a peek into gnanagurudasan prakash prakasam md mrch mha center of excellence in diabetes &...
TRANSCRIPT
Prakasam 2015
Technology in Diabetes – today and tomorrow!No cure as yet, but…
A Peek Into
Gnanagurudasan PRAKASH Prakasam MD MRCH MHACenter of Excellence in Diabetes & Endocrinology&Sutter Children’s Hospital, Sacramento, CA
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Disclaimer
Goal is not to cover the entire topic of all new advances but to give you a taste of what is happening.
I am not endorsing any product (approved on unapproved in the US or anywhere else).
In the time I have, I will only be able to touch upon many areas and this lecture no means covers every aspect of treatment in Diabetes
Culturally and Economically appropriate treatment improves outcome in diabetes management
Our Care Model In Sacramento Coordinate initial
stabilization in the ED followed by care in the PICU.
Once stabilized - Teaching of self management on the pediatric floor along with introduction to our support system including social network and research.
Systematic approach to reduce length of stay while maintaining quality
Discharge from hospital is followed by outpatient coordination: daily phone calls with MD team meetings school nurses education teleconference journal clubs support groups MD follow up
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SW
MD
RN
RD
DP
CDE
PENS
SchoolSN*
Ped End
o
* Social Network
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On the WEB!
Sackid INFO – YouTube channel
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Videophone Technology Year – 2003. Connect and dial like a
regular phone call. No-show rates reduced
by 90% American Telemedicine
Chose this as one of the top 10 research presentations for the year.
However, CCS told us that it was home health care and did not qualify as medical service.
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Story of Vibhav In India
Digital Doctors KVIE video link(20:12) Insulin dependent at 3 months of age ( S/P
pancreatic surgery). Today –He is a healthy 13 year old using an
insulin pump and glucose sensor in his hometown Kolkatta, India.
In person and telemedicine care. And of course connected to our SN
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Glucose Monitoring
anTcient method modern method
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Glucose Monitors – NOW!
http://main.diabetes.org/dforg/pdfs/2015/2015-cg-glucose-meters.pdf
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The Connected Meters! The Connected Device -
interactive blood glucose monitoring system works a lot like your current meter but also automatically transmits blood glucose readings, activity information, and how you’re feeling to provide a real-time picture of your health.
The Smart Cloud- develops the insight. It analyzes the data, determines what should be done, and gives instant feedback that leads to effective self-management.
The Care Team – CDE to interact when needed
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The prototype of the first pump that delivered glucagon as well as insulin, backpack style, was in the
early '60s.
Omni Pod - the world’s first tubing-free insulin pump.
Insulin Delivery Modes Insulin Pumps
How far have we come?
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Insulin Delivery Modes Insulin Pumps
•provide continues insulin delivery
•infusion site needs to be changed only every 2-3 days
You cannot learn about all of them!
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Choices – Pumps
http://main.diabetes.org/dforg/pdfs/2015/2015-cg-insulin-pumps-chart-update.pdf
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V-Go for type 2 Diabetes The V-Go is an insulin pump for
people with type 2 diabetes that’s replaced every 24 hours.
Because it doesn’t use electric power from a battery, some, call it a disposable insulin delivery device instead of a pump.
Like a patch pump, the device sticks to the body and delivers a continuous stream of rapid-acting insulin at a rate of 20, 30, or 40 units of insulin per 24 hours, depending on model.
At mealtime, a user can press a button to deliver an additional 2 units per push, for a max bolus of 36 units.
How does the V-Go get by without power? It’s spring loaded. A spring slowly presses out the basal insulin.
The mealtime insulin is delivered by the physical push of the button.
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T-Slim Shuttle – how does it work
https://youtu.be/IHHdZdVds8I
The Tandem t:slim pumping mechanism is designed to work with its bag-style insulin reservoir. A mobile component inside the device—an insulin shuttle—slides between the reservoir, where it fills with insulin, and the infusion line, where it delivers insulin.
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Customizeable Basal Rates
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Does HbA1C & Blood Sugar Check Tell the Entire Story?
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HbA1c versus Glycemic Variability
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Benefits of CGMS
• Increased security from alarms & alerts
• Immediate feedback - look and learn
• BG trend provides more information than static readings
• Control + safety
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Sensor Converts Glucose to Electronic Signals
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288 data points per day
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Newer Insulins
Lispro Aspart Glulisine
Glargine Determir Glargine 300
How do these insulin work?
