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Diabetes Technology Meeting 2008

The eighth annual Diabetes Technology Meeting was held in Bethesda, Maryland from November 13-15, 2008. In attendance were over 600 scientists, engineers, and doctors from government, industry, academia, and clinical practice. During the three days of workshops and sessions, speakers shared information on a variety of topics, including continuous glucose monitoring, non-invasive glucose monitoring, novel insulin formulations, insulin delivery technologies, the state of the artificial pancreas, and various types of computer technologies. Here is a summary of some of the sessions:

  • During the pre-meeting workshop on Noninvasive Glucose Monitoring, Mark Arnold, PhD, from the University of Iowa presented Issues of Measurement Variance in Noninvasive Glucose Sensing with Near-Infrared Spectroscopy. Dr. Arnold described the enormous variances that are found over very small areas of the skin and the challenges that these variances bring to the goal of using near-infrared light to sense glucose levels noninvasively. Given these daunting challenges, it's clear why there are no near-infrared glucose sensors commercially available today.
  • Sandy Asher, PhD, presented A Novel Ocular Technology for Measuring Glucose in Tears. Reviewing the literature, Dr. Asher reported that various studies have shown differing levels of glucose in tears, and that, while their own studies found very low levels, these levels were sufficient to measure glucose using novel photonic crystal technology. It's not clear if this technology will be commercially viable, as Dr. Asher pointed out several challenges, including variation between levels in the left and right eye, as well as changes brought about by rubbing the eye and even yawning.
  • Aaron Kowalski, PhD, chair of the JDRF's Artificial Pancreas Project, presented the keynote address, Accelerating the Availability of an Artificial Pancreas. Dr. Kowalski, well known in the community, offered a brief review of the history of diabetes technology that has led us to the doorstep of an artificial pancreas. He then presented a six-step pathway to a fully closed loop system, beginning with turning off the pump when the sensor detects a very low glucose level, then a hypoglycemia minimizer, then a hypo- and hyperglycemia minimizer, then a hybrid closed loop, then a fully closed loop system. Each of these is achievable using technology available today (nothing needs to be invented).
  • Joseph Lucisano, PhD, from GlySens, presented Long-Term Results of a Subcutaneous Glucose Sensor in Animals. The GlySens device is implanted and uses two sensors which compare baseline information with the enzyme mediated information to yield better glucose data, according to Dr. Lucisano. Clarke Error Grid data showed 96% of results in the A+B range for one year, with 4% in the C range and none in D or E. Data for just months 7-12 showed 98.4% in A+B.
  • In Nanoparticle Delivery of Hepatic Targeted Insulin, Blair Geho, MD, PhD, from Diasome Pharmaceuticals spoke about their technology which delivers insulin -- injected or taken orally -- directly to the liver with the goal of re-establishing normal insulin presence there. Dr. Geho reported that just 1% of injected insulin was sufficient to achieve significant clinical benefits. His poster, which compared injected NPH with and without the hepatic delivery in patients with type 1, noted a 43% reduction in post-prandial glucose levels with the hepatic targeted insulin.
  • William Tamborlane, MD, from Yale University reported results from the JDRF Real-Time Continuous Glucose Monitoring Trial. This trial was similar to the study recently published in The New England Journal of Medicine (see Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes; The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group), but this study included patients with initial HbA1c levels of 7% or below. Dr. Tamborlane reported that the use of a continuous glucose sensor in patients with an HbA1c of 7% or below resulted in a significant reduction in the frequency of hypoglycemia -- a very important finding for patients who are achieving their blood glucose targets. In addition, at the end of the 26 week study, 88% of those using a real time continuous glucose sensor kept their HbA1c under 7%, compared with 63% of controls (p<0.001). Dr. Tamborlane noted that the weight of evidence from this study demonstrates the importance of continuous monitoring in patients with HbA1c values of 7% or less.
  • In one of the most interesting and entertaining presentations ever at a Diabetes Technology Conference, Charles E. Wiedmeyer, DVM, PhD, spoke about Continuous Glucose Monitoring in Veterinary Medicine - Up and Coming. Offering insight into the challenges of caring for pets with diabetes (he noted that few in the audience had patients which bit them during glucose monitoring), Dr. Wiedmeyer reported on using continuous glucose sensors in dogs, cats, cows, and horses. One interesting tidbit was using super glue to hold the continuous sensor in place on the animal's body, though he urged caution in translating that to humans.
  • Ed Damiano, PhD, presented an update on his lab's dual hormone work in Bi-Hormonal Closed-Loop Control of Blood Glucose Using Dual Subcutaneous Infusion of Insulin and Glucagon in Type 1 Diabetes. Previously, Dr. Damiano reported on his initial work in pigs. With new data from human patients with type 1 diabetes, Dr. Damiano was able to report on the success of their team's two-pump system and controller. Of particular interest was the discovery that several study participants had exceptionally high anti-insulin antibody levels, and that impacted the pharmacokinetics of insulin, requiring a slight modification to the control algorithm to account for the slower onset of and longer duration of action in these patients.
  • Athanassios Sambanis, PhD, spoke during the session on tissue engineering, presenting Cell Sources and Critical Technologies for Cell-Based Therapies for Diabetes. His lab at Georgia Tech is working on engineering a replacement tissue for beta cells, among other work. Dr. Sambanis suggested that two different cell types might be necessary in a biological replacement for the pancreas, one that provides immediate insulin secretion in response to post-prandial glucose spikes and another that offers a more steady release.

See Also

 

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Mark Arnold, PhD, spoke about the challenges of noninvasive sensing during Thursday's workshop

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Sandy Asher, PhD, showed his color shifting crystals, the basis for an ocular glucose sensing contact lens

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Aaron Kowalski, PhD, delivered the keynote address, Accelerating the Availability of an Artificial Pancreas

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William Tamborlane, MD, from Yale University reported results from the JDRF Real-Time Continuous Glucose Monitoring Trial

JSH
November 19, 2008



                 
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