Το μέλλον της ινσουλινοθεραπείας και της τεχνολογίας στον Σακχαρώδη Διαβήτη

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1 Το μέλλον της ινσουλινοθεραπείας και της τεχνολογίας στον Σακχαρώδη Διαβήτη Α.Μητράκου Αν.Καθηγήτρια Ε.Κ.Π.Α. Μονάδα Σακχαρώδη Διαβήτη Μεταβολισμού Θεραπευτική Κλθνική Νοσ.Αλεξάνδρα

2 The 25 Best Inventions of the Year 2013

3 Νέες Ινσουλίνες Αυξηση χρόνου ημισείας ζωής NPH DETEMIR 7-13 HRS GLARGINE DEGLUDEC 25 lower variability GLARGINE PEGULATED INSULINS Απορρόφηση Ινσουλίνης Adocia+Lilly: accelerates insulin penetration BD insulin into the skin by short needles (lymphatic absorption) Local warming patch Novo Nordisk increase flow by niconamide increase absorption by L arginine Thermalin faster binding to receptors Halozyme υαλουρονιδαση

BD insulin into the skin by short needles (lymphatic absorption) Local warming patch Novo Nordisk increase

4 AFREZZA:εισπνεομενη ινσουλίνη Afrezza comes in single-use cartridges. Afrezza peaks within 12 to 15 minutes and is out of the system within an hour, compared to current fast-acting insulins that usually take at least 20 minutes to kick in, peak at 2-3 hours, and can stay in the system for as long as five hours.

hour, compared to current fast-acting insulins that usually take at least 20

5 AFREZZA cartridges contain human insulin produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12). AFREZZA Inhalation Powder is a dry powder supplied as 4 unit or 8 unit cartridges. The 4 unit cartridge contains 0.35 mg of insulin. The 8 unit cartridge contains 0.7 mg of insulin

AFREZZA Inhalation Powder is a dry powder supplied as 4 unit or 8 unit cartridges.

6 Συσκευές αυτομέτρησης σακχαρου Post marketing surveillance.

7 The surveillance error grid. a tool to assess the degree of clinical risk from inaccurate blood glucose (BG) monitors

8 OFF LABEL Hospitals!!!!!!! No No ICU(No No in shock,hypotensive) CGM calibration??????

9 Abbott FreeStyle Libre Flash Continuous Glucose Monitoring System The sensor records blood glucose levels every minute, sampling the interstitial fluid using a 5mm long and.4 mm wide filament that penetrates the skin. It doesn t require any finger prick calibration, unlike all other currently available continuous glucose monitors. The display device takes only a second to copy the readings from the sensor and shows up to 90 days of historical trends. FreeStyle Libre System is clinically proven to be accurate, stable and consistent over 14 days without the need for finger prick calibration

It doesn t require any finger prick calibration, unlike all other currently available continuous glucose monitors.

10 GLUCAGON pens

11 Συνεχής Καταγραφή Accuracy in Hypo range Prediction of Hypoglycemia Less time lag New glucose sensing technology:direct electron transfer without using oxygen

12 Prediction of Hypoglycemia Additional inputs Accelerometer Skin temperature Near body temperature ECG/EEG Derived variables activity Exercise Prediction of hypo

13 13 MDT Confidential

14 All tissues in the human body, including skin, have the ability to conduct electricity. Indeed, this is how nerves function to relay information from one part of the body to another. The skin also has electrical activity, which is in constant, slight variation, and can be measured and charted. The skin's electrical conductivity fluctuates based on certain bodily conditions, and this fluctuation is called the galvanic skin response Sudden changes in emotion, such as fright, can trigger this response, as can other types of changes, such as the hot flashes that are characteristic of menopause. The galvanic skin response can be graphed on a chart for observation, in the same way that heart or brain activity is recorded. Even though this is the case, it is impossible to detect the type of emotion or physical change that elicited the reaction by simply looking at the graph The devices which measure this response are often referred to as feedback instruments, in part because of how this response is generated or detected. If this response is measured "actively," then a gentle electric current is passed through the body of the test subject to measure conductivity. A passive test measures the current that is generated by the person's body itself. The feedback from this is what constitutes the measured galvanic skin response.

The skin's electrical conductivity fluctuates based on certain bodily conditions, and this fluctuation is called the galvanic skin response Sudden changes in emotion, such as fright, can trigger this

15 Resetting the Metabolic Clock UC Santa Barbara researchers new insight into mammalian circadian rhythms could lead to therapies for certain metabolic disorders like obesity and diabetes

16 DIGITAL MEDICINE :Proteus System Ingestive sensor pill Transmits signal to a patch The patch tracks activity patterns,step counts and heart rate The patch transmits data to a mobile device Reasons for not taking the medication Cloud

patterns,step counts and heart rate The patch transmits

17 Artificial Pancreas Project Presentation to the JDRF International Development Committee January 26, 2006 ΤΕΧΝΗΤΟ ΠΑΓΚΡΕΑΣ Μέχρι το MDT Confidential

