Latest Thinking Like A Pancreas Blog

New diabetes innovations and discoveries

This yr's Scientific Periods of the American Diabetes Affiliation didn’t disappoint much of the research into diabetes medicine, gadget improvement, and other essential info on exercise management.

Here is a temporary summary:

AUTOMATIC INSULIN DELIVERY SYSTEMS, HCL SYSTEMS AND PUMP SYSTEMS

1. New Sort Infusion Set – Capillary Band: Angle 13.5 mm,
This The package is a steel-reinforced cannula that helps forestall bending. It has four "holes" for insulin to drip out of a versatile tube and seems to offer less irritation to surrounding tissues over a bigger insulin supply range

2. DIY HCL Results (College of Bern) Diabetes Middle Bern
Utilizing open APS, Android APS, Loop with 80 DIY customers who have 53 in widespread. 77.5% range, 18% high, four.5% low

  • + 9.Three% after altering DIY (comparable time of day and night time)
  • -1.2% in low range Decrease in day care, not low at night time
  • 3. 670G Expertise – Dr. Lal, Stanford

    • 79 patients (adults and adults) started with 670G, followed for 1 yr
    • Baseline A1c approx. eight%, 60% at
    • Automod interruption was widespread and 75% 44% of the lead-through had stopped utilizing the system
    • 12 mo 46% (32% used it at the least 70% of the time)
    • Those who have been more more likely to cease using it have been younger and those with greater A1c reasons, corresponding to: sensor (60%), provide issues (17%), worry of the lowers (10%), ideally MDI (7%), sports (7%)

    4. Gen Three iLet

    • Twin chamber with both insulin and glucagon transmissions
    • As well the system, you only have to enter the entered weight and wouldn’t have a run or training
    • If CGM knowledge shouldn’t be out there, the system offers primary knowledge based mostly on historical past and consumer flows [19659009] The CGM used within the system accommodates each Dexcom G5 and Eversensen
    • In a research of 34 adults w / T1, beginning with A1c <11, both in injections or in pump therapy
    • Goal set to 120 on gadget
      • Mean (days Three -7): 162 (regular tx), 155 (il)
      • Range (days Three-7): 62%, 70% (vital) [19659009] Low (days Three-7): .6%, .6 %
      • In a single day stays: .four%, zero%
    • Sensor MARD is larger w / Dexcom and time in low vary was larger with Eversense

    5. i-Let Insulin Only Bionic Panreas

    • The used CGM system consists of dexcom G5 or Eversense CGM
    • The consumer only inputs its weight and not using a driving or coaching period
    • Compared to the MDI / conventional pump consumer combination (iLet vs common) remedy):
      • Avg 155 vs 162 (no difference)
      • Time <54: .7% vs. 7%
      • Time <70: 2.eight% vs. 3.2% (not vital)
      • vary: 70% vs. 61% (vital)
      • Night time average: 148 vs 163 (vital)
    • Eversense users spent more time on hypoglycemia, perhaps d / t sensor differences

    INSULIN-TERAPIY

    Ultrarapid Lispro (URLi) improves postprandial blood sugar

    • Excipients: treprostinil (vasodilator), citrate (increases vascular permeability), which helps to offer 10 minutes of earlier onset by 3 occasions the first 30 minutes
    • 43% much less susceptible after 3 hours
    • Studies have been carried out in adults with T1D & T2D. Three groups: mealtime URL, consuming Humalog, 20 minute meal on Urli. The results included:
      • The A1c worth of the post-meal URL group led to .2 larger than in different teams
      • No change / distinction in complete insulin doses, basal or bolus
      • Submit-meal tour with URLi was about 30 points lower than Humalog with no distinction after 20 min meal URL
      • No distinction in hypoglycemia ranges except> four hours after meal (less hypo in meal occasions URli, nothing 20 min at postmeal URL)
      • Destructive use is that

    Glargine u300 vs. Degludec

    • Weakened kidney perform occurred at> 20% of T2, a danger issue for hypoglycaemia resulting from decreased insulin clearance
    • As the rise of eGFR, Gla-300 Idegin increases ( especially in eGFR <60).
    • The A1c Discount is 0.four
    • Finger Head Glucose is Less
    • No Change in Hypoglycemia Danger

    ROAD TO ARTIFICIAL PANCREAS

    Everybody has a racing automotive with one of the best synthetic pancreas for diabetes customers.

    Overview of Work Included:

    International Diabetes Closed Loop (Tandem Management IQ)

    • Research at the University of Virginia
    • 6-Month Randomized Multicenter Research, Tandem X2, Ant9x9 Gpu
    • closed loop
    • The system consists of automated correction plugs along with basal modulation and Hypo blocking system
    • Gradual enhancement of overnight management to slowly shift to 110-120 quick
    • 168 members, 14 years of age, did not participate in the research; control, extreme downsides
    • All statistically vital outcomes:
      • TIR 59% vs. 71%, results achieved immediately maintained (nighttime TIR 59% vs. 76%)
      • Ne w / A1c <6.5 at baseline, 85% TIR worth achieved
      • Imply 166 vs. 156
      • A1c 7.39 vs. 7.06
      • Time <70 1.93% vs. 1.40% [19659009] Time <54.24% vs. 21%
    • 97% CGM usage; average of 21 finger points per day
    • 92% of the time in closed-loop mode
    • No onerous decrease limits occurred
    • Ease of use score 4.7 / 5; want to proceed to make use of four.8 / 5
    • Meal notification continues to be required
    • Customers can prolong boluses
    • Uses the consumer's main primary profile as the start line
    • Potential starting: 4 th th ] qtr 2019

