The Artificial Pancreas and Research: Is this as Good as it Gets?
Posted Apr 15 2010 6:44am
Our modern technological dependency became crystal clear to me when I saw this morning’s headline “ The iPhone Doctor Makes House Calls” (IHT 15 April 2010). The popularity of the iPhone ( 8.7 million 1st quarter 2010 ) has produced a cottage industry of mobile phone repairmen and in New York, one of them makes personal home visits to owners and their broken iPhones. Modern society has become so dependent on mobile technology and other forms of “personal tech” that breakdowns and the expense of replacement (or the fear of losing contact) has deep ramifications. Our world has become full of innovative gadgets, and the mobile phone is a particular lifeline for maintaining a connection with family, friends, global networks, business or career opportunities, specialized information and social diversion. Without our gizmos and gadgets we truly become stranded (and forgotten) on a lonely desert island.
Some of us (like me) rely on personal tech for a different kind of lifeline – literally a survival lifeline. It would be impossible for me to measure my blood sugar with such precision without my glucose monitor and without that, insulin becomes impossible to manage. I could use injections instead of my insulin pump, but without the fine tuning and control – I might develop complications. My CGMS operates as a kind of manual pancreatic system and helps me better understand trends and variables. Great blood sugar control IS currently dependent upon the accumulation of and the relationship with diabetes management gadgetry. And just like we wait for the next numeric edition of a PC, or a mobile phone, there is always something better around the corner in the diabetes tech arena. What’s the next upgrade? Automated closed loop technology or the Artificial Pancreas .
Ever since the announcement on 13th January 2010, I’ve been thinking a great deal about the Artificial Pancreas Project, its implications, the FDA’s involvement (or the European Commission’s ) and industry’s use of technology serving as a functional cure for diabetes. It has worried me about the future of scientific research.
I was diagnosed in 1974, and as a scared 10 year old I was told a cure would be discovered in 20 years. When I had my 30th birthday, I recounted that former declaration to a doctor who remarked sympathetically “…maybe within your lifetime…” As the years have passed, I have never given up hope, but I wasn’t as enthusiastic about the artificial pancreas announcement as so many others appeared to be. A part of me mourned just a little and I wondered, is this as good as it gets?
A crude research time line is assembled here to identify important markers and where we are today. (I have not included everything – only highlighted significant research and devices that have led to the closed loop system).
Diabetes Research 1921-2010
1921 Discovery of Insulin
1955 Molecular structure of insulin discovered (Sanger)
1956 Discovery of glucose monitoring (urine)
1959 Discovery that beta-cells produce insulin (Lacy)
1967 Islet of Langerhans isolated (Lacy)
1966 First pancreatic transplant (Edmonton) 1971 First electronic blood glucose monitor – for docs
1972 First successful islet transplant – rats
1974 First human islet cell transplant
1976 HbA1c test discovered 1978 First portable insulin pump (device) (CSII) made for commercial use
1979 Antibodies that target islet cells discovered
1979 Synthetic insulin discovered 1983 First blood glucose monitor for home use
1992 First islet transplant on humans – unsuccessful
1998 Human stem cells sourced– promising for beta-cell usage
1999 Edmonton Protocol begins/one year later, patients (islets) still successful
2000 Diabetic mice are cured with pancreatic stem cells
2001 Seven regions of the human genome are linked to diabetes
2007 Nanoparticles of insulin delivered orally (not inhaled!) (rats)
2007 Human skin cells reprogrammed into stem cells 2006 CGMS (device) developed for commercial use 2010 Artificial Pancreas Project Collaboration announced, and begins in earnest USA/UK/Europe
My question for the scientific community and for advocacy groups focused on finding THE cure for diabetes is this… have we given up on cell therapy, immunology, regenerative, or replacement research? Certainly new innovative areas for research are out there too? With so much attention and support given to the artificial pancreas by academia, advocacy, clinicians, governments concerned about public health and yes, patients – I am beginning to think we have lost site of our goals. I also wonder where the past 80 years of research has gone? The Edmonton Protocol disappointed some because failure rates on pancreatic islet transplantation stand at 85-90% of total patient recipients (at the 2-5 year mark) and I wonder if this has had a negative drip down effect on the wider community of scientists. It’s not an easy thing to raise billions (in various currencies), work for years in the lab and be no closer to a cure. Curing diabetes has remained elusive, but should we focus all our efforts on technology and device management? Of course, I will be signing up for the artificial pancreas, but feel dubious and cynical as it appears to be more a (costly) upgrade replacing my current stock of diabetes tech gadgetry then a life-changing event. When the artificial pancreas arrives (and getting regulatory approval will take many years), I will study the tutorials on how to manage my new device and software, trouble-shoot and worry that sometimes the battery on my new system will just run out.
Just like I do with all my tech gadgets. Just like an iPhone.