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Breakthrough JDRF-funded artificial pancreas study welcomed as new data reveals people with type 1 diabetes average ten hypos a week

In a world first, British children with type 1 diabetes have successfully been entrusted to use pioneering artificial pancreas technology all by themselves at home overnight – without the careful supervision of expert researchers. Celebrities that live with the condition, including Hollywood actor Jeremy Irvine, have hailed the findings.

The latest trial, coordinated by the University of Cambridge and funded solely by JDRF, has shown for the first time globally that unsupervised use of the artificial pancreas overnight can be safe – while also providing exciting benefits.

Participants, all aged between 12 and 18, saw improved blood glucose control during the trial and experienced fewer nights with hypoglycaemic episodes.

The breakthrough trial, detailed in the journal Diabetes Care, comes as JDRF reveals UK people living with the condition are experiencing a “shockingly high” average of ten hypos a week – laying bare the urgent need for the artificial pancreas to become an accessible reality.

The figure of ten hypos per week has emerged through a first ever real-time information haul of more than 10,000 UK residents with type 1 diabetes, released to JDRF from the popular mySugr app. It follows the recent revelation that nine per cent of all hospital admissions for children and young people with diabetes are due to hypos.

All previous artificial pancreas trials, in hospitals and in home environments, have seen researchers strictly monitor patients. News of the successful unsupervised trial has had a positive response from UK celebrities that live with type 1 diabetes.

Hollywood actor Jeremy Irvine, who is a JDRF supporter, has lived with type 1 diabetes since the age of six. He said: “When the chance came for me to take part in early artificial pancreas trials a few years ago, I jumped at the opportunity. I wanted to play my own very small part in moving the artificial pancreas closer to reality. I’m really excited to hear of this latest progress – the scientists behind it are my heroes.”

Television presenter Dominic Littlewood gave his reaction to the statistic showing that UK people with type 1 diabetes are having 10 hypos a week. He said: “I have lived with type 1 diabetes for almost 40 years. When you do the maths, 10 per week means I may have had 20,000 hypos in my lifetime. That’s more than many people have had hot dinners. It highlights the challenge that this life-long condition represents.”

He added: “Worrying about hypos – let alone actually having one – is a daily stress for anyone with this condition. I experienced my worst hypo during the night in a hotel room just over 10 years ago. I found myself crawling along my hotel room floor, before finally being hospitalised. It nearly killed me. That’s why JDRF’s progress on the artificial pancreas means a lot to me.”

Sky News presenter Stephen Dixon, who was diagnosed with type 1 diabetes when he was 17, said: “I’ve always refused to let type 1 diabetes hold me back. But minimising hypos does take considerable effort. I always carry Glucogel or a snack around with me in case I feel the symptoms of a hypo come on – which has happened when I've been on air. The artificial pancreas is very exciting technology. I look forward to the time when I can use one myself as part of day-to-day life.”

Dr Roman Hovorka from the University of Cambridge is leading the UK effort to develop an effective artificial pancreas. As principal researcher on the trial, he said: “The study is an important stepping stone for the wider use of an artificial pancreas. We have shown that overnight home use is feasible and beneficial – allowing people to live their life more freely.”

He added: “The artificial pancreas is expected to transform the treatment of type 1 diabetes and we have proven that this promise holds. The success of this trial means that larger and longer studies are already in the pipeline.”

Professor Katharine Barnard, from the Human Development and Health Academic Unit at the University of Southampton, worked with Dr Hovorka on the trial to evaluate psychosocial impact. She said: “Hypoglycaemia – particularly at night – is a common fear among those living with type 1 diabetes and a major obstacle in achieving optimal blood glucose levels. The findings from this study are positive and are certainly worth investigating further.”

She added: “Reassurance, confidence and improved diabetes control are just some of the psychological and physical benefits that patients may witness as artificial pancreas technology continues to develop."

Karen Addington, Chief Executive of JDRF, said: “Type 1 diabetes is a challenging and complex condition that requires constant management every day. Hypos are what people living with type 1 diabetes hate the most and experiencing ten a week is a shockingly high figure.”

She added: "This particular research was funded solely by JDRF – but we salute the commitment of other organisations around the world who work with us, including Diabetes UK, which are also dedicated to making the artificial pancreas a reality. Continued collaboration is crucial until we find the cure."

 * From the Royal College of Paediatrics and Child Health (RCPCH)’s audit. The nine per cent figure is for England and Wales. The full audit can be accessed online.


