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Bionic pancreas could free type-1-diabetics from insulin pumps 

MD-FM Thursday June 19, 2014


 

SARAH:

MD-FM: the latest medical news from around the world, I’m Sarah Maxwell…

 

SEGMENT 1: DIABETES: A bi-hormonal bionic pancreas better than insulin pumps in type-1-diabetics

  

PETER:

And I’m Peter Goodwin. To begin with, exciting news from the annual meeting of the American Diabetes Association, where researchers showed that an i-Phone-controlled bionic pancreas could one day free patients with type-1 diabetes from using insulin pumps…

 

SARAH:

Yes.  Patients wear two miniature pumps coordinated by an iPhone to deliver insulin and glucagon in the right doses in response to continuous blood monitoring. And the device appeared to be more reliable than insulin pumps at controlling glucose levels over a trial period of five days. Dr. Steven Russell presented data at the meeting in San Francisco:

 

RUSSELL:

In both the adults and the adolescents, the bionic pancreas lowered the average glucose and at the same time was able to reduce the amount of low blood sugar or the need to treat with carbohydrates for low blood sugar.

 

SARAH:

That was Steven Russell, from The Massachusetts General Hospital in Boston, who said that, importantly, these results were obtained in a real-world setting…

 

RUSSELL:

In this situation, some people would eat multiple, some time very large meals, were able to drink alcohol, could exercise at multiple times of the day, any time they wanted –they could exercise when they were fasted in the morning before they’d eaten anything, at the end of the day long after their dinner –there’s a myriad of possibilities and there’s no way to test those until you get people out in the world doing what they want to do and I think that’s the big step for us –to do a study in that environment.

 

SARAH:

This wearable bionic pancreas is good because it delivers both insulin and glucagon:

 

RUSSELL:

People with diabetes not only lack insulin, they lack appropriate glucagon secretion in response to low blood sugar. And so this system is replacing both of these missing functions, not just one of them, which is the usual approach to treating diabetes and even the approach that many of the artificial pancreases take.

 

SARAH:

Again, that was Steven Russell, from Boston. And Professor Eric Renard, who didn’t participate in the study, gave MDFM his reactions to this latest advance in treatment:

 

RENARD:

A few years ago, we would never have thought that it would be so quick to use an artificial pancreas in everyday life so this is a very important study that adds further arguments to the feasibility of artificial pancreas and it is efficient as shown by this study.

 

SARAH:

That was Eric Renard, from France.

 

SEGMENT 2: Concentrated insulin glargine formulation further improves management of type 2 diabetes

 

PETER:

More from the ADA meeting now, and for patients with type-2 diabetes, a more concentrated insulin-glargine formulation than is currently available was better at reducing the risk of hypoglycaemia…

 

SARAH:

Yes, this was in a study looking at patients who had already failed oral anti-diabetic agents: Half were randomized to a daily 300 U/ml dose of insulin glargine, and the other were given the standard 100 U/ml, injected in the evening, over six months:

 

BOLLI:

At the end of the study, there were comparable benefits on glycaemic control, as shown by glycol-haemoglobin, but less hypoglycaemia, not only at night but also in the morning and early afternoon. So, in the end, one can hypothesize that U300 is more beneficial than U100 glargine because it reduces the risk of hypoglycaemia after injection and for the subsequent 16 hours.

 

SARAH:

That was study author Geremia Bolli, from Italy, who said that U300’s pharmacokinetic profile is apparently what makes it superior:

 

BOLLI:

With more concentrated insulin, the absorption from subcutaneous tissues is slower, more constant and longer... And this translates into a pharmacodynamic benefit of a flatter insulin activity over time.

 

SARAH:

And Professor Bolli added that: weight gain was lower with U300, which also appeared to be as safe as U100. Matthew Riddle, who did not participate in the study:

 

RIDDLE:

Insulin glargine has been proven to be quite safe and effective and it’s really helped us a lot clinically. The more concentrated formulation seems to have a somewhat better pharmacokinetic profile and we don’t have from these pre-registration trials, yet, very clear information on the patient populations who will benefit the most, but I think it’s an interesting program and an attractive option.

 

SARAH:

That was Dr. Matthew Riddle, from Oregon Health and Science University in Portland.

 

SEGMENT 3: Incretins do not appear to increase the risk of pancreatitis in type-2-diabetics

 

PETER:

And finally from the ADA meeting: the authors of a nationwide population-based study in Denmark declared that they don’t believe incretins are associated with an increased risk of pancreatitis…

 

THOMSEN:

Our main findings comparing incretins and other glucose-lowering drugs was that, no matter which type of glucose-lowering drug you use, you have a 40 per cent increased risk of pancreatitis, which suggests that it is not the specific drug but rather the underlying diabetes that is associated with pancreatitis. It fits well with the other results we have heard at this congress and also the FDA review from earlier this year that actually there’s not much evidence for any association between these new drugs and pancreatitis, which is obviously a nice thing for patients and doctors!