    Use of IQ control in youngsters

    • Extra glucose variants in youngsters 7-12 years than in another age group
    • Greatest end result when used 24/7, not just at night time.
    • 82% Time <70: 3.9% vs. 2.eight%
    • TIR 59% vs. 71%

    Horizon (OmniPod HCL) – Stanford

    • Makes use of a normal smartphone (software [19659009)] 73% time zone
    • The algorithm is repeatedly updated based mostly on earlier knowledge
    • "Hybrid" degree speeds – just like previous consumer settings
    • Meals to be reported [19659009] Potential begin date: Third-4th Krs 2020

    ] Medtronic Announcements

    * Partnership with Tidepool 098] The purpose is to develop and “an interoperable automatic insulin pump for the treatment of diabetes”

    * New Analysis – ”Advanced Enhanced Hybrid Closed loop System for Bluetooth Enabled MiniMed (TM) 780G designed to automate repair burners ”

    -” Pivotal Trial for Next Era Controller (TM) Steady Glucose Monitoring Sensor. ”

    HCL COMPONENTS

    CGM T applies the next criteria:

    • > 87% of all 20% values ​​of YSi
    • > 80% of 15% of YSi when over 180 AND no values ​​of <70
    • > 70% 15%: at 70-180
    • > 85% within 15mg / dl when less than 70 AND no values> 180
    • Comparable performance in adults and in bed is required
    • ROC Precision Tips also confirmed
    • ] No clinically vital gaps

    EXERCISE

    Dual hormone (insulin with glucagon) HCL

    • Citadel et al., Diabete's Care Vol 41, July 2018
    • Achieved greatest control throughout and after 45 minutes of exercise compared to single hormone HCL and open-loop use
    • Prevalence of melancholy: 3.four% (double hormone); 8.Three% (single hormone of HCL); 7.6% (PLGS)

    Fasting and PM Exercise

    • Jane Yardley, University of Alberta
    • 10 adults
    • 24 min HIIT session (twelve 10 seconds) and 10 min warm-up, 11 min. Fasting (7am): Elevated 32 mg / dl (1.8mmol) during exercise, additional elevated 7mg / dl (zero.4mmol) 1 hour later
    • Afternoon (5pm) 1 hour after gluceran bar: decreased 7 mg / dl (0.4 mmol over time), one other 21 mg / dl (1.2 mmol) 1 h later
    • (p = zero.039 1 h publish)

    Has day by day exercise or train contributed extra to insulin sensitivity ? [juliste]

    • Mano et al., Kyoto University, Japan
    • In topics with lower BMI (<23), exercise habits ("sweating point") correlate most strongly with impaired insulin resistance
    • . greater BMI () 23), non-exercise exercise (strolling for at the very least 1 h / day) correlates most strongly with decreased insulin resistance

    Ridell Mike, University of York, Toronto [19659009] Sort 1 Diabetes Coaching Initiative Pilot Research

  • 33 adults w / T1 exercising no less than 30 minutes with a mixture of aerobic, resistance, and interval training, twice weekly.
  • 24-hour training session: TIR 57%; training days: TIR 48%. There are not any differences based mostly on the type of exercise. Time over 180 on 33% on fitness days vs. 44% on non-exercise days. Time under 70: 4.5% on train days vs. Three.eight% on non-exercise days
  • The difference between the teams began to blur 16-20 hours after coaching periods.
  • ! -Perform (f, b, e, v, n, t, s) if (f.fbq) return; n = f.fbq = perform () n.callMethod?
    n.callMethod.apply (n, arguments): n.queue.push (arguments) if (! f._fbq) f._fbq = n;
    n.push = n; n.loaded =! zero; n.version = & # 39; 2.zero & # 39 ;; n.queue = []; t = b.createElement (e); t.async =! zero;
    t.rc = v; s = b.getElementsByTagName (e) [0]; s.parentNode.insertBefore (t, t) (window,
    document, "script", "https: //connect.facebook.net/en_US/fbevents.js"), window.fbAsyncInit = perform ()
    fusion_resize_page_widget ();

    jQuery (window) .resize (perform ()
    fusion_resize_page_widget ();
    );

    perform fusion_resize_page_widget ()
    var $ container_width = jQuery (& # 39; .facebook-like-widget-2 & # 39;) .width ();

    if (1> $ container_width)
    $ container_width = 200;

    its ($ container_width! = jQuery (& # 39;. facebook-like-widget-2 .fb-page & # 39;) .knowledge (& # 39; width & # 39;) && $ container_width! = jQuery (& # 39;) ;. facebook-like-widget-2 .fb-page & # 39;) .knowledge (& # 39; original-width & # 39;))
    jQuery (& # 39;. facebook-like-widget-2 .fb-page & # 39;) .attr (& # 39; data-width & # 39 ;, $ container_width);
    her (& # 39; undefined & # 39;! == typeFB)
    FB.XFBML.parse ();

    ;

    (perform (d, s, id)
    are you able to
    fjs = d.getElementsByTagName (t) [0];
    her (d.getElementById (id))
    return;

    js = d.createElement (s);
    js.id = id;
    js.src = "https://connect.facebook.net/en_US/sdk.js#xfbml=1&version=v2.11&appId=";
    fjs.parentNode.insertBefore (js, fjs);
    (doc, script & # 39 ;, & # 39; facebook-jssdk & # 39;));