Race to develop artificial pancreas hots up

JDRF has long supported development of the artificial pancreas, a closed loop system that would include a continuous glucose monitor (CGM) and an insulin pump, and set up the artificial pancreas consortium to help promote development of this technology around the world. This includes 21 clinics located around the world that are all involved with some aspect of research into the artificial pancreas.

The 7th International Conference on Advanced Technologies & Treatments for Diabetes in Vienna, Austria, attended by JDRF, focused on the exciting developments that have happened recently that will help make the artificial pancreas a reality in the near future.

In the UK, Roman Hovorka from the University of Cambridge is leading the JDRF-funded efforts in this field. As reported in a paper published in Diabetes Care last year, he and his colleagues showed that adolescents using a prototype artificial pancreas over a period of 36 hours in a research facility had significantly lower and less variable blood glucose levels than those using conventional pump therapy. More recently, Hovorka and team have had positive results in home-based studies.

The Cambridge prototype is far from the only one being developed. Many other researchers around the world are working on similar but subtly different models, often aimed at different subgroups of people with type 1, and a large number of these projects were discussed at the conference. For example, Moshe Phillip and colleagues have developed and are testing the ‘Glucositter’ artificial pancreas in Germany, Slovenia and Israel; and Edward Damiano and his US-based team have developed and are testing a ‘bionic pancreas’ in Boston.

Advances in artificial-pancreas related technology were a key theme of the meeting. Manufacturers Dexcom and Medtronic have responded to the successes of the competing global artificial pancreas research groups by improving the efficacy of their pumps and sensors.

Dexcom’s G4 Platinum CGM, shown to be more accurate than Medtronic’s Enlite CGM in a new study presented in Vienna, has already been upgraded by the development of the G4AP. Dexcom developed the new sensor technology, which is even more accurate than the G4 Platinum CGM, in conjunction with the University of Padova in Italy, specifically for use as part of an artificial pancreas system.

Similarly, Medtronic has already improved upon its MiniMed 530G, the first available pump system approved in both Europe and the US with a “low glucose suspend” feature that will automatically stop insulin delivery from the pump for two hours when an associated CGM reaches a preset low blood glucose level. While the 530G system is considered to be the first step of six on the path to a working artificial pancreas, the Medtronic MiniMed 640G is thought to be the second. The difference between the 530G and the 640G is that the latter will suspend insulin when hypoglycaemia is predicted, whereas the former will only do so if a preset hypoglycemic threshold is crossed. Medtronic hopes to launch the 640G in Europe sometime between mid 2014 and early 2015, and in two-to-three years in the US.

A key to the puzzle that remains to be solved is the speed which insulin can be absorbed into the body from an external pump, as with currently available options there is a delay of up to 20 minutes between insulin administration and uptake in the blood which makes smooth interaction between a CGM and an insulin pump tricky. A faster acting insulin than those currently available could solve this problem, but has yet to be developed.

Another method of speeding up insulin delivery is by going via the stomach. Eric Renard from Montpellier University, France is an expert on ‘intraperitoneal’ insulin pumps and spoke about them at the conference. The main problem with these pumps is that they have to be implanted in the stomach and are therefore quite invasive for most people with type 1. However, they can be very effective at improving blood glucose control in people whose diabetes is difficult to control. Renard is hoping to develop an artificial pancreas with an intraperitoneal pump, in order to improve treatment for people with highly variable response to insulin. 

JDRF tweeted from the conference. To read more and see pictures of the event you can follow the story here.


One step closer to the artificial pancreas

JDRF-funded researchers at the University of Cambridge have taken one more step towards making the artificial pancreas a reality.

In a new research paper published this week Dr Daniella Ellleri compared the ability of a portable artificial pancreas to control blood glucose levels overnight when starting it at 6pm (teatime) or at 9pm (bedtime).

The team found that when using the artificial pancreas from 6pm until 8am blood glucose levels were kept in the target range for 82% of the time.  No human intervention was needed at any point once the artificial pancreas was connected.

The system tested in this study is an updated and more portable version of the prototype which the team have been using in previous trials. The study evaluated its ability to control blood glucose levels overnight in hospital, and has helped to pave the way for trials with the portable artificial pancreas outside of a hospital setting. These new trials will give the research team an insight into how well the system can manage glucose control as part of the normal home routine of people with type 1.

The artificial pancreas is a closed-loop insulin delivery system that consists of an insulin pump, a continuous glucose monitor and a computer algorithm. The computer algorithm can take the measurements from the glucose monitor and tell the pump when to administer insulin. The system can keep a much tighter control of blood glucose levels than pump use alone and needs minimal user input.

