Artificial pancreas successful in type 2 diabetes tests(theregister.com)
theregister.com
Artificial pancreas successful in type 2 diabetes tests
https://www.theregister.com/2023/01/18/artificial_pancreas_successful_in_type/
26 comments
The evidence for treating and reversing type 2 with a plant based diet is staggering.
Whether you want to treat it with plants or some other diet (the evidence is strong with both vegan and omnivorous diets, the emphasis seems to be food diversity, whole foods, and perhaps some modicum of calorie restriction) is fine. It can be done.
Though, in defence of those suffering, the psychological component of developing and acquiring full fledged type 2 diabetes due to poor diet is no small feat to contend with. It can be done, but it takes a lot of confidence in advice given, support from those around you, and the sense that there’s real purpose and value in following through on such a large lifestyle change. At the moment it seems society is severely deficient in these pieces of the recovery puzzle.
Whether you want to treat it with plants or some other diet (the evidence is strong with both vegan and omnivorous diets, the emphasis seems to be food diversity, whole foods, and perhaps some modicum of calorie restriction) is fine. It can be done.
Though, in defence of those suffering, the psychological component of developing and acquiring full fledged type 2 diabetes due to poor diet is no small feat to contend with. It can be done, but it takes a lot of confidence in advice given, support from those around you, and the sense that there’s real purpose and value in following through on such a large lifestyle change. At the moment it seems society is severely deficient in these pieces of the recovery puzzle.
That's a very high level of confidence you have about a simple "cure" for a disease that many millions suffer from and is very widely known. Call me skeptical.
The scientific evidence of treating type 2 diabetes with diet isn’t hard to find. What’s hard to find is people with type 2 diabetes who are in the presence of people who will encourage them to change their lifestyles, support them, and help keep them on track. This is why there are millions of people suffering in the first place.
There’s a prolific culture that’s conducive to sickness and suffering, in large part due to diet, but the causes aren’t readily evident or understood by the people inside that culture. That needs to be overcome before any significant progress will be made in treating people with nutrition.
There’s a prolific culture that’s conducive to sickness and suffering, in large part due to diet, but the causes aren’t readily evident or understood by the people inside that culture. That needs to be overcome before any significant progress will be made in treating people with nutrition.
Type-2 diabetes can't be cured, but it can be put into remission for most patients through dietary changes to the extent that they no longer need exogenous insulin. Here is some research.
https://www.virtahealth.com/research
https://www.virtahealth.com/research
It's not a cure. If you resume your previous diet, it will return.
As a physician, it physically hurts whenever I read stuff like this.
First off, this is in huge bold letters at the top of the second link that you cite as evidence for a "cure" to diabetes:
> We don’t call it diabetes reversal, because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever.
Second, starting with diet/exercise before medicines is already medical standard of care for mild diabetes [1, 2]:
> 8.5 Individuals with diabetes and overweight or obesity may benefit from modest or larger magnitudes of weight loss. Relatively small weight loss (approximately 3–7% of baseline weight) improves glycemia and other intermediate cardiovascular risk factors. Larger, sustained weight losses (>10%) usually confer greater benefits, including disease-modifying effects and possible remission of type 2 diabetes, and may improve long-term cardiovascular outcomes and mortality. 8.12 Short-term nutrition intervention using structured, very-low-calorie meals (800–1,000 kcal/day) may be prescribed for carefully selected individuals by trained practitioners in medical settings with close monitoring. Long-term, comprehensive weight maintenance strategies and counseling should be integrated to maintain weight loss.
Many doctors will stop diabetes medications if patients can sustain a hemoglobin A1c < 6.5%. People with a new diagnosis of diabetes often have a hemoglobin A1c in the high 6% to low 7% range, and for them diet alone is often enough to get there. For a new diagnosis with a hemoglobin A1c in that mild range, any doctor worth their salt will recommend a trial of diet and exercise for 3 - 6 months and start medications only if the patient's hemoglobin A1c has not shown much improvement.
