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Is a "closed-loop" CGM and Pump a Cure?

Discussion in 'Stickies' started by Sarah Maddie's Mom, Jan 6, 2010.

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Is a "closed-loop" system a cure?

Poll closed May 6, 2010.
  1. Yes

    4 vote(s)
    1.7%
  2. No

    224 vote(s)
    96.1%
  3. I don't know

    5 vote(s)
    2.1%
  1. buggle

    buggle Approved members

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    I'm concerned about all the projects, including the AP. The vast majority are with industry partners who stand to make a huge, continuing profit from their products -- which means that a real cure would kill them business-wise. This is a massive conflict of interest and industry partners seem to be driving the direction of the research -- the CEOs of companies who have funded projects (with parent-raised money) sit on the JDRF board. Lewis, the CEO, is from Novocell and the chairman of the board from J&J. Even if you have a kid with T1, it's still hard to separate your corporate interests from research that should only have the best interests of type 1's at heart, not huge multi-nationals' bottom lines.

    This has become true of nearly all areas of medical research, not just diabetes. That's why we're not seeing anything come out but more expensive drugs and treatments that you get stuck using to stay alive.

    I hate to see the foundations and the corporations goals and missions getting tanged up in this gray area. They should be separate, because of the potential conflict.

    At least the AP might give something to our kids and I love the pump and CGM. I'd rather not subsidize industry, though. They are already making such huge profits that the percentage of our income spent on healthcare keeps going up every year.
     
  2. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

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    This is for sure not a cure. We all want a real cure!!!!!!!!!!!!
     
  3. joy orz

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    Ditto. I'm very concerned about the conflict of interest. The JDRF does provide support to families and help with some great advances in care, but it seems to me that the industry has no motive to make this disease go AWAY.

    I'm optimistic about Dr. Faustman's research. I ask friends and family who are interested in making donations, to donate directly to her lab at MGH. However, I do appreciate all the amazing technology we have at our fingers in the meantime. I certainly wouldn't want to be boiling glass needles every day.
     
  4. Christopher

    Christopher Approved members

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    uhmm...not quite sure why you quoted me....I never said the AP was a cure...:confused:
     
    Last edited: Jan 7, 2010
  5. Darryl

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    Prior to my currnent occupation, I worked as an engineer in the consumer and defense electronics and software fields for around 15 years, and for much of this time specialized in design of control loops. I've designed enough of them that I know what is possible and what is not.

    I'm not saying that anyone on the AP projct is lying, I am sure they believe that they are pursuing a good cause. Their time would be better spent on improving sensors and insulins, because when they do that, the AP might have a shot at working with slightly less human intervention than is currently needed for CGM use.

    ETA - I support the idea of a low CGM alarm resulting in pump shutoff, but only if the alarm still goes off so the low BG can be confirmed. Especially at night, when a "low BG" on a CGM can result from sleeping on the sensor.
     
    Last edited: Jan 7, 2010
  6. buggle

    buggle Approved members

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    The first paragraph of my post was in response to this statement of yours:

    I think using words like "it will never work" or "impossible" stifle creativity, hope and are just negative in general. No offense to those who use them, just that many things that were previously thought to be impossible or would never work have come to fruition.

    The rest was directed to other posters and everyone else in general. Sorry if I made it seem like you'd said it was a cure.
     
  7. Danielle2008

    Danielle2008 Approved members

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    All this recent talk about JDRF, Conflict of Interest, Big corporations, and no viable cure sure makes me feel like an idiot for having taken part in a JDRF funded test trial.

    Ah, oh well. At least I got paid to be poked, right??;)
     
  8. Ellen

    Ellen Senior Member

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    Thought I'd toss in this news article

    Artificial Pancreas | KCRG-TV9 | Cedar Rapids, Iowa News, Sports, and Weather | Local Health News

    Artificial Pancreas

    By Ashley Hinson


    Story Created: Jan 7, 2010 at 9:11 AM CST
    Story Updated: Jan 7, 2010 at 9:11 AM CST

