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Could Insulin Management be Controlled with an App?

Determining the appropriate amount of insulin to administer in response to drops in blood sugar can be challenging, but it is something that individuals with type 1 diabetes must do daily in order to manage their health. If left untreated, low blood sugar (or hypoglycemia) can be potentially fatal.

A team of researchers and physicians at Oregon Health & Science University (OHSU) are looking to improve diabetes management through a new app called DailyDose. While there are similar types of apps that exist, what sets DailyDose apart is that has demonstrated statistically relevant outcomes through multiple clinical studies. The AI algorithm for the app was originally developed entirely through a mathematical simulator, but when real-world data was used, the recommendations generated by the app aligned with recommendations provided by physicians, or were still considered safe, more than 99% of the time. In addition, improved glucose control was achieved. This was determined after 100 weeks of testing conducted in four-week trials.

Each trial involved 16 patients with type 1 diabetes and combined information from a continuous glucose monitor or wireless insulin pen with the app. Nearly 68% of the time, the recommendations generated agreed with those of physicians.

These findings are important because they show that the app may be effective in supporting individuals with type 1 diabetes in reducing risk of hypoglycemia by better managing insulin administration and blood glucose levels between appointments with their endocrinologist. Larger clinical trials are needed over longer periods of time to further determine the accuracy and effectiveness of the app in relation to other treatment strategies.

Technology is becoming increasingly more popular and advanced in terms of managing type 1 diabetes. There are numerous devices and apps already available and more in the works. This gives individuals with type 1 diabetes a wider variety of options in order to determine what works best for their needs and lifestyle.

Though not involved with this study, the Diabetes Research Connection (DRC) strives to continue growing understanding of type 1 diabetes and improving prevention and treatment methods as well as one day finding a cure. Early-career scientists can receive critical funding through the DRC to pursue novel research studies around T1D. Learn more about current projects and how to support these efforts at http://diabetesresearchconnection.org.

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Supporting Diabetes Management Via Drone

Type 1 diabetes (T1D) affects people from all walks of life around the world. A challenge in managing the disease is regular access to healthcare and necessary supplies. Healthcare providers in Ireland recognized the impact of this problem even more when natural disasters such as snowstorms, hurricanes, and flooding made it difficult for patients to reach clinics for their appointments or to get medications.

As a result, researchers turned to technology as a way to potentially help patients receive the care they need. They spent more than a year working out the logistics and regulatory compliance of using drones to deliver supplies to individuals in remote areas or those cut off from access following natural disasters or other incidents such as COVID-19. The researchers had to ensure that when using the drone, they were following all aviation and aerospace regulations, as well as medical and safety regulations.

The first flight traveled around 20 km each way going from Galway, Ireland, to the Aran Islands on September 13. The Wingcopter 178 drone delivered insulin from a pharmacy to a patient’s clinician and picked up a blood sample for remote testing of HbA1c levels. This test flight demonstrated that autonomous delivery of insulin is possible.

There was a significant amount of planning, research, and collaboration that went into making the drone delivery possible, but it is a starting point for making this technology available in healthcare. The researchers needed to have backup plans in place for each step of the process, and they worked closely with a multidisciplinary team including aviation and medication regulators.

However, this successful test flight is a stepping stone toward making drone delivery a reality for patients with diabetes. This could allow patients to continue receiving life-saving insulin and other supplies even when they are unable to make it out of their home. Diabetes does not take a break during pandemics or adverse events, and there are patients who live in rural communities where access to healthcare is a challenge.

Diabetes Research Connection (DRC) is excited to see how technology continues to improve and whether drone delivery becomes a feasible option as part of diabetes management and healthcare in general. The DRC provides funding for novel, peer-reviewed research studies focused on the prevention, cure, and improved management of type 1 diabetes. To learn more and support these efforts, visit https://diabetesresearchconnection.org.

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Could There Be More than One Form of Type 1 Diabetes?

Researchers know that there are significant differences between type 1 diabetes (T1D) and type 2 diabetes (T2D), but now they are digging a little deeper. When it comes to T1D, the disease may not affect everyone in the same way. According to a recent study, there may be more than one endotype, and a major differentiator could be age of diagnosis.

The study looked at a small sample of 19 children diagnosed with T1D within the past two years and compared age of diagnosis against amount of beta cell destruction and levels of proinsulin and C-peptides. They also compared these ratios in a group of 171 adults with T1D based on their age of diagnosis. Their results showed that children who were diagnosed before the age of 7 had much higher levels of proinsulin-insulin co-localization than those diagnosed after age 13. Individuals between ages 7 and 13 were divided and fell into one group or the other.

