finger Stick.
- Check before breakfast and my first shot.
- Gym today. The nurse checks me before I can participate.
- Mom or I check before lunchtime. Finger Stick. Shot.
- Soccer practice after school. Finger Stick.
- Suppertime. Finger Stick. Shot.
- Before Bedtime. Finger Stick. Snack or Shot.
- Bedtime. Finger Stick. Snack or Shot. I am OK.
JDRF today called the Food and Drug Administration’s (FDA) final artificial pancreas guidance a milestone in advancing better treatments for people with type 1 diabetes (T1D)-one of JDRF’s key goals.
The final FDA guidance issued Friday provides, for the first time, researchers and industry with a clear and reasonable roadmap of the FDA’s expectations for conducting human studies of artificial pancreas systems, and for their approval for marketing to people with diabetes.
JDRF first proposed draft guidance to the FDA in March 2011, after convening an expert panel of clinician researchers to assess the best ways to measure safety and effectiveness of artificial pancreas systems. JDRF then led an extensive scientific and patient advocacy campaign to encourage the FDA to adopt its recommendations. JDRF provided extensive comments on the FDA’s draft guidance, released in December 2011. The FDA’s final guidance incorporates nearly all of the recommendations made by JDRF and the clinical community.
“This FDA guidance is an important milestone in improving lives of people with type 1 diabetes,” said Jeffrey Brewer, president and CEO of JDRF. ”JDRF commends the FDA for its scientific leadership in the area of artificial pancreas systems, which have the potential to be the most revolutionary advance in treating type 1 diabetes since the discovery of insulin. Until we can cure this disease, we have an obligation to reduce the daily burden of managing it and enable people with the disease to live healthier lives.”
Today’s technologies for managing T1D leave millions exposed to substantial risks of blood sugar levels that are either too high or too low, despite their best efforts to maintain tight control of their diabetes. These extreme blood sugar levels can have serious consequences. High blood sugar levels (hyperglycemia) can cause long-term complications including heart disease, blindness, and stroke, and low blood sugar levels (hypoglycemia) can be life-threatening.
The FDA’s final guidance allows for a range of scientifically valid study designs, allowing flexibility that will encourage innovation in technologies for people with T1D while ensuring thorough evaluation of such systems before they can be prescribed by doctors. For example, the guidance recognizes “time in range” as a potential endpoint to use in artificial pancreas studies, as well as other measures of glucose control. It allows sponsors the ability to propose statistical measures of efficacy tailored for their systems, and accepts the use of continuous glucose monitoring (CGM) data in evaluating artificial pancreas systems.
For more information contact: William Sorensen, JDRF, 212-479-7558; email@example.com
This is a cool idea! Zip the Cure is a unique fundraising opportunity through JDRF for the ultimate reward: a cure for type 1 diabetes (T1D) and its complications. Originally created by 17-year-old Monica Oxenreiter from Pittsburgh, PA, Zip the Cure (ZTC) allows you to “sponsor” a zip code in the U.S. for just $50. The money goes to JDRF to fund type 1 diabetes research to cure, treat, and prevent T1D.
Here’s how it works:
• To sponsor a zip code go to zipthecure.com and use the search to find your zip code. If it’s already sponsored, you can choose another one close to you, or maybe the zip code of your child’s school; where you were born, or where your grandparents or relative lives. You can sponsor any zip code anywhere you desire!
• Each zip code costs $50 to sponsor. Imagine if we sponsored all the zip codes in the United States – that would be more than $2 million to support JDRF!
• There is no limit to the number of zip codes you can sponsor.
• You can name your sponsored zip code in honor of someone, in memory of a loved one or for yourself.
• You will “own” your zip code through the end of the calendar year. On January 1st, the map resets.
Let’s try and sponsor all the zip codes in our area. For any questions please visit zipthecure.com.
Until yesterday, I had never heard of the JDCA, the Juvenile Diabetes Cure Alliance, in my 14 years of living with Type 1D and volunteering in my local diabetes community.
Now I have. This month, the JDCA has introduced its latest report , “Is Type 1 Cure Research Funding Focused Enough?”
The report takes a look at a very important issue relating to cure research. Are the organizations being too broad when it comes to outlining plans for a type 1 diabetes cure and when funding projects? Based on JDCA’s research and the fact that there is no cure on the horizon, the non-profit’s analysis suggests that this is the case. The JDCA report says, “Without clearly defined goals, the non-profits are funding a wide array of research projects. As a result, a lot of money goes into efforts that are not working to deliver a Practical Cure for type 1 diabetes. This diverts resources from those projects that are working towards a specified cure goal that could help people now living with the disease.”
If you’re living with this chronic disease, you wanted a cure YESTERDAY. It’s been over 40 years since a group of parents founded the JDRF at their kitchen table and yet We R still seeking a Cure.
In order to improve the quality of life for Type 1Ds, it’s important to listen and gather as much relevant information as possible. We must keep asking the researchers, organizations and manufacturers “When?” When we will see real progress. We must push them to be smarter and more targeted with a limited amount of dollars because We R the Cure. We R doing this for ourselves and the generations to come.
The JDCA is a self-funded non-profit that aims to educate donors and prompt transparency in the charitable organizations that raise money to support research. JDCA says it is an independent analyst of the type 1 diabetes charitable universe and brings a business-like perspective to focus research toward a Practical Cure. Their mission is to direct donor contributions to the charitable organizations that are most effective at allocating funds to research opportunities that maximize chances of curing type 1 diabetes by 2025.