    BACKGROUND: Diabetes is a disease that causes the body to not produce or properly use insulin, a hormone necessary to convert sugar, starches and other food into energy. According to the American Diabetes Associate, 23.6 million children and adults in the United States suffer from the condition -- or 7.8 percent of the population. If diabetes isn't managed properly, long-term complications can result including neuropathy, blindness, kidney failure and amputations.
    MANAGING DIABETES: Most patients with diabetes live a life of never-ending calculations, testing blood sugar several times a day, counting carbohydrates and adjusting how much insulin to take. "That's the major burden of type 1 diabetes, that people have to think about that at all times, measure frequently -- as frequently as they can with the available technology -- and make insulin adjustments all the time," Boris Kovatchev, Ph.D., professor of Systems and Information Engineering at the University of Virginia, told Ivanhoe. New technology like continuous blood glucose monitors, which monitor blood sugar levels in the body, and insulin pumps, which dispense insulin without the need for injections, have made management of the disease easier.
    AN ARTIFICIAL PANCREAS? Researchers at the University of Virginia and abroad are testing a computerized system called the "artificial pancreas" that continuously regulates a diabetic patient's blood glucose. The system is composed of an insulin pump and a continuous blood glucose monitor. A computer uses an algorithm to do the calculations necessary to deliver the appropriate amount of insulin.
    Researchers have successfully tested the artificial pancreas on 23 patients. In clinical trials, patients underwent two 24-hour admissions, one in which they controlled their own blood sugar levels in physician-supervised sessions, and one in which they relied on the artificial pancreas system. Patients had identical eating sleeping and activity patterns during both hospital stays. Results show when patients controlled their own blood sugar, 23 episodes of low blood sugar occurred; when patients used the artificial pancreas, five such episodes took place. "The primar outcome of the study was five-fold reduction of low blood glucoses -- or nocturnal hypoglycemia -- and the secondary outcome was increased overall glucose control within the target range that was set in the study," Dr. Kovatchev said.
    The algorithm used by the artificial pancreas -- which allows for personalized treatment for each diabetes patient -- was co-developed by researchers in Virginia and Italy. A large, multi-center clinical trial of the artificial pancreas involving kids ages 12 to 18 is set to begin in January.

    FOR MORE INFORMATION, PLEASE CONTACT:
    Sally Jones
    Public Relations
    UVA Health System
    Charlottesville, VA
    (434) 924-9241
     
  9. Christopher

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    Danielle, I don't think you should second guess yourself just because of things that people have said in this thread. They are just people's opinions and conjecture. None of us know what the future will bring, no matter how much we fool ourselves into thinking we do. I am sure you had your reasons for participating and I am sure they were valid for you. And you did get some cash out of it..... :cwds:
     
  10. chbarnes

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    No, the AP is not a cure, and the name is mostly a fund-raising ploy. But if you called it the "super-smart pump" we would all be happy it was available.
    Of course, I would prefer a cure. Sadly, as a physician, I must concede that there are very few curable diseases. So, when you ask why we don't have a cure for type I diabetes, I have to also admit we don't have a cure for anything else. This is not just the result of our medical-industrial complex. Biological systems are notoriously difficult to change. Solid basic science often doesn't pan out.

    Chuck
     
  11. Becky Stevens mom

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    No, not a cure. My son will be cured when his own pancreas can produce insulin itself.

    I do believe with all my heart and soul that Dr Faustman is unlocking the secrets. She is a maverick and follows her own path in her research. In the book "The autoimmune epidemic" There was alot in there about other scientists that treat her like shes a flake. I think they are afraid of her and know that she is close to making some major breakthroughs.
     
  12. mom2two

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    NO WAY, its just that, a closed-loop system, it will be awesome no doubt, but its not a cure.
     
  13. JohnMom

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    I second this.
     
  14. Mikker

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    Agreed! I may not always agree with where JDRF decided to allocate money, but all in all... it is a wonderful organization and are doing wonders. Personally, I really appreciate your participation and applaud you. It's that kind of selflessness that will eventually help lead us to a cure.
     
  15. Jeff

    Jeff Founder, CWD

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    This is a wonderful discussion -- and exactly what I'd hope to stimulate by including "closed loop insulin pump and continuous glucose sensor" as an option in this week's poll, "How do you think type 1 diabetes will be cured first?"

    I will argure that "cure" can be defined several ways. Humanity has a very poor track record of truly curing any disease, but we have found ways to prevent, defeat, and treat many. An artificial pancreas -- the closed loop system -- would be a treatment advance. And if an artificial pancreas resulted in blood sugars always in the target range and (near) zero risk of complications, one could argue that is pretty close to a cure. (I do agree that a true "cure" means no more type 1 diabetes, but to be frank, I also think that is years, if not decades, away.)

    I would also like to respond to those who believe that an artificial pancreas / closed loop system is not possible -- because the data shows that it is in fact possible, even with the temporal limitations of sensor lag and slow onset of insulin action. Comparing a closed loop insulin pump to a flight control system, for example, misses the point -- we don't need to be 100% perfect in a closed loop system because we have other feedback mechanisms to help us correct when needed. A fully automated flight control system doesn't have the same capability.

    Data already shows that current pump, sensor, and insulin technology can result in dramatic increases in time spent in range and concurrent dramatic reduction in time spent hypoglycemic and hyperglycemic -- which reduces the risk for both short- and long-term issues of diabetes (hypoglyemic problems and hyperglycemic complications). Even more importantly is the ability of the current technology to control blood glucose levels during sleep. While delivering essentially perfect control when you don't eat and don't move might seem insignificant, giving us parents back the night and allowing people with diabetes to sleep safely and soundly will provide a dramatic improvement in our quality of life -- to say nothing about the improvement in health outcomes that will derive from being in control for at least one-third of one's life.