The researchers also compared results against CD20Hi and CD20Lo immune profile designations for each participant. Children age 7 or younger tended to be CD20Hi, while those age 13 or older were CD20Lo, and the children in between were aligned with their respective groups based on whether they were CD20Hi or CD20Lo.

These differences in proinsulin and C-peptide concentrations demonstrate a distinction in how individuals are impacted by T1D, leading to at least two separate endotypes. Understanding whether an individual has T1D endotype 1 (T1DE1) or T1D endotype 2 (T1DE2) could enable more targeted and effective treatment of the disease based on how each group responds. Individuals with T1DE1 are identified as having higher levels of beta cell loss, therefore may have more difficulty regulating blood glucose. Those with T1DE2 may retain more beta cells, and determining ways to activate and protect these cells could support improved natural insulin production.

Recognizing that T1D affects people differently is a step in the right direction toward more personalized medicine and targeted therapies. Therapeutic trials could be aimed at groups depending on age of diagnosis and specific endotype in the future as larger studies are conducted to determine the significance of these findings.

Diabetes Research Connection (DRC) is committed to supporting advances in research around type 1 diabetes and provides early-career scientists with critical funding for their studies. Research is focused on preventing and curing type 1 diabetes, minimizing complications, and improving quality of life for those living with the disease. Learn more and support these efforts by visiting https://diabetesresearchconnection.org.

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Artificial Pancreas App Supports Type 1 Diabetes Management

Maintaining good glycemic control is challenging when living with type 1 diabetes. Individuals must carefully monitor their blood glucose levels throughout the day, then administer the appropriate amount of insulin to try to stay within target range. This can be more difficult than it sounds. Furthermore, many people with type 1 diabetes struggle with their blood sugar dropping overnight while they are asleep.

Patients living in the UK may have access to a new artificial pancreas app that takes away some of the stress and burden of constant blood sugar management. The CamAPS FX app works in conjunction with the Dana RS insulin pump and the Dexcom G6 continuous glucose monitor. Using a complex algorithm, the app tracks blood glucose levels, then automatically adjusts insulin administration accordingly. This reduces the demand for regular finger sticks to check blood sugar, and patients do not need to calculate how much insulin they require on their own.

The app has been approved in the UK for individuals age one and older, including pregnant women, who have type 1 diabetes. It was developed based on 13 years of clinical research conducted by Professor Roman Hovorka from the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust and his team at the Wellcome-MRC Institute of Metabolic Science. In addition, data from the app can be shared with patients’ healthcare teams allowing them to provide more personalized diabetes care.

Technology has made some significant advancements in type 1 diabetes care, and this is one more example of how it can impact management of the disease and improve health outcomes. Artificial pancreas technology is an area that researchers have been focused on improving over the years in order to give patients more options and reduce the burden of managing the disease.

Diabetes Research Connection (DRC) is excited to see more results from use of the app and what it could mean for future diabetes management, not just in the UK but around the world. Currently the app is only available to patients at select diabetes clinics in the UK. Though not involved with this project, the DRC is committed to advancing diabetes research to help prevent and cure type 1 diabetes, minimize complications, and improve quality of life for those living with the disease. Early-career scientists can receive up to $50K in funding to support novel, peer-reviewed research projects. To learn more about current studies and contribute to these efforts, visit https://diabetesresearchconnection.org.

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Using Telehealth to Enhance Pediatric Type 1 Diabetes Management

Telehealth has come a long way in improving access to care. It has become even easier for patients to connect with healthcare providers without going to their office. Using available technology, a recent study out of the University of California, Davis (UC Davis) examined whether management of type 1 diabetes (T1D) in pediatric patients could be improved through telehealth.

Fifty-seven patients under the age of 18 participated in the study where they were connected with a member of the research team every four, six, or eight weeks via video conference for at least one year. This was in addition to quarterly clinic visits. All of the patients had suboptimal glycemic control before the study began, and most lived at least 30 miles away from the hospital.

The program was led by Stephanie Crossen, a pediatric endocrinologist at UC Davis Health. Prior to each video call, patients sent data from their diabetes devices for Crossen and her team to review. After one year, their findings showed that “83 percent of participants completed four or more diabetes visits within a year, compared to only 21 percent prior to the study,” and “mean HbA1c decreased from 10.8 to 9.6 among participants who completed the full year.”

In addition, 93 percent of participants were highly satisfied with the program, and more participants were using technology such as insulin pumps and continuous glucose monitors (CGMs). However, one area that did not change significantly was the number of diabetes-related emergency room or hospital visits.

