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First succesful step along the process of developping the artificial pancreas

 MD-FM Thursday 27 June, 2013

 

 

 

GENERIQUE

Carillon

 

Sarah:

MD-FM, Medical News from around the world with Derek Thorne.

 

P1

DEREK:

Hello, and with me is Sarah Maxwell. To begin with, for patients with type-1 diabetes and documented nocturnal hypoglycemia, a “smart” device, that interrupts insulin delivery, reduced the risk of low blood glucose related events overnight, without increasing glycated hemoglobin values

 

SARAH:

Yes, that’s according to a study, presented at the last American Diabetes Association meeting and published in the New England Journal of Medicine, that randomized nearly 250 patients to have, sensor-augmented insulin-pump therapy with or without a “threshold-suspend” feature, for three months:

 

Bergenstal_01 : We can reduce hypoglycemia by close to forty percent, particularly overnight, and we can do this without any elevation in the overall blood sugar. So we think this is the first step along the process of developping the artificial pancreas = 18 sec

 

SARAH:

Senior study author Rich Bergenstal, executive director at the Park Nicollet International Diabetes Center in Saint Louis.

 

DEREK: 

Hmm, this sounds interesting so how is the device reducing the risk of hypoglycemia?

 

SARAH:

Well, it has a “threshold-suspend” feature that interrupts the insulin delivery at a preset sensor glucose value, of 70 mg/dl. Rich Bergenstal, in Saint Louis again:

 

Bergenstal_02 : So we’ve had insulin pump for thirty years. We’ve had sensors for 5 to 7 years that measure the blood sugar every 5 minutes and send the numbers to the pump. But for the first time now, we’re evaluating software in the pump that can read those sugar and automatically adjust the insulin. So we are putting intelligence, we are putting brain in the pump. This has been studied in small studies around the world, in France. This is the largest randomized trial to really test this feature = 33 sec

 

SARAH:

And there was also a 60% reduction of the more severe hypoglycemia, that need urgent intervention from another person. And one of the leading experts in the field, professor Eric Renard, from the University Hospital of Montpellier, gave us his reactions:

 

Renard _01 : In a way it’s a validation of the current practice that many patients and many doctors have in France. It was probably needed because previous studies were all limited studies in numbers. They were sufficiently good to be approved in Europe, but, in the US, the FDA was very frightened of any error in the measurement of hypoglycemia that would stop the pump were there is no need for that and the result would be ketoacidosis. This was the main obstacle in US. And so this study definitely demonstrate that there is no risk for ketoacidosis and there is a benefit of having stop hypoglycemia = 41 sec

 

SARAH:

And many international teams are already working on the next step in the process: developing an artificial pancreas:

 

Renard_02 : In a way it is a first example of authorised and commercialized closed-loop. It is limited because it is only for hypoglycemia but in the last session, there was the first demonstration that we can simulate a system that would be a stop hyperglycemia. If you combine stop hypo and stop hyper, it’s not closed-loop but it’s really a control in a range = 24 sec

 

SARAH:

Eric Renard, from the University Hospital of Montpellier, France

 

 

VIRGULE MUSICALE

 

P2

 

DEREK:

It’s the 30th anniversary of the NIH funded Diabetes Control Complications Trial, or DCCT, and for patients with type-1 diabetes, it shows there are major long-term benefits with intensive therapy

 

SARAH:

Yes, back in 1983 the DCCT randomized 1500 patients with recent type-1 diabetes to either: intensive therapy, aimed at achieving near-normal glucose levels, or conventional therapy, aimed at avoiding hypoglycemia. In 1993, intensive therapy became the standard approach: compared to conventional treatment, there was a fall in the early stages of eye, kidney and nerve complication by as much as 76 percent…

 

DEREK:

Hmm, so what’s the latest then? What results do we have this year?

 

SARAH:

Well, with long-term intensive therapy there’s a 50 percent reduction in the risk for all diabetes complications, particularly kidney and cardiovascular diseases, and the benefit is still spreading:

 

Nathan_01 : Clearly, a saving life is very important and we are not yet ready to talk about mortality, but we will be ready to talk about it in the next half year or so, as we get more and more results. However I think reduction of heart disease by 57%, reducing heart attack or stroke, I think that’s extremly important. So you can pick whichever one, they’re all reduced by about 50% = 23 sec

 

SARAH:

That was David Nathan, director of the Massachusetts General Hospital Diabetes Center, in Boston, and co-chair to the DCCT/EDIC.