 

SARAH:

That was Professor Reimar Thomsen, from Denmark, talking to us at the ADA meeting in San Francisco.

 

SEGMENT 4: Are preoperative beta-blockers systematically necessary in non-emergency coronary artery bypass grafting surgery?

 

PETER:

In patients having non-emergency coronary artery bypass grafting surgery (CABG) preoperative beta-blockers apparently did not improve outcomes…

 

SARAH:

Yes, that’s the controversial finding, published in JAMA Internal Medicine, from a study showing no mortality advantage and, paradoxically, an increased incidence of atrial fibrillation in patients who got beta-blockers compared to those who didn’t.

 

PETER:

Hmm, but the American College of Cardiology and the American Heart Association do recommend that all patients having CABG should be treated with beta blockers to reduce the risk of atrial fibrillation don’t they? So, how strong is the evidence from this new study?

 

SARAH:

Well, it’s not a randomized trial. It’s a retrospective database analysis of hospitals performing cardiac surgery over the past five years in the United States. However, it did include over 500,000 patients getting non-emergency CABG surgery.

 

PETER:

So it’s from an impressive data set rather than a trial setting out to measure this prospectively. I wonder what we should make of these findings?

 

SARAH:

Well, the authors said: a prospective randomized trial would help to clear up the situation. But in the meantime, clinicians should go on with current guidelines.

 

SEGMENT 5: Tofacitinib more effective than methotrexate in medically-naïve rheumatoid arthritis patients

 

PETER:

For patients with rheumatoid arthritis, the oral Janus-kinase-inhibitor tofacitinib, when given first-line, was a clinically superior treatment to methotrexate. That’s according to a study reported in the New England Journal of Medicine

 

SARAH:

Yes, tofacitinib is already approved second-line for patients who don’t get enough relief from methotrexate therapy. Now, this trial shows it’s actually more effective first-line. Senior study author Ronald van Vollenhoven:

 

VAN VOLLENHOVEN:

In both the x-rays –to look at how much damage occurred in the joints –and the clinical signs and symptoms of the disease, tofacitinib did significantly better than methotrexate.

 

SARAH:

That was Professor van Vollenhoven, from Karolinska Institute in Stockholm. But he said that the risk of infection was higher with tofacitinib than with methotrexate:

 

VAN VOLLENHOVEN:

What I think people are nervous about with tofacitinib is that maybe, every once in a while, patients will get a really serious infection --an opportunistic infection or a life-threatening infection. That has been seen very rarely in any of the clinical trials with tofacitinib but, with a new drug, there’s also sort of a feeling that you want to be extra careful because you just don’t know what might happen with longer-term use with more widespread use when more patients will be exposed to this drug.

 

PETER:

We shouldn’t forget, of course, that tofacitinib is also much more expensive than methotrexate…

 

SARAH:

Yes, and Professor van Vollenhoven concluded that methotrexate should remain the standard for now but, one day, this might change…

 

VAN VOLLENHOVEN:

I think this result is very exciting because it points to a possible way in the future, where we could possibly start using other first line treatments than methotrexate, with even better results. But then, I think we need to be better at predicting who is really going to need it –We don’t have the good markers, the biomarkers, for which drug to use in which patient... There is a lot of research going into that but we do not know yet.

 

IN BRIEF 1: Antidepressant use during first trimester of pregnancy does not increase babies’ risk of cardiac malformations


PETER:

Finally, in brief: babies born to women who took antidepressants during the first trimester of pregnancy had no significant increase in the risk of cardiac malformations, compared to babies not exposed to these agents. That’s the finding of a cohort study, reported in the New England Journal of Medicine, that looked at nearly a million pregnant women. More specifically, it showed that there appeared to be no significant association between the use of paroxetine and right ventricular outflow tract obstruction, or the use of sertraline and ventricular septal defects.

 

IN BRIEF 2: Antiepileptic drug use while breastfeeding does not increase babies’ risk of adverse cognitive effects

 

PETER:

It’s apparently safe for mothers to breastfeed while taking anti-epileptic drugs. That’s according to a study, published in JAMA Pediatrics, that found antiepileptic therapy was not associated with any increased risk of adverse cognitive effects in children. Investigators looked at breastfeeding and IQ data from 181 children who were followed up to the age of six.

 

 

PETER:

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!

 

 

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