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Harnessing the Power of Technology to Improve the Lives of Those with Diabetes
Can J Diabetes 39 (2015) 188e189
Contents lists available at ScienceDirect
Canadian Journal of Diabetes journal homepage: www.canadianjournalofdiabetes.com
Research Update
Harnessing the Power of Technology to Improve the Lives of Those with Diabetes Polly VandenBerg BSc (hon) Manager, Research Knowledge Translation, Canadian Diabetes Association, Toronto, Ontario, Canada
Technology is a growing part of our daily lives. In 2012, 83% of Canadian households had Internet access and, of those, 69% had more than 1 device with which they could go online (1). In many cases, technology can make our daily tasks easier and faster. Diabetes care and research are also evolving to shape the way the disease is treated and managed. The Canadian Diabetes Association is funding 104 research grants and awards in 2014 and 2015, some of which are exploring the various uses of technology in diabetes research, care and management. Of these are Dr. James Johnson (receiving operating grant 20142017) and Dr. Marta Szabat (receiving a postdoctoral fellowship award 2012-2015, supervised by Dr. Johnson), both at the University of British Columbia. Drs. Johnson, Szabat and team have developed a sophisticated screening tool. They are using unbiased proteomic analysis and functional genomics to allow them to screen multiple proteins at the same time. Dr. Johnson is using these approaches to understand how fatty acids kill beta cells and to understand better how to protect beta cells. Dr. Johnson’s aim is to find the mechanisms that cause obesity to be a risk factor for type 2 diabetes. Dr. Szabat is screening existing drugs that are already on the market for other diseases. She has screened 1120 offpatent drugs for the ability to increase beta cell function and survival. Thus far, she has found several promising results that she will be studying further. One particular target seems to increase both the maturity and function of beta cells while also protecting beta cells from diabetes-related damage. These 2 research projects have the potential to find ways of stopping or reversing the progress of type 2 diabetes. Two of our researchers are focused on creating and using new technologies to help treat and manage type 1 diabetes. If successful, this technology may be adapted in the future to help people with type 2 diabetes as well. Both Dr. Bruce Perkins (receiving operating grant 2013-2015) at the University of Toronto and Dr. Rémi RabasaLhoret (receiving operating grant 2014-2017) at the Clinical Research Institute of Montréal are examining the efficacy of a wearable artificial pancreas. Dr. Kelly Tennant (receiving a postdoctoral fellowship award 2014-2016, supervised by Dr. Craig Brown) at the University of Victoria is examining a new way to stimulate brain repair after stroke. Dr. Rabasa-Lhoret and his team have developed 2 closed-loop systems (CLSs) that can be used as wearable artificial pancreases by people with type 1 diabetes. Both systems include a continuous 1499-2671/$ e see front matter Ó 2015 Canadian Diabetes Association http://dx.doi.org/10.1016/j.jcjd.2015.03.008
glucose sensor, a pump that delivers hormones, and a “smart” dosing algorithm that links the sensor to the pump. One version infuses insulin only; the second infuses insulin or glucagon, depending on blood glucose levels. Dr. Rabasa-Lhoret is comparing the 2 versions of this CLS with traditional insulin pump therapy in adults and adolescents with type 1 diabetes. So far, the results are very promising: The artificial pancreas reduces the risk for both hypo- and hyperglycemia, with the dual-hormone CLS outperforming both the single-hormone CLS and the traditional insulin pump. Dr. Rabasa-Lhoret is now testing his CLS in adolescents in 3 challenging situations: 3 nights at a diabetes camp; 3 days at a diabetes camp and 3 weeks in an outpatient setting (home, school, etc.). Dr. Perkins is conducting a multicentre, randomized, 3-way trial comparing the single-hormone CLS, the dual-hormone CLS and conventional pump therapy in regulating overnight glucose levels in adults with type 1 diabetes, in a home-based setting and with the presence of medical personnel. The artificial pancreas has a great potential to improve the quality of life and health of people with type 1 diabetes, to prevent hypoglycemia and to lessen the burden of diabetes for families and healthcare providers. People with diabetes are at high risk for stroke. Unfortunately, they are also more likely to have a difficult recovery after having a stroke, compared to their healthy peers. Dr. Tennant wants to help people recover from stroke by taking advantage of the brain’s natural ability to repair itself. Her research focuses on the thalamus. Dr. Tennant is examining what happens to the lines of communication between the body and the brain after the brain is damaged by a stroke. Using an experimental light therapy, Dr. Tennant hopes to stimulate growth of surviving brain cells in the thalamus to help re-establish proper connections between the brain and body and improve recovery in healthy animals and in animals with diabetes. As our use of technology increases, details of our lives are increasingly captured in databanks. Canadian Diabetes Associationfunded researchers Dr. Kaberi Dasgupta (receiving Operating Grant 2012-2015) at the Research Institute of McGill University Health Centre; Dr. Meranda Nakhla (receiving operating grant 2014-2017) at the Research Institute of McGill University Health Centre and Dr. John-Michael Gamble (receiving a clinician scientist award 20132018) at Memorial University of Newfoundland are examining databases to analyze how to better prevent, treat and manage diabetes.
