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A diabetes cure?????

Question:

Found the following in the U.S. News and World Report for May 3, 1999. Under the outlook section. DIABETES SUFFERERS GET SOME GOOD NEWS. FDA has cleared Avandia and declared safe Actos.. But the following is what amazed me.  Has anyone else heard of this? The two new medications, expected on the market thissumme4r, are the first of more treatments soon to be available.  Scientists have cured Type I diabetes in animals by using an artificial pancreas that may one day be implanted in a human to produce the insulin the natural pancreas cannot make.

Response:

Viola, Part one is the standard press release from SmithKline and Lilly for their new products. These are not a cure, and are only new treatments. How part two about the "artificial pancreas" got included in with an article on Actos and Avandia is beyond me !  Actos and Avandia are for Type 2 diabetes. The artificial pancreas would be for Type 1. You have to understand the interests of the people involved. The magazine writers are often not very sophisticated about medicine or science. They are looking for something that will interest you, grab your attention, and make you buy the next copy of their rag. The researchers are typically underfunded and need more research money. They are the starving artists of the science world. Anything they can say to the magazine writer that will get attention, and therefore research money, they will say. Unfortunately the semi-literate magazine/newspaper writer may have misunderstood what the researcher was saying, and what gets printed sometimes is so far from the truth we just laugh. I’ve been misquoted so badly that I now write down the information so they can review it again when they get to their office, and offer to proofread their story for them. The problem is even worse for television news crews. Whenever they come to my office they only want two things. Pictures of insulin needles and pictures of children with diabetes. A picture of a child , doing an injection, makes them ecstatic.  I don’t care WHAT the news is, that’s what they ask for. Sometimes they will settle for a pregnant woman instead of a child, but she needs to be showing quite a bit. When Rezulin came out and they found out it wasn’t for children, and didn’t involve needles they were quite dejected. One of the stations was smart though. They used some file footage of insulin syringes & needles and made the news that Rezulin saved everyone from the injections. They then tacked on a promo fed to them by Parke Davis made to look like a news report. (All the companies do this. About 1/3 of your medical news is actually a commercial produced by a manufacturer,  made to look like a network news report.) The artificial pancreas is not a new concept. I can’t say much more unless we know some of the details of your story. Various mechanical and biological pancreases have had short term success in animals, and have been well reported. I think one day we will see an artificial pancreas. It’s just not big news until it’s ready to use on humans. William Biggs MD – Hide quoted text — Show quoted text – Found the following in the U.S. News and World Report for May 3, 1999. Under the outlook section. DIABETES SUFFERERS GET SOME GOOD NEWS. FDA has cleared Avandia and declared safe Actos.. But the following is what amazed me.  Has anyone else heard of this? The two new medications, expected on the market thissumme4r, are the first of more treatments soon to be available.  Scientists have cured Type I diabetes in animals by using an artificial pancreas that may one day be implanted in a human to produce the insulin the natural pancreas cannot make.

Response:

I wonder if there is too much money to be made by the companies that make insulin, syringes testers etc. Why would they be in a rush for a "cure"? I think I’m turning into a cynic, but this diabetic thing isn’t "fun" anymore…

You can say that again. I worry less about diabusiness not working towards a cure. Instead I worry about diabusiness working AGAINST a cure. A huge disappointment was when Eli Lilly, the insulin maker, bought rights to Diabetes Institutes revolutionary INGAP islet cell regeneration technology. After that the team that discovered INGAP was more or less dismantled and went to work on other things. Now INGAP has taken "the long and winding road" to realisation. To email me remove the NOSPAM from my email address

Response:

Scientists have cured Type I diabetes in animals by using an artificial pancreas that may one day be implanted in a human to produce the insulin the natural pancreas cannot make. I think the important phrase, above, is "…may, one day…" "one day", we may have cures for all ills, but, right now, a practicable artificial pancreas is still some way off. regards, IanP

Tell Jack Benny and Totie Capote

Response:

    I wonder if there is too much money to be made by the companies that make insulin, syringes testers etc. Why would they be in a rush for a "cure"?     I think I’m turning into a cynic, but this diabetic thing isn’t "fun" anymore…     Larry,     Yeah?     Tell Esther Rolle.

Response:

I wonder if there is too much money to be made by the companies that make insulin, syringes testers etc. Why would they be in a rush for a "cure"? I think I’m turning into a cynic, but this diabetic thing isn’t "fun" anymore… Larry, – Hide quoted text — Show quoted text – Scientists have cured Type I diabetes in animals by using an artificial pancreas that may one day be implanted in a human to produce the insulin the natural pancreas cannot make. I think the important phrase, above, is "…may, one day…" "one day", we may have cures for all ills, but, right now, a practicable artificial pancreas is still some way off. regards, IanP

Response:

Scientists have cured Type I diabetes in animals by using an artificial pancreas that may one day be implanted in a human to produce the insulin the natural pancreas cannot make.

