A Peek Into
Gnanagurudasan PRAKASH Prakasam MD MRCH MHA
Center of Excellence in Diabetes & Endocrinology
&
Sutter Children’s Hospital, Sacramento, CA
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Goal is not to cover the entire topic of all new
advances but to give you a taste of what is
happening.
 I am not endorsing any product (approved on
unapproved in the US or anywhere else).
 In the time I have, I will only be able to touch
upon many areas and this lecture no means
covers every aspect of treatment in Diabetes
 Culturally and Economically appropriate
treatment improves outcome in diabetes
management
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Coordinate initial stabilization in
the ED followed by care in the
PICU.
Once stabilized - Teaching of self
management on the pediatric
floor along with introduction to
our support system including
social network and research.
Systematic approach to reduce
length of stay while maintaining
quality
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Discharge from hospital is followed
by outpatient coordination:
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daily phone calls with MD
team meetings
school nurses education
teleconference journal clubs
support groups
MD follow up
MD
CDE
RN
* Social Network
PENS
SN*
Ped
Endo
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School
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DP
SW
RD
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Year – 2003.
Connect and dial like a regular
phone call.
No-show rates reduced by
90%
American Telemedicine Chose
this as one of the top 10
research presentations for the
year.
However, CCS told us that it
was home health care and did
not qualify as medical service.
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Digital Doctors KVIE video link(20:12)
Insulin dependent at 3 months of age ( S/P pancreatic
surgery).
Today –He is a healthy 13 year old using an insulin
pump and glucose sensor in his hometown Kolkatta,
India.
In person and telemedicine care.
And of course connected to our SN
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anTcient method
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modern method
http://main.diabetes.org/dforg/pdfs/2015/2015
-cg-glucose-meters.pdf
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The Connected Device -interactive
blood glucose monitoring system
works a lot like your current meter
but also automatically transmits
blood glucose readings, activity
information, and how you’re
feeling to provide a real-time
picture of your health.
 The Smart Cloud- develops the
insight. It analyzes the data,
determines what should be done,
and gives instant feedback that
leads to effective selfmanagement.
 The Care Team – CDE to interact
when needed
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The prototype of the first pump that
delivered glucagon as well as insulin,
backpack style, was in the early '60s.
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Omni Pod - the world’s first tubing-free insulin pump.
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•provide continues insulin delivery
•infusion site needs to be changed only
every 2-3 days
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http://main.diabetes.org/dforg/pdfs/2015/2015
-cg-insulin-pumps-chart-update.pdf
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The V-Go is an insulin pump for people
with type 2 diabetes that’s replaced every
24 hours.
Because it doesn’t use electric power
from a battery, some, call it a disposable
insulin delivery device instead of a pump.
Like a patch pump, the device sticks to
the body and delivers a continuous
stream of rapid-acting insulin at a rate of
20, 30, or 40 units of insulin per 24 hours,
depending on model.
At mealtime, a user can press a button to
deliver an additional 2 units per push, for
a max bolus of 36 units.
How does the V-Go get by without
power? It’s spring loaded. A spring slowly
presses out the basal insulin.
The mealtime insulin is delivered by the
physical push of the button.
https://youtu.be/IHHdZdVds8I
The Tandem t:slim
pumping mechanism is
designed to work with its
bag-style insulin reservoir.
A mobile component
inside the device—an
insulin shuttle—slides
between the reservoir,
where it fills with insulin,
and the infusion line,
where it delivers insulin.
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Increased security from
alarms & alerts
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Immediate feedback - look
and learn
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BG trend provides more
information than static
readings
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Control + safety
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Lispro
Aspart
Glulisine
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Glargine
Determir
Glargine 300
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Seeds such as soybeans containing very high
levels of protein can undergo desiccation, yet
survive and revive after water absorption. A.
Carl Leopold, began studying this capability at
Cornell University in the mid 1980s.
 He found soybeans and corn to have a range
of soluble carbohydrates protecting the seed's
cell viability. Patents were awarded to him in
the early 1990s on techniques for protecting
"biological membranes" and proteins in the
dry state.
 Using the knowledge gleaned from studying
the preservation of proteins in dry soybeans,
Carl developed a method to preserve peptide
hormones like insulin in the glassy state so
that they can be pulverized into a powder and
inhaled by diabetics as an alternative to selfinjection
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The clinical trial is testing Medtronic’s 670G
“hybrid-closed loop” system (insulin pump +
Enlite 3 CGM sensor) in people with type 1
diabetes.
Based on the Enlite 3 CGM reading every five
minutes, the 670G pump’s software
automatically increases/decreases insulin
delivery to target a blood glucose of 120 mg/dl.
The 670G algorithm is fully integrated within
the pump itself, so a patient only needs to wear
the Enlite 3 CGM sensor and the MiniMed 670G
pump – no need to carry a separate CGM
receiver.
The 670G is considered a “hybrid-closed loop”
because the user still needs to bolus for meals
and notify the system of exercise.
Otherwise, it mostly takes care of insulin
dosing in the background, which is very
effective at night (80%+ time-in-range in one
study we’ve seen
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A team at De Montfort
University is developing a
device which when
implanted into the
peritoneal cavity will
automatically release the
correct amount of insulin
in response to varying
blood sugar levels.
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The ‘artificial pancreas’ is
currently in prototype
form and undergoing preclinical trials.
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Built-in wireless CGM
technology
No separate processor, all
the smarts are already
built-in
Two pumps in one
Streamlined, simple, and
friendly user-interface
A 4.3″ touch-screen display
brings all the information
you need right to your
fingertips through an
extremely simple and
elegant user-interface.
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The other trial involves BetaO2’s experimental therapy
called BetaAir and is being
conducted at Uppsala
University Hospital in Sweden.
The immune protective
BetaAir encapsulation device
contains human islets from
donated cadaver pancreases.
A unique feature of the BetaAir
system is the ability to provide
the implanted cells with
additional oxygen via a special
port to help sustain them after
implantation.
https://youtu.be/O9phosi-C94
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ViaCyte's innovative product is based on
the differentiation of stem cells into
pancreatic beta cell precursors (PEC01™), with subcutaneous implantation in
a retrievable and immune-protective
encapsulation medical device
(Encaptra® drug delivery system).
Once implanted, the precursor cells
mature into endocrine cells that secrete
insulin and other hormones in a
regulated manner to control blood
glucose levels.
ViaCyte's goal is a product that can free
patients with type 1 and type 2 diabetes
from long-term insulin dependence.
ViaCyte has received substantial
financial support from both the
California Institute for Regenerative
Medicine (CIRM) and JDRF.
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As important as Innovation in Treatment
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Center of Excellence in Diabetes & Endocrinology
3814 Auburn Blvd, Suite 72, Sacramento, CA
Phone: 916 426 1902
Fax: 916 426 1940
www.sackid.com
www.facebook.com/mycede
Youtube: Sackidinfo
Twitter: SackidMD & Sackiddiabetes
Facebook: Sackiddiabetes, SackidMD
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