Still, the study shows that telehealth could be a valuable intervention for children and youth with type 1 diabetes to help them better manage their disease and health outcomes. A reduction in HbA1c levels and an increase in frequency of care is encouraging. Telehealth may be one more tool for effectively supporting individuals with T1D.

Research continues to advance the understanding, treatment, and management of T1D. Though not involved with this study, the Diabetes Research Connection (DRC) supports these efforts as well by providing critical funding to early-career scientists studying the disease.  Researchers can receive up to $50K for novel, peer-reviewed projects aimed at preventing or curing type 1 diabetes, minimizing its complications, and improving quality of life for individuals living with the disease. To learn more, visit https://diabetesresearchconnection.org.

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Leveraging the Power of Light to Manage Type 1 Diabetes

A common problem in managing type 1 diabetes is maintaining relatively stable blood glucose levels. By the time a person realizes their blood sugar is rising or falling and begins to treat it, they may already experience spikes. This can be tough on the body and lead to over- or undertreatment in an effort to curb the highs or lows. Though technology has made it faster and easier to track blood glucose levels and more accurately administer insulin, it’s still not a perfect system.

A recent study reveals that researchers may have come up with a way to manage blood sugar without manually administering insulin. They engineered pancreatic beta cells to be responsive to exposure to blue light. By introducing a photoactivatable adenylate cyclase (PAC) enzyme into the cells, they produce a molecule that increases insulin production in response to high levels of glucose in the blood.

The molecule is turned on or off by blue light and can generate two to three times the typical amount of insulin produced by cells. However, it does not boost production when glucose levels in the blood are low. Furthermore, the cells do not require more oxygen than normal cells, which helps alleviate the common issue of oxygen starvation in transplanted cells.

The study was conducted on diabetic mice, so more research is needed to determine whether the process will be as effective in humans. If it is, this could mean that individuals with type 1 diabetes may have an option for controlling blood sugar levels without pharmacological intervention. When paired with a continuous glucose monitor (CGM) or other device as well as a source of blue light, it could create a closed loop model of managing the disease by functioning as a bioartificial pancreas.

This could be potentially life changing for individuals living with type 1 diabetes, and Diabetes Research Connection (DRC) is excited to see how the study progresses. Though not involved with this project, the DRC supports advancement of type 1 diabetes research and treatment options by providing critical funding for early career scientists pursuing novel research projects. Learn more by visiting http://diabetesresearchconnection.org.

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Could Implantable Glucose Sensors be a Viable Option for Monitoring Blood Sugar?

Diabetes management has come a long way over the years. Some people have transitioned away from constant finger pricks and begun using continuous glucose monitoring (CGM) systems to track their blood sugar and alert them to episodes of hyperglycemia or hypoglycemia. However, not everyone has the same level of adherence to using this technology, so results can be inconsistent.

Researchers from Diablo Clinical Research recently conducted a study on the use of implantable, subcutaneous continuous glucose sensors for diabetes management. A small sensor was placed under the skin, and then a transmitter was positioned over top providing wireless power and transmission of data to a mobile app. The transmitter also vibrated to alert users of episodes of hyper- or hypoglycemia in addition to alerts being sent to the app.

There were 90 adults with type 1 and type 2 diabetes who participated in the nonrandomized, prospective, masked, single-arm study which lasted for 90 days. Sixty-one of the participants had type 1 diabetes. Individuals underwent accuracy assessment visits on days 1, 30, 60, and 90 to compare results of the implantable sensor versus a bedside glucose analyzer. In addition, some participants also partook in hyperglycemia and hypoglycemia challenges on days 30, 60, and 90. There were only eight participants who did not complete the study, and 12 reports of mild adverse events and two moderate adverse events.

Following the study, the results showed “more than 90% of continuous glucose monitoring system readings within 20% of reference values.” Furthermore, “the system correctly identified 93% of hypoglycemic events and 96% of hyperglycemic events by the reference glucose reader.” The implantable CGM system used was Eversense by Senseonics.

Additional clinical studies are necessary to further evaluate the safety and accuracy of the system and expand potential use to pediatric patients as well. However, preliminary results show high levels of safety and accuracy in this small study.

This is an exciting step toward providing individuals with T1D another option for managing diabetes allowing them to measure blood sugar levels more consistently and with less intervention. The Diabetes Research Connection (DRC) is interested to see how this study advances moving forward and what it may mean for diabetes management in the future. The DRC raises funds for early career scientists to perform peer-reviewed, novel research designed to prevent and cure type 1 diabetes, minimize its complications, and improve quality of life for those living with the disease. To learn more and support these efforts, visit http://diabetesresearchconnection.org.

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