Maebh Kelly, Research Communication Officer at JDRF, said, ‘This research is another step towards the development of a fully functional artificial pancreas, which will vastly improve the lives of people with type 1. The next step, home trials, will be the biggest test yet of the system’s abililty to control blood glucose levels overnight.’


Moving towards a glucagon pump

JDRF-funded researchers at Oregon Health and Science University have discovered a way to keep liquid glucagon stable so that it could be used in diabetes pumps.

The research which was led by Dr W Kenneth Ward was presented at the American Diabetes Association’s (ADA) annual scientific meeting this week. Dr Ward and his team found that reducing the level of acid in the glucagon compound meant that it could be kept as a liquid for longer periods of time. At the moment, glucagon cannot be stored as a liquid and is kept as a powder which, when added to liquid needs to be used immediately.

This research could broaden the use of glucagon to treat hypoglycaemia and is an important step towards the development of a multi-hormone, automated artificial pancreas. Future generation artificial pancreas systems could act just like the body and be able to release glucagon as well as insulin to keep a tighter control on blood glucose levels.

Glucagon is a hormone that raises blood sugar levels and works together with insulin to fine tune blood glucose levels. Previous research has shown that insulin treatment together with glucagon reduces hypoglycaemia. 

Rachel Connor, Head of Research Communication at JDRF said, ‘JDRF are committed to developing the next generation multi-hormone artificial pancreas and for this we need stable liquid glucagon that can be used in a pump. Dr Ward’s research is an exciting step towards this goal.’

Read about more JDRF-funded research that has been presented this week at the ADA meeting on the JDRF US site


Royal interest in type 1 diabetes

Today is an historic moment for JDRF. For the first time ever, we welcomed a member of the royal family to learn about JDRF's research into finding the cure for type 1. HRH Duchess of Cornwall visited the Cambridge Wellcome Trust clinical research facility just after noon today to learn more about type 1 research and to speak to celebrities and young people living with type 1 who have been involved with clinical trials. She met with researchers from the University of Cambridge who are working on developing the Artificial Pancreas and preventing type 1 diabetes and its complications.

HRH spent time with Jeremy Irvine, star of Steven Spielberg’s film, Warhorse who has type 1 diabetes and took part in artificial pancreas trials in 2005 and 2007. He explained how technology helps him manage his type 1 with a hectic filming career.

She also talked to BBC Radio 4 Today Programme presenter Justin Webb and his son Sam who has type 1 diabetes, and discussed the family’s hope for the cure.

The Duchess of Cornwall learned about two JDRF-funded trials. The Artificial Pancreas Project and The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT).

During the visit, Professor Dunger announced that 3,000 young people have now been screened across three continents as part of this international clinical trial, which is exploring ways to prevent the complications of type 1 diabetes.

Her Royal Highness met Dr Tim Tree and talked about D-GAP, Diabetes – Genes, Autoimmunity and Prevention project, which is exploring the causes and triggers of type 1 diabetes in people affected by the condition.

This visit was a chance for Her Royal Highness to decide how she might like to be associated with JDRF in the future. We are delighted to have had this opportunity to meet her, and look forward to seeing how a relationship might develop with HRH in the future.

Photography by Dominic Clemence


Member of the Royal Family recognises JDRF research

We are delighted and excited to let you know that Her Royal Highness The Duchess of Cornwall will visit The Cambridge Wellcome Trust Clinical Research Facility at Addenbrooke’s Hospital in February to learn more about the work of JDRF. She will meet with researchers who are working to prevent type 1 diabetes and its complications, as well as speaking to children with type 1 who have been involved with clinical trials.

Her Royal Highness will be welcomed by HM Vice Lord-Lieutenant of Cambridgeshire, Mrs Jane Lewin Smith JP, before touring the facility with Karen Addington, Chief Executive at JDRF, and Professor David Dunger, of The University of Cambridge.

The Duchess of Cornwall will also meet with Dr Roman Hovorka and Dr Tim Tree to learn about their JDRF funded research.  Dr Hovorka is working to develop a Closed Loop Artificial Pancreas whilst Dr Tree will be discussing the Diabetes Genes, Autoimmunity and Prevention (DGAP) Project. 

This visit will be a chance for Her Royal Highness to decide how she might like to be associated with JDRF in the future. We are delighted to have this opportunity to meet with her as she only works with charities that she has personally selected, and look forward to telling you more about the visit at a later date.