P. VandenBerg / Can J Diabetes 39 (2015) 188e189
Women who have had gestational diabetes are at an increased risk for developing type 2 diabetes later in life, as are the offspring of those pregnancies. Healthful eating and physical activity can help to prevent this from happening. When a mother has gestational diabetes, her other children and her partner could also both be at increased risk for developing type 2 diabetes because families often share physical activities and eating habits. Dr. Dasgupta and her team plan to analyze information from 3 Québec databases to determine whether fathers and adolescent children have higher future risks for type 2 diabetes when the mothers have had gestational diabetes. If this is true, Dr. Dasgupta and others can develop diabetes-prevention efforts that focus on the whole family. Emerging adulthood is the transition period between childhood and adulthood, when young adults become independent, establish their identities and make career and educational choices. This is a challenging time, especially for young adults who are managing a chronic illness like diabetes, as they take more responsibility for their own health. At this time, many emerging adults fail to move from a pediatric diabetes clinic to an adult clinic, only to come back to the medical system once they have diabetes-related complications. Dr. Nakhla is examining provincial databanks in Québec that contain all visits to doctors and hospitals by emerging adults with diabetes to find out why emerging adults do not enter adult clinics, what happens to them when they leave pediatric care and which factors improve their health. This research will allow Dr. Nakhla to
189
advise the government and healthcare providers about how to provide the care emerging adults need. Dr. Gamble proposes to study the real-world safety and effectiveness of incretin-based medications by using a database of detailed healthcare records for individuals with type 2 diabetes, including information concerning prescription medication use; diagnoses made by general practitioners and specialists; laboratory tests performed by healthcare providers (e.g. cholesterol levels, kidney function); and hospitalizations and deaths. He will use the information in the database to assess the risks and benefits of using incretin-based therapies compared to other commonly used therapies. This study will contribute to an understanding of the realworld effects of the newest medications for type 2 diabetes and will help patients, clinicians and policymakers to assess the overall risks and benefits of these medications. The Canadian Diabetes Association knows that embracing technology in its many forms will allow researchers to continue to unlock the mysteries of diabetes and to find ways to improve the lives of people living with the disease.
Reference 1. Statistics Canada. The Daily, Tuesday, November 26, 2013. http://www.statcan.gc. ca/daily-quotidien/131126/dq131126d-eng.pdf. Accessed March 16, 2015.
Contents lists available at ScienceDirect
Canadian Journal of Diabetes journal homepage: www.canadianjournalofdiabetes.com
Research Update
Harnessing the Power of Technology to Improve the Lives of Those with Diabetes Polly VandenBerg BSc (hon) Manager, Research Knowledge Translation, Canadian Diabetes Association, Toronto, Ontario, Canada
Technology is a growing part of our daily lives. In 2012, 83% of Canadian households had Internet access and, of those, 69% had more than 1 device with which they could go online (1). In many cases, technology can make our daily tasks easier and faster. Diabetes care and research are also evolving to shape the way the disease is treated and managed. The Canadian Diabetes Association is funding 104 research grants and awards in 2014 and 2015, some of which are exploring the various uses of technology in diabetes research, care and management. Of these are Dr. James Johnson (receiving operating grant 20142017) and Dr. Marta Szabat (receiving a postdoctoral fellowship award 2012-2015, supervised by Dr. Johnson), both at the University of British Columbia. Drs. Johnson, Szabat and team have developed a sophisticated screening tool. They are using unbiased proteomic analysis and functional genomics to allow them to screen multiple proteins at the same time. Dr. Johnson is using these approaches to understand how fatty acids kill beta cells and to understand better how to protect beta cells. Dr. Johnson’s aim is to find the mechanisms that cause obesity to be a risk factor for type 2 diabetes. Dr. Szabat is screening existing drugs that are already on the market for other diseases. She has screened 1120 offpatent drugs for the ability to increase beta cell function and survival. Thus far, she has found several promising results that she will be studying further. One particular target seems to increase both the maturity and function of beta cells while also protecting beta cells from diabetes-related damage. These 2 research projects have the potential to find ways of stopping or reversing the progress of type 2 diabetes. Two of our researchers are focused on creating and using new technologies to help treat and manage type 1 diabetes. If successful, this technology may be adapted in the future to help people with type 2 diabetes as well. Both Dr. Bruce Perkins (receiving operating grant 2013-2015) at the University of Toronto and Dr. Rémi RabasaLhoret (receiving operating grant 2014-2017) at the Clinical Research Institute of Montréal are examining the efficacy of a wearable artificial pancreas. Dr. Kelly Tennant (receiving a postdoctoral fellowship award 2014-2016, supervised by Dr. Craig Brown) at the University of Victoria is examining a new way to stimulate brain repair after stroke. Dr. Rabasa-Lhoret and his team have developed 2 closed-loop systems (CLSs) that can be used as wearable artificial pancreases by people with type 1 diabetes. Both systems include a continuous 1499-2671/$ e see front matter Ó 2015 Canadian Diabetes Association http://dx.doi.org/10.1016/j.jcjd.2015.03.008
