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Road to the Artificial Pancreas (2014 Update)
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Road to the Artificial Pancreas (2014 Update)

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A presentation designed to inform patients on the current status of artificial pancreas research, what they can expect to come along on the way toward realizing its promises and what they can do now …

A presentation designed to inform patients on the current status of artificial pancreas research, what they can expect to come along on the way toward realizing its promises and what they can do now to benefit from this field of research.

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  • 1. Road to the Artificial Pancreas Kevin McMahon CEO & Founder Type 1 Technology Ventures, LLC Advanced Diabetes Management Retreat Texas Lions Camp - Kerrville, Texas April 26, 2014
  • 2. ?
  • 3. According to the JDRF: “An artificial pancreas will integrate two currently available technologies -- continuous glucose monitors and insulin pumps -- with a software that provides the right amount of insulin at the right time. It will enable people with diabetes to achieve tight blood glucose control avoiding both highs and dangerous lows, thereby significantly reducing the risk of the disease's devastating complications.” Source: http://artificialpancreasproject.com/about/algorithm.html My observation: JDRF AP website last updated 2012 including several broken links when visited in April 2014. What is the AP?:
  • 4. AP Trial Sites: http://j.mp/clinicaltrials-gov-apSearch
  • 5. USA based AP Trial Sites: http://j.mp/clinicaltrials-gov-apSearch
  • 6. It works!!! Well, kind of… Just like a Meter = CGM (if you’re willing to poke your finger and check blood sugar every 5 minutes) Current Status of the AP:
  • 7. A. In a very small number of well controlled trials B. Only under supervision C. In a controlled setting D. For well screened patients with good skills E. For short duration not more than a few days F. 10s if not 100s of millions $ already invested G. Always looking for more $ H. Nobody can say when it will be approved I. Once approved, nobody can say when it will be available J. Nobody knows how much it will cost K. Nobody knows what your cost will be (e.g. Insurance) Status of the AP:
  • 8. An artificial pancreas will integrate many current and yet to be developed technologies: 1. in-body, on-body and near body sensors. 2. mechanized dosing machines. 3. drugs to affect regulation and counter-regulation of blood sugar 4. software that provides the right amount of dosing & instruction at the right time. 5. communications for remote command and control It will enable people with diabetes to achieve improved blood glucose control experiencing significantly fewer highs and lows including shorter duration. In addition to significantly reducing the risk of the disease's devastating complications, patients and their families will also enjoy a much improved quality of life while simultaneously reducing the overall cost of care. Source: Patent applications and grant proposals submitted by Kevin McMahon & Diabetech since 2002. My View on the AP?:
  • 9. In 2007, according to JDRF: “There is no need for remote monitoring in the development of the Artificial Pancreas. Furthermore, there is no business model to commercialize this feature.” Source: breakfast meeting in Dallas, Texas between A. Kowalski - AP Director, JDRF and K. McMahon Remote Command & Control:
  • 10. Perspectives Change: AP Goes Mobile 2011 JDRF Funds Pilot System Prior to this study, artificial pancreas tests had employed laptops wired to continuous glucose monitors and insulin pumps. The paper called the old AP “a system limiting free movement and too cumbersome to be used beyond hospital confines.” - Boris Kovatchev, UVA researcher Source: http://j.mp/mhealthnewsAP; a story by Neil Versel based on clinical trials published in Diabetes Care.
  • 11. Inputs ----> Magic ---> Outputs My AP Equation:
  • 12. Static patient profile (age, weight, etc…) type of insulin (ie - u100 vs u400) ratios (I:C, ISF, etc…) time of day ratios anything you program today Dynamic command machines to start blood sugar level (bgl) rate of change in bgl nutrition (consumed vs. served) insulin on board glucagon on board (* new) command machines to stop anything you can observe today Two Kinds of Inputs:
  • 13. Static I don’t think there are any Dynamic command the pump(s) to dose command the pump(s) to stop query the sensor(s) assess quality of machinery manage time and synchronize tell the patient to do something notify a remote caregiver Outputs are Dynamic:
  • 14. Devices, Software and Computer Networks that consider inputs and generate outputs based in their inherent limitations. The military refers to this as C4 : command, control, communications and computers. When they add the human element they add an i; C4 i Magic is: Never underestimate the power of “i”
  • 15. Inputs ----> Magic ---> Outputs My AP Equation: repeat
  • 16. Inputs ----> Magic ---> Outputs My AP Equation: repeat predict
  • 17. Inputs ----> Magic ---> Outputs My AP Equation: repeat predict compare
  • 18. Inputs ----> Magic ---> Outputs My AP Equation: repeat predict compare suggest
  • 19. Situational Awareness Assisted by C4 : ● ambient sensors to remind us that it’s hot out (temperature) ● bio sensors to suggest a basal change (activity) ● interfaces that communicate situation to the user better than today’s screens (glance-ables, beeps, blips and buzzes) ● personalized feedback to address uniqueness (rewards) ● life-like simulators for educational purposes (virtual patients) Rest Stops On The Road to AP:
  • 20. Make Something: DexWatch Don Browne, engineer w/t1 “The interface for a CGM should be a watch; not something shoved in your pocket.” The key is that it should be something you can easily glance at vs. hidden away.
  • 21. 1. Write a check 2. Get others to write checks 3. Register for participation in a future trial: (http://j.mp/clinicaltrials-gov-apSearch) 4. Learn how to get the most out of what you have available to you today 5. Practice what you’ve learned every day 6. Make something 7. Share your knowledge 8. Support innovation and each other Eight things you can do:
  • 22. Road to the Artificial Pancreas Kevin McMahon kevin@type1techventures.com Advanced Diabetes Management Retreat Texas Lions Camp - Kerrville, Texas April 26, 2014 Thank You!