But there are also people with hemoglobin A1cs greater than 10. These people have blood sugar levels that are dangerously high. Waiting 3 to 6 months for diet/exercise before starting medications would leave them at significantly increased risk of risk of lethal com[plications like DKA [3].
Very heavy calorie restriction is also not an option for these people because they have a blunted beta-adrenergic response, which means that unlike you and me, they do not release stores of glycogen from their liver when their blood sugar drops low. Which means that if they don't get enough calories for 1 - 2 days, their blood sugar will drop critically low. We see this in the hospital all the time.
So it's not just a matter of doctors throwing insulin and other expensive medications at everyone who walks through the door in diabetes. There is a broad spectrum of severity in diabetes, and different points on the spectrum require different approaches.
[1]: https://diabetesjournals.org/care/article/46/Supplement_1/S1...
[2]: https://diabetesjournals.org/care/article/46/Supplement_1/S1...
[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642652/
First off, this is in huge bold letters at the top of the second link that you cite as evidence for a "cure" to diabetes:
> We don’t call it diabetes reversal, because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever.
Second, starting with diet/exercise before medicines is already medical standard of care for mild diabetes [1, 2]:
> 8.5 Individuals with diabetes and overweight or obesity may benefit from modest or larger magnitudes of weight loss. Relatively small weight loss (approximately 3–7% of baseline weight) improves glycemia and other intermediate cardiovascular risk factors. Larger, sustained weight losses (>10%) usually confer greater benefits, including disease-modifying effects and possible remission of type 2 diabetes, and may improve long-term cardiovascular outcomes and mortality. 8.12 Short-term nutrition intervention using structured, very-low-calorie meals (800–1,000 kcal/day) may be prescribed for carefully selected individuals by trained practitioners in medical settings with close monitoring. Long-term, comprehensive weight maintenance strategies and counseling should be integrated to maintain weight loss.
Many doctors will stop diabetes medications if patients can sustain a hemoglobin A1c < 6.5%. People with a new diagnosis of diabetes often have a hemoglobin A1c in the high 6% to low 7% range, and for them diet alone is often enough to get there. For a new diagnosis with a hemoglobin A1c in that mild range, any doctor worth their salt will recommend a trial of diet and exercise for 3 - 6 months and start medications only if the patient's hemoglobin A1c has not shown much improvement.
But there are also people with hemoglobin A1cs greater than 10. These people have blood sugar levels that are dangerously high. Waiting 3 to 6 months for diet/exercise before starting medications would leave them at significantly increased risk of risk of lethal com[plications like DKA [3].
Very heavy calorie restriction is also not an option for these people because they have a blunted beta-adrenergic response, which means that unlike you and me, they do not release stores of glycogen from their liver when their blood sugar drops low. Which means that if they don't get enough calories for 1 - 2 days, their blood sugar will drop critically low. We see this in the hospital all the time.
So it's not just a matter of doctors throwing insulin and other expensive medications at everyone who walks through the door in diabetes. There is a broad spectrum of severity in diabetes, and different points on the spectrum require different approaches.
[1]: https://diabetesjournals.org/care/article/46/Supplement_1/S1...
[2]: https://diabetesjournals.org/care/article/46/Supplement_1/S1...
[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642652/
Ok, maybe a little bit of big marketing in calling it an artificial pancreas.
This is an incremental improvement on existing insulin pump tech right?
This is an incremental improvement on existing insulin pump tech right?
Finally a thing I'm qualified to talk about! This is my area of expertise. The term "artificial pancreas" is a historical artefact of the original systems from the 1980s, which called anything that controlled blood sugar effectively an "artificial pancreas". These systems do not cover any of the hepatic or hormonal functions of the pancreas, just the malfunctioning islet cell part.
That being said, commoditization of a fully closed loop insulin delivery system would be a godsend for the millions of people living with completely uncontrolled diabetes. Uncontrolled diabetes accounts for between 30-40% of raw healthcare spend every year, and it's growing. Primary care like this will keep patients adhering to it out of the hospital and improve their lives immeasurably.
