Di­a­betes and tech­nol­ogy meet

Re­searchers are de­vis­ing an ar­ti­fi­cial pan­creas that could cut com­pli­ca­tions for di­a­betes pa­tients, writes Lyn­nette Hoff­man

The Weekend Australian - Travel - - Health -

FOR 10 months run­ning, Karen Rose woke up hourly through the night to check her son Bren­dan’s blood sugar lev­els ‘‘ to en­sure he stayed alive’’. Bren­dan, who suf­fers from type 1 di­a­betes, had de­vel­oped a com­pli­ca­tion that caused his blood sugar to spike and dip un­pre­dictably sev­eral times a day, strain­ing his or­gans and putting him at greater risk of seizures, un­con­scious­ness and even death in the short term.

In the longer term, he faced com­pli­ca­tions in­clud­ing heart dis­ease and stroke.

Try­ing to main­tain a stable blood glu­cose level to min­imise those risks is no sim­ple task, as Rose can tell you.

But in­ter­na­tional re­searchers are edg­ing closer to tech­nol­ogy that could make the bat­tle sig­nif­i­cantly eas­ier — dra­mat­i­cally cut­ting down com­pli­ca­tions such as those above, as well as blind­ness, re­nal fail­ure and am­pu­ta­tions for pa­tients with type 1 and in­sulin-de­pen­dent type 2 di­a­betes.

Some 250,000 Aus­tralians are af­fected, and the num­ber is grow­ing. The num­ber of chil­dren with type 1 di­a­betes is in­creas­ing at a rate of about 5 per cent a year, ac­cord­ing to a re­port by Aus­tralian In­sti­tute of Health and Wel­fare last year. The re­port also found that death rates for peo­ple with in­sulin-treated di­a­betes were three times higher than in the gen­eral pop­u­la­tion. The dis­ease shaves an av­er­age 15 years off life­spans.

To com­bat all that, re­searchers from the Ju­ve­nile Di­a­betes Re­search Foun­da­tion are work­ing to cre­ate an ‘‘ ar­ti­fi­cial pan­creas’’. They are us­ing com­pli­cated math­e­mat­i­cal equa­tions to de­velop soft­ware that links ex­ist­ing tech­nolo­gies — in­sulin pumps and con­tin­u­ous glu­cose mon­i­tors — so they work like a real pan­creas, says Aaron Kowal­ski, di­rec­tor of JDRF’s in­ter­na­tional ar­ti­fi­cial pan­creas pro­gram.

Ev­ery­thing from hor­mones to stress lev­els and from diet to ex­er­cise has an im­pact on glu­cose lev­els, so get­ting the right amount of in­sulin at the right time is a con­stant chal­lenge. ‘‘ Fewer than 50 per cent of peo­ple with type 1 di­a­betes achieve tar­get glu­cose lev­els,’’ Kowal­ski says. ‘‘ Even with ad­vanced tools it’s very dif­fi­cult to get their glu­cose lev­els close to (those of) a per­son who doesn’t have di­a­betes. Even peo­ple mon­i­tor­ing nine times a day spend less than 30 per cent of the day in the tar­get range.’’

The JDRF re­searchers are de­vel­op­ing al­go­rithms that pre­dict changes caused by hu­man be­hav­iour, so that the in­sulin goes di­rectly where it’s needed in real time.

The way cur­rent tech­nol­ogy works, there’s a time lag be­tween sens­ing glu­cose lev­els in the blood and ac­tu­ally get­ting the in­sulin to where it needs to be.

The longer the de­lays, the more the com­pli­ca­tions, says as­so­ci­ate pro­fes­sor Fer­gus Cameron, head of di­a­betes ser­vices at the Royal Chil­dren’s Hospi­tal in Melbourne. ‘‘ Glu­cose changes are hap­pen­ing in a very deep part of the body where the pan­creas and the liver are, whereas we’re sens­ing it in the skin and de­liv­er­ing it in the pe­riph­ery, miles away from where it’s ac­tu­ally hap­pen­ing,’’ he says.