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So – this is how they did it!
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Insulin Degludec*
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Degludec
PEGlispro (BIL)*
PE0139*
Gla-300 A 3x Concentrated Preparation
Nocturnal Window for Analysis of Hypoglycemia With Gla-300
GLP-1 Receptor Agonists in Combination With Basal Insulin
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Inhaled Insulin Seeds such as soybeans containing
very high levels of protein can undergo desiccation, yet survive and revive after water absorption. A. Carl Leopold, began studying this capability at Cornell University in the mid 1980s.
He found soybeans and corn to have a range of soluble carbohydrates protecting the seed's cell viability. Patents were awarded to him in the early 1990s on techniques for protecting "biological membranes" and proteins in the dry state.
Using the knowledge gleaned from studying the preservation of proteins in dry soybeans, Carl developed a method to preserve peptide hormones like insulin in the glassy state so that they can be pulverized into a powder and inhaled by diabetics as an alternative to self-injection
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Patch PENS/ Pumps
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Hybrid Closed Loop Pivotal Trial in Type 1 Diabetes -
The clinical trial is testing Medtronic’s 670G “hybrid-closed loop” system (insulin pump + Enlite 3 CGM sensor) in people with type 1 diabetes.
Based on the Enlite 3 CGM reading every five minutes, the 670G pump’s software automatically increases/decreases insulin delivery to target a blood glucose of 120 mg/dl.
The 670G algorithm is fully integrated within the pump itself, so a patient only needs to wear the Enlite 3 CGM sensor and the MiniMed 670G pump – no need to carry a separate CGM receiver.
The 670G is considered a “hybrid-closed loop” because the user still needs to bolus for meals and notify the system of exercise.
Otherwise, it mostly takes care of insulin dosing in the background, which is very effective at night (80%+ time-in-range in one study we’ve seen
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InSmart Artificial Pancreas
A team at De Montfort University is developing a device which when implanted into the peritoneal cavity will automatically release the correct amount of insulin in response to varying blood sugar levels.
The ‘artificial pancreas’ is currently in prototype form and undergoing pre-clinical trials.
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The Future
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Bionic Pancreas
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How does it look now?
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iLET – 2 pumps in one
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Bionic Pancreas – the iLet.
Built-in wireless CGM technology
No separate processor, all the smarts are already built-in
Two pumps in one Streamlined, simple, and
friendly user-interface A 4.3″ touch-screen
display brings all the information you need right to your fingertips through an extremely simple and elegant user-interface.
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Stem Cell Research
The other trial involves Beta-O2’s experimental therapy called BetaAir and is being conducted at Uppsala University Hospital in Sweden.
The immune protective BetaAir encapsulation device contains human islets from donated cadaver pancreases.
A unique feature of the BetaAir system is the ability to provide the implanted cells with additional oxygen via a special port to help sustain them after implantation.
https://youtu.be/O9phosi-C94
ViaCyte's innovative product is based on the differentiation of stem cells into pancreatic beta cell precursors (PEC-01™), with subcutaneous implantation in a retrievable and immune-protective encapsulation medical device (Encaptra® drug delivery system).
Once implanted, the precursor cells mature into endocrine cells that secrete insulin and other hormones in a regulated manner to control blood glucose levels.
ViaCyte's goal is a product that can free patients with type 1 and type 2 diabetes from long-term insulin dependence.
ViaCyte has received substantial financial support from both the California Institute for Regenerative Medicine (CIRM) and JDRF.
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Encapsulation
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Gene therapy: Designing a viral vector to deliberately infect cells with DNA to carry on the viral production of insulin in response to the blood sugar level
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Care Coordination
As important as Innovation in Treatment
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I HAVE A DREAM – A CUREuntil then
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My Dream
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My Dream
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Connectivity – With Care!
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Thank You!
Center of Excellence in Diabetes & Endocrinology
3814 Auburn Blvd, Suite 72, Sacramento, CAPhone: 916 426 1902Fax: 916 426 1940www.sackid.comwww.facebook.com/mycedeYoutube: SackidinfoTwitter: SackidMD & SackiddiabetesFacebook: Sackiddiabetes, SackidMD