18 Συνεχης Καταγραφη της Γλυκοζης Το Προ-σταδιο του τεχνητου παγκρεατος ΣΥΝΕΧΗΣ ΚΑΤΑΓΡΑΦΗ ΣΑΚΧΑΡΟΥr ΑΛΓΟΡΙΘΜΟΣ ΡΥΘΜΙΣΗΣ ΑΝΤΛΙΑ ΙΝΣΟΥΛΙΝΗΣ

19 CLOSED LOOP / ARTIFICIAL PANCREAS AP@HOME JDRF3

20 Pumps and CGM overview Accuchec Combo Aimas Vibe Navigator Dexcom G4 Dana

Number of clinical reports 2006-2012 * 21 MDT Confidential *Not exhaustive: PubMed search for

21 Number of clinical reports * 21 MDT Confidential *Not exhaustive: PubMed search for reports of prospective/retrospective clinical trials; sponsorship/ funding disregarded; searched Jan.

22 Αυτόματη διακοπή παροχής ινσουλίνης Ασφάλεια ειδικά την νύχτα 22 MDT Confidential

Blood glucose 5o Bήμα: 640G, PLGM Technology PLGM technology Basal and bolus presets Remote bolusing from meter Active insulin on home screen Ns PLGM Technology Veo LGS Feature Vs: Suspends at

23 Blood glucose 5o Bήμα: 640G, PLGM Technology PLGM technology Basal and bolus presets Remote bolusing from meter Active insulin on home screen Ns PLGM Technology Veo LGS Feature Vs: Suspends at 70mg/dL Vr: Resumes after 2hr Vs Nr Vr NGP PLGM Feature Ns: Suspends if user is below 140 mg/dl and is predicted to be below 70mg/dl in 30 min Time Nr: Resumes if user is above 80 mg/dl and is predicted to be at or above 110mg/dl in 30min and insulin has been suspended for at least 30 min 23 MDT Confidential

24 CareLink - Χρήση μέσω διαδικτύου Aποθήκευση δεδομένων Medronic CareLink Personal CareLink Pro Password

25 CareLink Λογισμικό Διαχείρισης του Διαβήτη TM Το CareLink Pro 3 συνδυάζει δεδομένα από την Αντλία Ινσουλίνης, το Πομπό CGM και τον μετρητή σακχάρου, ώστε αναπαράγοντας παρατηρήσεις ασθενών και θεραπευτικές εκτιμήσεις να βοηθά ώστε να παίρνονται πιο εύστοχες αποφάσεις. Δημιουργεί ευκολοανάγνωστες αναφορές, που προσφέρουν ιδανικό έλεγχο και διευκολύνουν την ταυτοποίηση των προτύπων και των προβλημάτων. Ασφαλές, online λογισμικό διαχείρισης, επιτρέπει να κατεβαίνουν τα στοιχεία της αντλίας σε ένα PC. Επιτρέπει να δουλεύεις από απόσταση με τον γιατρό σου Συμβατό με πληθώρα μετρητών

26 Diabetes Type 2

27 OmniPod No tubing & discreet Waterproof Easy to use Built in blood glucose meter Free Style

28 I can sweat and do the most intense back bends, head stands and hand stands, and the Pod stays on my belly or my arm like glue

29 Closed-Loop Artificial Pancreas Systems: Engineering the Algorithms:DOYLE Group F.J. Doyle III, L. M. Huyett, J. B. Lee, H. C. Zisser, E. Dassau, Closed- Loop Artificial Pancreas Systems: Engineering the Algorithms, Diabetes Care, May 2014.

31 Clinical evaluation of a personalized artificial pancreas E. Dassau, H. Zisser, R.A. Harvey, M.W. Percival, B. Grosman, W. Bevier, E. Atlas, S. Miller, R. Nimri, L. Jovanovic, F.J. Doyle III "Clinical evaluation of a personalized artificial pancreas," Diabetes Care, vol. 36, no. 4, pp , Apr E. Dassau, Diabetes Care,36,pp ,2013. the ability of a control algorithm tailored to an individual s glucose characteristics to successfully regulate glycemia, even when faced with unannounced meals or initial hyperglycemia.

33 HOVORKA 2014

34 Moshe Phillip, M.D., Tadej Battelino,

35 DAMIANO Engineers from Boston University have developed a bionic pancreas system that uses continuous glucose monitoring along with subcutaneous delivery of both rapid-acting insulin (to lower blood glucose) and glucagon (to raise blood glucose) as directed by a computer algorithm. The bionic pancreas automatically makes a new decision about insulin and glucagon dosing every five minutes; that's 288 decisions per day, 7 days per week, 365 days per year.

36 The BIONIC pancreas

37 WEARABLE DEVICES and NETWORK PLATFORMS for Artificial Pancreas and Advanced Glucose Management watches glasses smartphones Mobile development frameworks (Healthkit,Android Wear)coupled to Cloud resources-store and analyze data advanced glucose management

38 I Cloud Stimulation technology to Teach Diabetes Care Management Skills and Insulin Dosing

39 Connected Care Device: Functionality Portable 8-12 hrs battery life 1. Pump & Sensor 2. Connected Care Device 3. Cloud Network 4. Web Connected Device 39 MDT Confidential

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