So no, I wouldn't compare this to an insulin pump alone. It's like comparing the latest self driving cars out of Waymo to the cruise control on a 1994 Corolla.
The results (66% TIR 70-180mg/dL) aren't incredible, but believe it or not are far better than most diabetics are able to get. For reference, a person without diabetes will typically have numbers in the 95% or higher range.
We're currently finishing a study in the hospital to improve on these results in a big way!
That being said, commoditization of a fully closed loop insulin delivery system would be a godsend for the millions of people living with completely uncontrolled diabetes. Uncontrolled diabetes accounts for between 30-40% of raw healthcare spend every year, and it's growing. Primary care like this will keep patients adhering to it out of the hospital and improve their lives immeasurably.
So no, I wouldn't compare this to an insulin pump alone. It's like comparing the latest self driving cars out of Waymo to the cruise control on a 1994 Corolla.
The results (66% TIR 70-180mg/dL) aren't incredible, but believe it or not are far better than most diabetics are able to get. For reference, a person without diabetes will typically have numbers in the 95% or higher range.
We're currently finishing a study in the hospital to improve on these results in a big way!
It sounds like they've taken the existing Type-1 cgm plus self-adjusting pump and used it on type-2 diabetics. Solid medical study. Hardly a breakthrough, IMO.
> the real innovation of the Cambridge design is its mobile app, CamAPS HX, which uses an algorithm developed by the team that Cambridge University states "predicts how much insulin is required to maintain glucose levels in the target range."
It certainly sounds like it. I've only read the linked article and haven't dug elsewhere but this seems like a new algorithm for closed loop systems (Tandem has one; Medtronic has one; there may be others). Technology like this is amazing for diabetics (am Type 1 and have a tandem/dexcom closed loop system and love it) but is nothing like an artificial pancreas.
It certainly sounds like it. I've only read the linked article and haven't dug elsewhere but this seems like a new algorithm for closed loop systems (Tandem has one; Medtronic has one; there may be others). Technology like this is amazing for diabetics (am Type 1 and have a tandem/dexcom closed loop system and love it) but is nothing like an artificial pancreas.
As a recently diagnosed type 1 im really concerned about adopting a pump system out of security concerns. Is there a way to disable wirelss communication when not in use on the pumps?
While I sympathize, may I ask why you consider security such a concern? The odds of someone having the means (hacking a medical device would not be easy), the motive (why are they targeting you specifically) and the opportunity (they'd need to be in very close proximity to connect wirelessly to your device) seems miniscule. Most crimes are crimes of opportunity and while not impossible it seems unlikely that any non-high-profile individual would be the target of such an attack.
Its more of a principal thing than anything else.
My experiences in healthcare IT/INFOSEC combined with all the blatantant anti-consumer behavior of a lot of these different equipment manufacturers have left a bitter taste in my mouth.
I legitimately dont trust them to vet their bluetooth stack. Or to pick a competant serices comapny to do it either.
I dont trust the judgement of the "accredited" firms that pay for play coach them into many of these certifications that are required to sell/manufacture these devices.
I dont trust the fact I cannot personally see the logic/code that drives the devices decision making process.
I dont trust them on the principal of the move twords smart phone management of everything. Even if the device itself is secure. Im being forced to extract my personal health information and store it all at someloint in plaintext on another device that for all intents and purposes for the average american is horribly insecure and likely is already loaded with carrier spyware. BTW most of the management apps for cgms REQUIRE google play services.(No safteynet check to verify the application itself from what I can tell.)
I dont like the fact that I likely wouldnt be able to repair the device in the event of the manufacturer ceases to exist.
Its not that someone wants to kill me, but the idea of making the likelihood some asshole with a decent antenna and a laptop could send me to the hospital or worse a non 0 chance kind of seems silly to me in general.