When glu­cose lev­els change in the blood it might take 10 min­utes be­fore there is a sim­i­lar change in the tis­sue of the skin, and like­wise it can take about half an hour for in­sulin de­liv­ered to the skin to ac­tu­ally change glu­cose lev­els in the blood.

Pre­vi­ous at­tempts to im­prove the sys­tem have in­cluded in­sert­ing glu­cose sen­sors close to the heart, but that kind of in­va­sive pro­ce­dure has com­pli­ca­tions of its own, lead­ing to re­newed fo­cus on a high-tech so­lu­tion, Cameron says.

Other cur­rent re­search is look­ing at trans­plant­ing the islet cells in the pan­creas that cre­ate in­sulin.

Type 1 di­a­betes is caused by the body’s in­abil­ity to make in­sulin, or make enough, be­cause th­ese cells have been de­stroyed. In type 2 di­a­betes, in­sulin is there but cells lose their abil­ity to metabolise glu­cose in re­sponse to the hor­mone.

Cameron says a tech­no­log­i­cal so­lu­tion will prob­a­bly hap­pen be­fore a bi­o­log­i­cal one.

Small-scale stud­ies have al­ready shown that pre­lim­i­nary ver­sions of the ar­ti­fi­cial pan­creas work in con­trolled hospi­tal set­tings. But more work needs to be done be­fore it will be avail­able for use in real peo­ple in ev­ery­day life.

Sci­en­tists are still learn­ing what fac­tors im­pact glu­cose lev­els, and in what ways — and that in­for­ma­tion is es­sen­tial to de­vel­op­ing the al­go­rithms that make the soft­ware work, says as­so­ci­ate pro­fes­sor Tim Jones, a pae­di­atric di­a­betes spe­cial­ist at Princess Mar­garet Hospi­tal, who is re­search­ing ex­actly that.

‘‘ For ex­am­ple, when you’re asleep your body doesn’t pro­tect blood glu­cose as well as when you’re awake, so your lev­els might go lower,’’ Jones says. ‘‘ Or when you ex­er­cise dur­ing the day, it takes your body 18 hours to re­place the en­ergy to the mus­cles, so your blood glu­cose would drop overnight and that can re­sult in a seizure,’’ he says.

Dif­fer­ent forms of ex­er­cise also have dif­fer­ent ef­fects. A steady jog low­ers blood glu­cose much more quickly than the sort of stop-start ex­er­cise that kids tend to play, while a hard sprint ac­tu­ally makes it go up. THE fed­eral Gov­ern­ment an­nounced this month that it will fund sub­si­dies to help peo­ple liv­ing with in­sulin-de­pen­dent di­a­betes ac­cess in­sulin pumps. While are still im­per­fect, they do achieve bet­ter re­sults than sim­ply in­ject­ing in­sulin.

Cur­rently fewer than 17 per cent of peo­ple with type 1 di­a­betes who are un­der age 18 use the pumps, which range in price from $6000 to $8000. The most re­cent bud­get al­lo­cated $5.5 mil­lion over four years to help make them more af­ford­able.

Fam­i­lies with in­comes of less than $59,842 will be el­i­gi­ble for the max­i­mum sub­sidy of $2,500, while those earn­ing be­tween $59,842 and $98,386 will be el­i­gi­ble for a slid­ing scale of sub­sidy rang­ing from $500 to $2,500. A $500 sub­sidy will be avail­able for fam­i­lies with in­comes above that.

‘‘ With re­search clearly show­ing the longterm health ben­e­fits of good blood glu­cose con­trol, it makes good eco­nomic sense for the Gov­ern­ment to sub­sidise this tech­nol­ogy for peo­ple that re­ally need it,’’ says Di­a­betes Aus­tralia CEO Matt O’Brien.

Pic­ture: David Crosling

On guard: Fer­gus Cameron with young pa­tient Mitchell, 13. Tech­nol­ogy has been har­nessed to re­place the need for nee­dles.

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