I think the important phrase, above, is "…may, one day…" "one day", we may have cures for all ills, but, right now, a practicable artificial pancreas is still some way off. regards, IanP

Response:

Nippon Rinsho 1999 Mar;57(3):719-25 [Design and development strategy for wearable and implantable artificial endocrine pancreas]. [Article in Japanese] Shichiri M, Nishida K Department of Metabolic Medicine, Kumamoto University School of Medicine. [Medline record in process] The ultimate goal of development of an artificial endocrine pancreas is for long-term strict glycemic control, and therefore, the trend in development is now from bedside-type to wearable- or implantable-type. With either a miniaturized extracorporeal glucose monitoring system based on microdialysis sampling method or a ferrocene-mediated needle-type glucose sensor covered with highly biocompatible membrane, and with subcutaneous insulin infusion algorithm using short-acting insulin analogue, long-term physiological glycemic control could be obtained by wearable artificial endocrine panceras. The next step will be directed to the implantable one. Non-invasive infrared absorbance spectroscopy to fit into an artificial tooth prosthesis, an implantable artificial endocrine pancreas, in which measured glucose concentrations are transmitted telemetrically to implanted computer and pump system, might be developed. PMID: 10199159, UI: 99215372 – Pharmacol Ther 1999 Jan;81(1):37-51 Pharmacological management of diabetes: recent progress and future perspective in daily drug treatment. Emilien G, Maloteaux JM, Ponchon M Laboratory of Pharmacology, Universite Catholique de Louvain, Brussels, Belgium. [Medline record in process] Glycaemic control in Type 1 diabetes has been proven efficient in preventing microvascular and neurological complications. The assumption that good control of hyperglycaemia may also have significant impact on alleviation of complications in Type 2 diabetes has gained growing support in recent years. Measures such as body weight reduction and exercise improve the metabolic defects, but pharmacological therapy is most frequently used. The sulphonylureas stimulate insulin secretion. Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycaemia. Acarbose helps to spread the dietary carbohydrate challenge to endogenous insulin over time. These pharmacological treatments can improve blood glucose regulation in Type 2 diabetes patients. However, the key to strict glycaemic control with use of exogenous insulin lies in the creation of delivery methods that emulate physiologic insulin secretion. Insulin lispro, a recombinant insulin analogue, is identical to human insulin except for the transposition of proline and lysine at positions 28 and 29 in the C-terminus of the B chain. Evidence suggests that patients perceive their quality of life to be improved with insulin lispro when compared with regular human insulin, and that satisfaction with treatment is greater with the insulin analogue. Numerous new pharmacological approaches are under active investigation, with the aim of promoting insulin secretion, improving the action of insulin, or slowing carbohydrate absorption. With respect to continuous subcutaneous insulin infusion therapy and implantable pumps, despite that this approach is not widely utilised, it appears to bring us as close to achieving glycaemic control as is feasible with current treatment approaches. However, general application of such technology requires significant improvements in several areas, such as improvement of patency of catheter, pump failures due to early battery depletion incidents, and pump miniaturisation. Future perspective resides on insulin analogues with longer half-lives that would provide better basal insulin coverage in association with fast-acting analogues. PMID: 10051177, UI: 99158486 IEEE Trans Biomed Eng 1999 Feb;46(2):148-57 A model-based algorithm for blood glucose control in type I diabetic patients. Parker RS, Doyle FJ 3rd, Peppas NA Department of Chemical Engineering, University of Delaware, Newark 19716, USA. A model-based predictive control algorithm is developed to maintain normoglycemia in the Type I diabetic patient using a closed-loop insulin infusion pump. Utilizing compartmental modeling techniques, a fundamental model of the diabetic patient is constructed. The resulting nineteenth-order nonlinear pharmacokinetic-pharmacodynamic representation is used in controller synthesis. Linear identification of an input-output model from noisy patient data is performed by filtering the impulse-response coefficients via projection onto the Laguerre basis. A linear model predictive controller is developed using the identified step response model. Controller performance for unmeasured disturbance rejection (50 g oral glucose tolerance test) is examined. Glucose setpoint tracking performance is improved by designing a second controller which substitutes a more detailed internal model including state-estimation and a Kalman filter for the input-output representation. The state-estimating controller maintains glucose within 15 mg/dl of the setpoint in the presence of measurement noise. Under noise-free conditions, the model-based predictive controller using state estimation outperforms an internal model controller from literature (49.4% reduction in undershoot and 45.7% reduction in settling time). These results demonstrate the potential use of predictive algorithms for blood glucose control in an insulin infusion pump. PMID: 9932336, UI: 99131128 Am J Surg 1998 Dec;176(6):622-6 Surgical experience with implantable insulin pumps. Department of Veterans Affairs Implantable Insulin Pump Study Group. Thompson JS, Duckworth WC, Saudek CD, Giobbie-Hurder A Omaha Veterans Affairs Medical Center, Nebraska, USA. BACKGROUND: A recent Veterans Affairs cooperative trial demonstrated that intensive insulin therapy via an implantable pump with intraperitoneal insulin delivery reduced glycemic variability and improved quality of life compared with multiple daily insulin injections. Our aim was to determine perioperative morbidity and assess long-term function of the implantable insulin pump. METHODS: Fifty-one adult patients with type 2 diabetes had infusion pumps placed over a 2-year period at seven VA Medical Centers as part of a randomized prospective study. RESULTS: All pumps were placed successfully. There were two (4%) perioperative complications. There were no wound complications. Duration of pump use ranged from 12 to 25 months (mean 20). Catheter obstruction (57%) and pump malfunction (25%) were the most common reasons for pump explantation. Catheter occlusions increased after 12 months. Catheter occlusion was treated by percutaneous rinse procedure in 75% and revisional procedures in 31% of patients. CONCLUSIONS: Implantable insulin pumps can be placed with minimal surgical morbidity. Attention to surgical detail and infusion protocol permits satisfactory long-term function. Pump/catheter complications increase with time but are usually resolvable by either operative or percutaneous manipulations. Publication Types:

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