 

P3

 

DEREK:

And now for patients with Type-2 diabetes, lixisenatide added to standard care, including basal insulin, with or without oral anti-diabetic agents, reduced HbA1c by 77%. Standard treatment without the once-daily prandial glucagon-like peptide-1, or GLP-1 for short, receptor agonist only had a 29% reduction. These results were presented at the 2013 annual meeting of the American Diabetes Association, in Chicago and were mainly obtained by reducing postprandial glucose daytime exposure.

 

 

 

VIRGULE MUSICALE

 

P4

 

DEREK:

Reassuring evidence for younger women taking HRT. For women aged 50 to 55 years, hormone replacement therapy with conjugated equine estrogens, or CEEs, doesn’t affect global cognitive function

 

SARAH:

Yes, that’s according to the Women’s Health Initiative Memory Study of Younger Women or WHIMSY, published in JAMA Internal Medicine. The study that preceded it found that for women over 65, hormone therapy caused detrimental effects on cognitive functioning. But here, these younger women on the equine preparation had similar cognitive scores to women taking a placebo. Lead study author Sally Shumaker gave us the details:

 

AUDIO

“We found actually no effect, we found no benefit and no detriment. So no negative effect and conclude that there is actually at this point in time from what we can tell from this particular study, no reason to believe that there is any problems associated with younger women going on hormone therapy for a relatively short period of time. What we do know is that hormone therapy is very effective for postmenopausal and perimenopausal symptoms. The hot sweats, what we call vasomotor symptoms, in fact its one of the most effective therapies for that. So this is very promising to learn that there is no noticeable harm in cognition associated with women going on this therapy for that short period of time during the menopausal transition.” = 45secs

 

SARAH:

That was Dr Sally Shumaker from the Wakeforest School of Medicine in Winston-Salem, North Carolina. And Francine Grodstein of Brigham and Women’s Hospital says, these provide reassuring data all round:

 

AUDIO:

“For healthcare providers prescribing hormone therapy, for a younger women with menopausal symptoms, I think this is now nice reassuring evidence that those harms found in older women don’t appear to extend to younger women.” = 14secs

 

SARAH:

That was Francine Grodstein from Boston.

 

VIRGULE MUSICALE

 

P5

 

DEREK

Genes linked to migraine have been identified in a large-scale, worldwide investigation looking at genome-wide association data, published this week in Nature Genetics

 

SARAH:

Yes, it compared the DNA of 25,000 patients with migraines to 100,000 healthy individuals and found 12 genes for migraine, five of which were newly identified as linked to the onset of migraine. The genes highlight, for the first time, important neurobiological mechanisms that give clues to what is happening in the brains of patients with migraines. And in the long run, information from these mechanisms can help tailor treatment approaches. Lead study author Arn Van Den Maagdenberg:

 

AUDIO:

“We identify a few mechanisms that we think are very important in understanding how migraine comes about, one is that some of the genes show a dysfunction of neurotransmitters and a function of neurals. So we think that something goes wrong in that process in patients and will lead to migraine attacks. Another lets say clear indication we have is that vascular genes play a role and we have first evidence now for oxygenated stress being a factor in migraine. And these new mechanisms shed light on the pathophysiology of migraine.” = 33Secs

 

SARAH:

That was professor Arn Van Den Maagdenberg from Leiden University Medical Centre in The Netherlands.

 

BREVE 1 Sur fond musical

 

DEREK:

Finally, in brief:

 

Taking prenatal doses of iron daily, substantially improved birth weights of babies in a linear dose-response fashion. That’s according to a comprehensive meta-analysis of randomised trials, published in the British Medical Journal, that showed, babies birth weights went up and the risk of low birth weight went down, with every 10mg increase of iron dose the mother took per day.

 

And...

 

BREVE 2

 

Men who are diagnosed as azoospermic are more likely to develop cancer than the general population. That’s the conclusion of a study, funded by the National Institute for Child Health and Human Development, which is the first to examine the cancer risk of azoospermia in particular, or to link it to non-germ-cell cancers. Moreover, a diagnosis of azoospermia before age 30 carries an eight-fold cancer risk.

 

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

 

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