TL;DR Preverse incentives mixed with a sense of general apathy twords "doing the right thing" are a big turn off for me.
My experiences in healthcare IT/INFOSEC combined with all the blatantant anti-consumer behavior of a lot of these different equipment manufacturers have left a bitter taste in my mouth.
I legitimately dont trust them to vet their bluetooth stack. Or to pick a competant serices comapny to do it either.
I dont trust the judgement of the "accredited" firms that pay for play coach them into many of these certifications that are required to sell/manufacture these devices.
I dont trust the fact I cannot personally see the logic/code that drives the devices decision making process.
I dont trust them on the principal of the move twords smart phone management of everything. Even if the device itself is secure. Im being forced to extract my personal health information and store it all at someloint in plaintext on another device that for all intents and purposes for the average american is horribly insecure and likely is already loaded with carrier spyware. BTW most of the management apps for cgms REQUIRE google play services.(No safteynet check to verify the application itself from what I can tell.)
I dont like the fact that I likely wouldnt be able to repair the device in the event of the manufacturer ceases to exist.
Its not that someone wants to kill me, but the idea of making the likelihood some asshole with a decent antenna and a laptop could send me to the hospital or worse a non 0 chance kind of seems silly to me in general.
TL;DR Preverse incentives mixed with a sense of general apathy twords "doing the right thing" are a big turn off for me.
Lots of good points. Thanks for the insight!
Edit: I'd suggest taking a look at Tidepool Loop which recently got FDA clearance. It might align with your interests/requirements (though still requires a big-brand insulin pump/CGM)
Edit: I'd suggest taking a look at Tidepool Loop which recently got FDA clearance. It might align with your interests/requirements (though still requires a big-brand insulin pump/CGM)
Thank you! Tidepool looks to have some really cool looking features thanks for pointing it out!
Yes. Some models don't have it at all.
Why do these articles always attract glib and judgemental comments from people who have no personal experience with type 2 diabetes and whose study of the issue amounts to "a few things I read about this a while ago."
Is there any discussion online that is not like this?
This isn’t new, there are open source “artificial pancreases” out there that have been around since at least 2017[1]. It’s good to see more focus and study on this though.
[1] https://www.hanselman.com/blog/open-source-artificial-pancre...
[1] https://www.hanselman.com/blog/open-source-artificial-pancre...
Roman Hovorka (last author on the paper) has been working on this problem at Cambridge for the better part of 20 years! His was one of the first to see hospital use (through a partnership with BBraun) and also to employ the more advanced MPC techniques from chemical engineering.
A fundamental problem with this approach is it is managing the end points of the insulin system while ignoring the start points. And you intake sugars your body will digest them and absorb through the gut into the bloodstream. As the level raises your body needs to burn or store the glucose to keep the blood level within safe ranges. One option is to store the glucose as glycogen primarily in muscle tissue and insulin is a part of the signal for this process. Another option is to convert the sugar to fat for storage, again using insulin as a signal. In the first case you have a fairly low limit (about 500g in muscle, another 100g in the liver, for an adult male of average size) and once this is full you can't use this pathway to store any more glucose. You then have to shunt all the remaining glucose into your fat cells by converting it into fats.
So if you have someone who has a chronically high intake of sugars, complex or simple, they will eventually fill their muscle reserves and be storing further sugar as fat. This will always require insulin to activate the glucose storage pathways and this will escalate over time if the level is high enough. Adding more insulin is a solution in the very acute timeframe, but chronically it is just escalating the problem.
The better solution is to reduce the intake of sugars. This means that you need less insulin to manage it, you don't increase resistance to insulin over time, and you don't progress diabetes. You can add fats in place of the sugar for energy and they burn and store without using huge amounts of insulin, so you keep the overall insulin load low and reduce the need for supplemental insulin.