glucose sensor, a pump that delivers hormones, and a “smart” dosing algorithm that links the sensor to the pump. One version infuses insulin only; the second infuses insulin or glucagon, depending on blood glucose levels. Dr. Rabasa-Lhoret is comparing the 2 versions of this CLS with traditional insulin pump therapy in adults and adolescents with type 1 diabetes. So far, the results are very promising: The artificial pancreas reduces the risk for both hypo- and hyperglycemia, with the dual-hormone CLS outperforming both the single-hormone CLS and the traditional insulin pump. Dr. Rabasa-Lhoret is now testing his CLS in adolescents in 3 challenging situations: 3 nights at a diabetes camp; 3 days at a diabetes camp and 3 weeks in an outpatient setting (home, school, etc.). Dr. Perkins is conducting a multicentre, randomized, 3-way trial comparing the single-hormone CLS, the dual-hormone CLS and conventional pump therapy in regulating overnight glucose levels in adults with type 1 diabetes, in a home-based setting and with the presence of medical personnel. The artificial pancreas has a great potential to improve the quality of life and health of people with type 1 diabetes, to prevent hypoglycemia and to lessen the burden of diabetes for families and healthcare providers. People with diabetes are at high risk for stroke. Unfortunately, they are also more likely to have a difficult recovery after having a stroke, compared to their healthy peers. Dr. Tennant wants to help people recover from stroke by taking advantage of the brain’s natural ability to repair itself. Her research focuses on the thalamus. Dr. Tennant is examining what happens to the lines of communication between the body and the brain after the brain is damaged by a stroke. Using an experimental light therapy, Dr. Tennant hopes to stimulate growth of surviving brain cells in the thalamus to help re-establish proper connections between the brain and body and improve recovery in healthy animals and in animals with diabetes. As our use of technology increases, details of our lives are increasingly captured in databanks. Canadian Diabetes Associationfunded researchers Dr. Kaberi Dasgupta (receiving Operating Grant 2012-2015) at the Research Institute of McGill University Health Centre; Dr. Meranda Nakhla (receiving operating grant 2014-2017) at the Research Institute of McGill University Health Centre and Dr. John-Michael Gamble (receiving a clinician scientist award 20132018) at Memorial University of Newfoundland are examining databases to analyze how to better prevent, treat and manage diabetes.
P. VandenBerg / Can J Diabetes 39 (2015) 188e189
Women who have had gestational diabetes are at an increased risk for developing type 2 diabetes later in life, as are the offspring of those pregnancies. Healthful eating and physical activity can help to prevent this from happening. When a mother has gestational diabetes, her other children and her partner could also both be at increased risk for developing type 2 diabetes because families often share physical activities and eating habits. Dr. Dasgupta and her team plan to analyze information from 3 Québec databases to determine whether fathers and adolescent children have higher future risks for type 2 diabetes when the mothers have had gestational diabetes. If this is true, Dr. Dasgupta and others can develop diabetes-prevention efforts that focus on the whole family. Emerging adulthood is the transition period between childhood and adulthood, when young adults become independent, establish their identities and make career and educational choices. This is a challenging time, especially for young adults who are managing a chronic illness like diabetes, as they take more responsibility for their own health. At this time, many emerging adults fail to move from a pediatric diabetes clinic to an adult clinic, only to come back to the medical system once they have diabetes-related complications. Dr. Nakhla is examining provincial databanks in Québec that contain all visits to doctors and hospitals by emerging adults with diabetes to find out why emerging adults do not enter adult clinics, what happens to them when they leave pediatric care and which factors improve their health. This research will allow Dr. Nakhla to
189
advise the government and healthcare providers about how to provide the care emerging adults need. Dr. Gamble proposes to study the real-world safety and effectiveness of incretin-based medications by using a database of detailed healthcare records for individuals with type 2 diabetes, including information concerning prescription medication use; diagnoses made by general practitioners and specialists; laboratory tests performed by healthcare providers (e.g. cholesterol levels, kidney function); and hospitalizations and deaths. He will use the information in the database to assess the risks and benefits of using incretin-based therapies compared to other commonly used therapies. This study will contribute to an understanding of the realworld effects of the newest medications for type 2 diabetes and will help patients, clinicians and policymakers to assess the overall risks and benefits of these medications. The Canadian Diabetes Association knows that embracing technology in its many forms will allow researchers to continue to unlock the mysteries of diabetes and to find ways to improve the lives of people living with the disease.
Reference 1. Statistics Canada. The Daily, Tuesday, November 26, 2013. http://www.statcan.gc. ca/daily-quotidien/131126/dq131126d-eng.pdf. Accessed March 16, 2015.