Jeremy Irvine rises to fame in Warhorse film

As we welcome 2012, we are delighted to see JDRF supporter Jeremy Irvine in the spotlight this weekend, as the UK premier of film Warhorse is shown on the big screen in Leicester Square. Actor Jeremy, who has type 1 diabetes, takes the lead role in the film adaptation of the west end show , directed by the world famous Steven Spielberg.

Jeremy was under a different spotlight when the BBC filmed him talking about his involvement in JDRF’s Artificial Pancreas trial at the University of Cambridge in 2005 and again in 2007.

As a rising star and Hollywood actor, Jeremy is already back on set, shooting for his next film Great Expectations. Over the years, despite a busy schedule as his acting career has taken off, Jeremy has spoken at many JDRF events, showing his support of our search for the cure for type 1 diabetes.

Jeremy said: "Without the research funded by JDRF I don't believe I would be able to have the career I'm enjoying now. Thanks to the huge developments being made in the treatment of type 1 diabetes no child should have to feel diabetes needs to stop them following their aspirations."

If you want to see him in action, you will be able to watch Jeremy’s debut performance on screen at local cinemas from next Monday. Keep an eye on our website for news of how we will be working with Jeremy in the coming year to raise awareness of type 1 diabetes.


The artificial pancreas ventures out of the clinic!

JDRF-funded researchers working as part of the Artificial Pancreas Consortium at Montpellier University Hospital in France and at the Universities of Padova and Pavia in Italy ran experiments with two patients in parallel.

Both patients attained near-normal glucose levels after spending a night outside hospital while their diabetes was automatically managed by a prototype artificial pancreas system. The patients were each asked to test the system by eating a meal in a restaurant and then spending a night in a hotel, all while using the device.

Eight more patients enrolled in the trial will begin outpatient testing in the coming weeks in Montpellier, France and in Padova, Italy.

Rachel Connor, Head of Research Communication at JDRF commented ‘This is brilliant news for people with type 1. Testing this system outside the hospital for the first time is an important milestone in the journey toward making the system available to people with type 1 around the world.’


$1.9 billion potential healthcare saving for USA with artificial pancreas

A study carried out on behalf of JDRF in the US has revealed the potential savings that could be made to the Medicare programme (which provides health insurance to those over 65 years old or who have disabilities) because of the artificial pancreas. These savings are estimated to total $1.9 billion over 25 years.
The JDRF Artificial Pancreas project aims to link an insulin pump with a continuous glucose monitor (CGM) to provide automatic, real-time monitoring of blood glucose and delivery of insulin. Early studies of a prototype artificial pancreas have already shown clinical improvements in blood glucose control.

The research team, led by Dr Michael J. O’Grady, modelled 25 years of medical costs for people between 30 and 60 years old. Their analysis revealed the accumulated cost savings resulting from avoiding complications in this group.

Poorly controlled blood glucose levels in type 1 diabetes can cause complications later in life, such as diabetic eye disease and cardiovascular disease. A new technology that can significantly slow or stop the progression of these has the potential to deliver substantial health and financial benefits. 


T1 Youth Ambassadors meet JDRF CEOs

Some of our T1 Youth Ambassadors met with Karen Addington, Chief Executive of JDRF UK, and Jeffrey Brewer, Chief Executive of JDRF International. Read Ambassador Elizabeth Sheils' account of the day:

"Last Friday I had the opportunity to go to the JDRF offices in London, I managed to see where all my friends work. I also had a peak at the stationary cupboard and spotted many Rufus bears and Pingus! It wasn’t actually the main aim of the day to snoop around the office (that was just a bonus). I was there to meet four other T1 Youth Ambassadors, Karen Addington (chief executive of JDRF UK) and Jeffrey Brewer (chief executive of JDRF International). The Youth Ambassadors had the chance to talk to Jeffrey and ask him all sorts of questions about research, type 1, and how the JDRF runs in the US. I found it was a fascinating day – I learnt lots about the research being undertaken and where it could eventually lead. It was extremely exciting thinking that there are so many ideas surrounding curing type 1 – from once a day injections to small procedures every 18 months inserting ‘protected’ insulin producing cells. Both of these would allow the person with type 1 to live almost as if they did not have type 1 at all, being able to eat without carbohydrate counting and living without the fear of hypoglycemia or hyperglycemia. Unfortunately these types of ‘cures’ are a few years down the line but it encourages me that they are being researched and pushes me to want to do more to raise awareness and money for type 1. I was also greatly inspired by the other T1 Youth Ambassadors and it was fascinating hearing about their work. I really enjoy being part of this programme!