Someone who is a type 2 diabetic may be able to reduce to zero supplemental insulin with a low enough sugar diet. They may also over time reduce their insulin resistance to the point where there is no diagnostic marker of diabetes at all, such as hba1c, fasting insulin/glucose, etc. Along with the markers much of the secondary harm is able to halt or reverse depending on the damage. You won't undo blindness but joint pain, neuropathy, excessive urination, fatigue, muscle wastage, and so on are all modifiable by ongoing diet. Making their insulin level higher to compensate for the diet is a temporary solution but if you don't deal with the diet it is just putting off the solution to the problem.
So if you have someone who has a chronically high intake of sugars, complex or simple, they will eventually fill their muscle reserves and be storing further sugar as fat. This will always require insulin to activate the glucose storage pathways and this will escalate over time if the level is high enough. Adding more insulin is a solution in the very acute timeframe, but chronically it is just escalating the problem.
The better solution is to reduce the intake of sugars. This means that you need less insulin to manage it, you don't increase resistance to insulin over time, and you don't progress diabetes. You can add fats in place of the sugar for energy and they burn and store without using huge amounts of insulin, so you keep the overall insulin load low and reduce the need for supplemental insulin.
Someone who is a type 2 diabetic may be able to reduce to zero supplemental insulin with a low enough sugar diet. They may also over time reduce their insulin resistance to the point where there is no diagnostic marker of diabetes at all, such as hba1c, fasting insulin/glucose, etc. Along with the markers much of the secondary harm is able to halt or reverse depending on the damage. You won't undo blindness but joint pain, neuropathy, excessive urination, fatigue, muscle wastage, and so on are all modifiable by ongoing diet. Making their insulin level higher to compensate for the diet is a temporary solution but if you don't deal with the diet it is just putting off the solution to the problem.
"less time managing their condition", is such an incredibly low bar.
Edit: I'd like to see this contrasted with dietary changes and other lifestyle changes. Also, the words "artificial" and "pancreas" do not appear in the study.
Edit: I'd like to see this contrasted with dietary changes and other lifestyle changes. Also, the words "artificial" and "pancreas" do not appear in the study.
"halved the amount of time patients spent with high glucose levels, doubled the amount of time glucose levels were safe"
That's huge. Diabetes is a disease that involves damage over time. Sugar (glucose specifically) is an extraordinarily damaging substance when it is present in high concentrations. If you can keep your blood sugar level within the goal range for longer, that means that you've reduced the time window in which significant damage is being done to various organs around the body. This in turn reduces the chance of developing complications of diabetes like kidney disease, retinal disease, neuropathies, and vascular disease of the heart and brain.
That's huge. Diabetes is a disease that involves damage over time. Sugar (glucose specifically) is an extraordinarily damaging substance when it is present in high concentrations. If you can keep your blood sugar level within the goal range for longer, that means that you've reduced the time window in which significant damage is being done to various organs around the body. This in turn reduces the chance of developing complications of diabetes like kidney disease, retinal disease, neuropathies, and vascular disease of the heart and brain.
It said "half as much", and that's a lot. It can amount to hours per day, and a lot of needle sticks that leave you looking and feeling like a pincushion. You have to calculate your carb input for everything that goes in your mouth. It's very wearing day after day, with zero days off.
It's subject to a lot of variables, not all of which are known. Both too high and too low are problems, and the solutions are not instant. It's easy to veer from too high to too low and back by overcorrecting.
So yeah, half as much time is a very big deal. This is not a one pill a day proposition. It's like having to be conscious of your pulse or breathing.
It's subject to a lot of variables, not all of which are known. Both too high and too low are problems, and the solutions are not instant. It's easy to veer from too high to too low and back by overcorrecting.
So yeah, half as much time is a very big deal. This is not a one pill a day proposition. It's like having to be conscious of your pulse or breathing.
[deleted]
Sometimes just looking after yourself properly is all you need.
https://www.theguardian.com/lifeandstyle/2013/may/12/type-2-...
https://www.diabetes.org.uk/diabetes-the-basics/type-2-rever...