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Vol. LXVI, No. 15
July 18, 2014
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Digest

Bionic Pancreas Outperforms Insulin Pump

From right, researcher Dr. Steven Russell of Massachusetts General Hospital stands with Frank Spesia and Colby Clarizia, two participants in a type 1 diabetes trial testing an electronic device called a bionic pancreas—the cellphone-sized device shown—which replaces their traditional fingerstick tests and manual insulin pumps.

From right, researcher Dr. Steven Russell of Massachusetts General Hospital stands with Frank Spesia and Colby Clarizia, two participants in a type 1 diabetes trial testing an electronic device called a bionic pancreas—the cellphone-sized device shown—which replaces their traditional fingerstick tests and manual insulin pumps.

Photo: Adam Brown, Diatribe.org

People with type 1 diabetes who used a bionic pancreas instead of manually monitoring glucose using fingerstick tests and delivering insulin using a pump were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs. The full report of the findings, funded by NIDDK, appeared online June 15 in the New England Journal of Medicine.

The researchers—at Boston University and Massachusetts General Hospital (MGH)—say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type 1 diabetes walk an endless tightrope. Because their pancreas doesn’t make the hormone insulin, their blood glucose levels can veer dangerously high and low. Several times a day they must use fingerstick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump.

In two scenarios, researchers tested a bihormonal bionic pancreas, which uses a removable tiny sensor located in a thin needle inserted under the skin that automatically monitors real-time glucose levels in tissue fluid and provides insulin and its counteracting hormone, glucagon, via two automatic pumps. In one scenario, 20 adults wore this device combination and carried a cell phone-sized wireless monitor around Boston for 5 days, unrestricted in their activities. In the other, 32 youth wore the device combination for 5 days at a camp for children with type 1 diabetes. Both groups were also monitored for 5 days wearing their own conventional pumps that deliver insulin.

“The bionic pancreas system reduced the average blood glucose to levels that have been shown to dramatically reduce the risk of diabetic complications,” said co-first author Dr. Steven Russell of MGH. “This is tremendously difficult with currently available technology, and so most people with diabetes are unable to achieve these levels.”

Telemedicine Catches Blinding Disease in Premature Babies

Telemedicine is an effective strategy to screen for the potentially blinding disease known as retinopathy of prematurity (ROP), according to a study funded by NEI. Investigators say the approach, if adopted broadly, could help ease the strain on hospitals with limited access to ophthalmologists and lead to better care for infants in underserved areas of the country.

The telemedicine strategy consisted of electronically sending photos of babies’ eyes to a distant image-reading center for evaluation. Staff at the image-reading center, who were trained to recognize signs of severe ROP, identified whether infants should be referred to an ophthalmologist for evaluation and potential treatment. The study tested how accurately the telemedicine approach reproduced the conclusions of ophthalmologists who examined the babies onsite.

“This study provides validation for a telemedicine approach to ROP screening and could help save thousands of infants from going blind,” said Dr. Graham Quinn of Children’s Hospital of Philadelphia and lead investigator for the study, which was reported June 26 in JAMA Ophthalmology.

Researchers Extend Liver Preservation for Transplantation

Researchers have developed a new supercooling technique to increase the amount of time human organs could remain viable outside the body. This study was conducted in rats; if it succeeds in humans, it would enable a world-wide allocation of donor organs, saving more lives.

The research is supported by NIBIB and NIDDK.

The first human whole organ transplant 60 years ago—a living kidney transplant—changed the landscape of the medical world. Since then, transplants of skin, kidneys, hearts, lungs, corneas and livers have become commonplace. But due to a shortage of donor organs, more than 120,000 patients are still on waitlists for organ transplantation in the United States alone.

The difficulty with long-term preservation of human organs stems mostly from the extensive tissue damage that occurs when organs are cryopreserved, frozen at temperatures of -320.8 degrees Fahrenheit. While freezing is successful for single cells and simple tissues, the problem is exacerbated with whole organs because of the multiple cell types and other structures that react differently to cold. To combat these problems, Dr. Martin Yarmush and Dr. Korkut Uygun of the Center for Engineering in Medicine at Massachusetts General Hospital have developed a 4-step preservation technique that has tripled the amount of time that rat livers can be stored before transplantation.

The researchers described their process in the June 19 online issue of Nature Medicine.—compiled by Carla Garnett


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