    And I would also suggest that industry participation in this work is not just essential but also good, and that claims of industry "suppressing a cure" or being motivated by profit (as if that is a bad thing) miss the point and do not portary the hundreds, if not thousands, of people working hard to solve this challenging problem correctly. (As an aside, how many of you would go to work each day if you were not paid?) Companies involved in diabetes care have to make a profit if we are to see the development of new and improved tools to help us care for diabetes. If you like the predictablly fast (or slow) action of insulin analogs, the small size and features in today's insulin pumps, five second blood glucose readings, and continuous glucose sensing (with whatever limitations you ascribe to it), know that without profit from previous products these new tools would not exist. When Marissa was diagnosed in September 1989 -- not that long ago -- there was Regular and NPH, almost no kids on (large insulin) pumps, and the fastest blood glucose reading was 120 seconds using a drop of blood that would make you cry. No one wants that again.

    It's also important to know that many scientists are working on biological solutions, including immune therapies to stop the underlying destruction of beta cells, improved devices to be implanted with islets with no or only local (rather than systemic) immunnosuppression, and other strategies for providing a cellular rather than a technical replacement of insulin (and c-peptide at the same time). Most of this work is in academia, and the teams I know are among the most passionate and dedicated in any field.

    And while I am very confident that science will find a biological answer for type 1 diabetes, I am not sure that it will be in my lifetime. From what I have learned, type 1 diabetes is more complicated than almost anyone imagined it could be. So I look forward to the improvements in care and quality of life that will come from the closed loop systems, limitations and all, as those systems will help to ensure that my daughter -- and all of our daughters and sons -- are healthy enough to enjoy the benefits of the true biological cure when that day finally comes.

    Again, thanks to everyone for contributing to this wonderful discussion.
     
  16. Deal

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    Sounds more like the Drug companies have come up with an alternative cure they can live with...
     
  17. buggle

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    I don't think anyone is disputing that big pharmaceutical companies should make a profit. I also believe that the people working on the research and development of new products are good, decent people. My husband has even considered working on the development of algorithms for the AP. I know our children's lives and the quality of their lives depends on good products from the diabetes industry. The CGM is my favorite thing in the entire world.

    That said, there is good reason to keep the industry separated from influencing the funding decisions for basic research. Do a google search on, "research bias pharmaceutical" and a stack of papers will come up addressing this issue. Pharma has one goal and that's to make as big a profit for their shareholders as possible. Their goals may not be in the best interest of the public -- particularly scientific advancement and work towards a cure. They are driven to produce new products with the largest profit potential or find new markets for their existing products. Let's say they found a new drug that required periodic treatment and they could still charge a huge amount of money from it, but this drug could keep a type 1 from needing insulin, strips, pumps, CGM, the AP. They would sit down and do a business analyses and if this new drug would lose the company massive profits, do you guys think they'd produce it? Would they put out a therapy that could improve the lives of people if they lost billions of dollars a year?

    It's a major conflict of interest to have a foundation run by CEOs from huge industry partners who stand to make billions of dollars from products and who have personal financial gain from preventing basic research that could replace their products. And to take donations raised by families who have been targeted by marketing/PR companies with campaigns that have promised the money will go towards a cure for their children and then spend it on the development of products with partners with another goal has some ethical dilemmas, IMO.

    Each side has a place and purpose. The non-profit research side shouldn't be run by the corporate side. I feel that the AP being touted as a "cure" is part of a well-planned PR campaign by marketing firms.
     
    Last edited: Jan 9, 2010
  18. Danielle2008

    Danielle2008 Approved members

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    And you don't believe that whoever finds the cure for any disease, won't be the richest person on the planet?

    I can just imagine what people would pay to cure cancer once and for all.

    I personally feel the opposite. Some day, the cure will be found(whether in my lifetime, or the future to come). Now it is a race to see who gets to that finish line first. Because in the end, whoever finds it, will be a very, very rich person.
     
  19. bgallini

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    I haven't read any other answers yet but if we need to keep buying insulin and pump/cgm supplies and monitoring everything to make sure it's working right and changing settings and dealing with Drs and insurance on a very regular basis, then I wouldn't consider Alex to be cured.:(
     
  20. Jacob'sDad

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    What I would really like to have is a computer program that analyzes all the data I can give it, like carbs consumed, CGM data, exercise, fat consumed...basically all the data I can give it, and makes recommendations on changes to basal, ICRs, ISFs, DIA, prebolus timing, etc.

    It doesn't have to be perfect, it just has to come up with ideas that are better than what I can come up with on my own.

    I would think that this type of computer analyzation is something they are doing anyway as part of the AP program.
     

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