One fact which stood out from the day was about the money used for research into type 1. In 2009, UK government funding bodies committed £51 million to research to tackle diabetes however only £6 million of this was relevant to type 1. Which is a massive contrast compared to the US who spent $150 million, the Australian government committed $36 million and Canada $20 million all on research to help cure, treat and prevent type 1 diabetes. It was shocking to learn that so little is spent on type 1 diabetes however this is also seen in the lack of people using insulin pumps (3.9%) compared to the US (35%) and Europe (15-20%). Even fewer people are using continuous blood glucose monitoring (CGMs). These facts are very concerning when you consider that one of the main pieces of research working to help remove many of the burdens of type 1 is an artificial pancreas composed of an insulin pump, a CGM an algorithm. This would provide the exact amount of insulin and at the correct time to ensure normal blood glucose levels are achieved. However if the UK currently falls behind most of the other developed countries in their uptake for insulin pumps and CGMs this will be a great problem when artificial pancreas systems are readily available. It does seem exceptionally unfair that people who live with type 1 miss out on latest treatments especially if they can make living with the condition a bit easier.

Jeffrey Brewer made an interesting point during the meeting, he said that people living with type 1 have to administer life saving (and threatening) medication everyday for the rest of their lives which definitely puts things into perspective. Type 1 cannot be seen which often leads to people completely underestimating what it is like to live with a life threatening condition. It would be wonderful to have an Artificial Pancreas and I cannot imagine how frustrating it would be if one was released onto the market and only 5% of people could use it!

As T1 Youth Ambassadors we are trying our best to make sure this doesn’t happen! If you would like to join us click here to find out more."

Elizabeth has a regular blog on our T1 Website. Click here to read more about her experience of life with type 1 diabetes.


JDRF urges public to be ‘Hypo Aware’ in National Diabetes Week

As people affected by type 1, unfortunately many of you have experienced hypoglycaemia and live with the worry of either yourself or your child having a hypo. JDRF discovered that despite it being a serious life-threatening health issue, more than half (53 per cent) of UK population do not know it is a dangerous state of low blood glucose.

This YouGov survey of 2075 adults comes 90 years after scientists Banting and Best discovered insulin in the lab, and first saved the life of someone with type 1 diabetes. Since then, treatment has improved greatly, but because people living with type 1 diabetes are still dependent upon insulin injections or pump infusions, we recognise that this means living with the day to day fear of hypoglycaemia.

We are releasing these survey results today to mark National Diabetes Week. We are encouraging the general public to understand how type 1 diabetes affects people in the UK, to learn the symptoms of Hypoglycaemia and to become hypo-aware, so they could help someone in an emergency.

JDRF funded researchers at the University of Cambridge and around the world are currently developing an ‘artificial pancreas’, a piece of technology that may one day provide exactly the right amount of insulin in the body of someone with type 1 diabetes, exactly when it’s needed. This could be the end of hypoglycaemia, as the system would automatically regulate blood glucose levels, mimicking a healthy pancreas. You can read more about the research here 


JDRF and Amylin partner to explore if mixing human hormone with insulin could better treat type 1

Juvenile Diabetes Research Foundation and Amylin Pharmaceuticals have today announced that they will be working together to fund a series of clinical studies testing the use of amylin in type 1 diabetes treatment. The research will establish whether mixing the drug pramlintide, a man-made version of the human hormone amylin, with insulin could improve blood glucose control in people with type 1 diabetes, compared to the use of insulin alone.

In a healthy pancreas, both insulin and amylin are produced and released by the same cells. The two hormones work together to help stabilise blood glucose levels. Insulin helps the body regulate production and storage of glucose, while amylin helps control the rate at which glucose enters the blood after meals.

Currently, patients who use pramlintide must separately administer their daily insulin therapy, either through injections or an insulin pump. Creating a mixture of the two drugs that still offers the benefits of both hormones, might better mimic the way a healthy pancreas works.

This is the second research partnership between JDRF and Amylin working to improve treatments for people with type 1 diabetes. The project is part of JDRF’s Industry Discovery and Development Partnership (IDDP) program aiming to accelerate research that will lead to better treatments and a cure for type 1 diabetes.

Eleanor Kennedy, Head of Research Communication at JDRF said, ‘ It will be interesting to see whether mixing pramlintide with insulin has the potential to help people with type 1 diabetes tighten their glucose control. We look forward to seeing the outcomes of the research resulting from this partnership.”