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Stuart Weinzimer, MD

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Stuart Weinzimer, MD. Associate Professor, Pediatrics. Yale ... The Dawn of the Artificial Pancreas. Stuart A Weinzimer, MD. Associate Professor of Pediatrics ... – PowerPoint PPT presentation

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Title: Stuart Weinzimer, MD


1
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2
Stuart Weinzimer, MD
  • Associate Professor, Pediatrics
  • Yale University School of Medicine

3
The Dawn of the Artificial Pancreas
2006 Annual JDRF ConferenceGlobal Diabetes
Research Forum
  • Stuart A Weinzimer, MD
  • Associate Professor of Pediatrics
  • 12 May 2006

4
Why do we need an artificial pancreas?
  • Present methods of diabetes treatment improve,
    but dont normalize, blood glucose levels
  • Burden of care extremely high
  • Islet cell replacement therapies limited to small
    segments of population and not well-suited for
    children with T1D

5
Design elements for artificial b-cell
  • Insulin pump to accurately and precisely deliver
    variable amounts of insulin
  • Continuous glucose sensor to accurately determine
    ambient glucose levels
  • Effective algorithms to vary insulin delivery
    rates based on real-time glucose sensor outputs

6
Components of an Algorithm for Insulin
Delivery(the Non-Engineers Approach)
  • When glucose is high, give more insulin
  • When glucose is low, give less insulin
  • When glucose is rising, increase insulin delivery
  • When glucose is falling, reduce insulin delivery

7
External Closed-loop DevelopmentStep 1 Sensor
Augmented Pump Rx
  • external pump
  • real-time glucose sensor used 24/7
  • clinicians, patients parents devise and adjust
    algorithm
  • sensors downloaded for retrospective insulin
    dosage adjustments

8
Example of a real-time algorithm
  • calculate of the amount of insulin needed to
    cover the carbohydrates and correct for high BG
  • check sensor arrow make following adjustments
  • ? (90 Up) increase meal dose by 20
  • ? (45 Up) increase meal dose by 10
  • ? (No change) no change in meal dose
  • ? (45 Down) decrease meal dose by 10
  • ? (90 Down) decrease meal dose by 20

9
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10
Why do we need an artificial pancreas?
  • We are built to make errors
  • Lewis Thomas

11
In Vivo Physiological Insulin Secretion
Blood Glucose
Insulin
12
Algorithm Components
Blood Glucose
Insulin
Derivative
Integrative
Proportional
13
External Closed-loop DevelopmentStep 2
Algorithm for Insulin Delivery
  • Proportional to the glucose level
  • Derivative rate-of-change of the glucose
  • Integrative slowly adaptive basal rate

14
Prototypic closed-loop system
  • Sensor signals transmitted to a laptop computer
    that displays the sensor glucose and calculates
    rate of insulin delivery
  • Rate of insulin delivery is transmitted to the
    insulin pump

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16
First PEDIATRIC Closed-Loop Patient
17
Mean glucose levels in first 5 subjects
18
Closed-loop control compared to traditional
open-loop pump therapy
400
300
BG (mg/dL)
200
100
0
Pre-B
Post-B
Pre-L
Post-L
Pre-D
Post-D
19
Effect of peripheral insulin delivery
20
Closed-loop vs. hybrid control
21
Where do we go from here?
  • Improving closed-loop / hybrid algorithms
  • Optimize prandial control
  • Demonstrate persistent reduction in nocturnal
    hypoglycemia
  • Characterize performance under dynamic conditions
  • Feasibility studies of ambulatory CL control

22
Financial Support
  • Juvenile Diabetes Research Foundation
  • Medtronic MiniMed
  • NIH NICHD / NIDDK
  • Novo Nordisk

23
Acknowledgements
  • Yale Research Team
  • Karena Swan
  • Elizabeth Doyle
  • Kristin Sikes
  • Heather Mokotoff
  • Amy Steffen
  • Melody Martin
  • GCRC Staff

24
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