̽��ֱ�� of Cambridge - JDRF

̽��ֱ��life-changing artificial pancreas

cjb250 — Thu, 20 Jan 2022 08:30:12 +0000

An artificial pancreas developed by Cambridge researchers is helping protect very young children with type 1 diabetes at a vulnerable time of their lives. New research shows that it is both safe to use and more effective at managing their blood sugar levels than current technology.

World’s first artificial pancreas app licensed for people with type 1 diabetes in UK

cjb250 — Mon, 16 Mar 2020 00:39:50 +0000

̽��ֱ��CamAPS FX app works with an insulin pump and a glucose monitor to automatically deliver insulin to people living with the condition via a complex algorithm.

Around 400,000 people in the UK are affected by type 1 diabetes, 29,000 of them children. It is a chronic, life-threatening condition that has a life-long impact on those diagnosed with it and their families. Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions just to stay alive, because their pancreas no longer produces insulin itself.

̽��ֱ��app - which Professor Hovorka hopes will become available on the NHS in the future - will take over much of the management of the condition. This is particularly important at night, when many people with type 1 diabetes experience potentially dangerous low blood glucose levels.

̽��ֱ��app can also upload the user’s blood glucose measurements seamlessly to Diasend, an online platform, allowing their diabetes team to provide more personalised care.

̽��ֱ��CamAPS FX app is backed by 13 years of clinical research carried out by Professor Hovorka and his research group at the Wellcome-MRC Institute of Metabolic Science. It is licensed for use by both adults and children with the condition and is the first artificial pancreas system to be licensed for use in pregnancy, or by young children aged one and above.

Professor Hovorka said: “This is a major stepping stone towards providing widely available, clinically proven, and user-friendly artificial pancreas technology to people with type 1 diabetes.

“Our aim is to alleviate the ever-present burden of type 1 diabetes and improve health outcomes. This is the outcome of hard work, with more to come. We are indebted to all who are helping us on this journey.”

At launch, the app will be supported by a small number of UK diabetes clinics. People who wish to use the app will need to confirm which clinic they attend, and must be using a Dana RS pump and a Dexcom G6 continuous glucose monitor.

Professor Hovorka and his research team will work to continue to bring this technology to all who need it, via the NHS. Key to this will be the generation of data to support the case for NHS provision.

̽��ֱ��commercial launch is a milestone in the journey towards a fully automated artificial pancreas for everyone with type 1 diabetes. Such technology will fundamentally change life with the condition by working with a range of insulin pumps and glucose monitors to lift the burden of managing a condition that is relentlessly unpredictable day and night.

Professor Hovorka will continue refining the artificial pancreas through research into mealtime glucose control and improving ease of use.

̽��ֱ��research behind the app has been funded by the type 1 diabetes charity JDRF, Diabetes UK, the National Institute for Health Research, the National Institutes of Health, Horizon 2020, and the Leona M and Harry B Helmsley Charitable Trust.

Karen Addington, UK Chief Executive of JDRF, said: “JDRF is proud to have supported Professor Hovorka’s artificial pancreas research from the beginning, nearly 15 years ago. This app is a major innovation and a significant milestone on the road to a fully automated and interoperable artificial pancreas. There’s still more work to do, but this is an exciting step.”

Fiona O’Reilly, who has been using the app as part of a clinical trial, said: “Overall, it makes me feel free. It is the closest I have been to living without the burden of type 1 diabetes since I was diagnosed, which is a fabulous feeling – I feel less fearful of hypoglycaemia, and less ashamed of the fact that I find achieving good glycaemic control so tricky.

“And it makes me feel more positive of my future with diabetes, that I have a chance of avoiding all the associated complications. It also makes me feel lucky to live in a time where this technology is possible and really grateful to be given the chance to try it out.”

̽��ֱ��app is now available for UK users to download onto Android phones via the Amazon Appstore. ̽��ֱ��app is available on a subscription basis starting at £70 per month.

Adapted from a press release by the JDRF.

̽��ֱ��world’s first licensed, downloadable artificial pancreas app for people with type 1 diabetes launches today, based on over a decade of research by Professor Roman Hovorka at the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust.

This is a major stepping stone towards providing widely available, clinically proven, and user friendly artificial pancreas technology to people with type 1 diabetes

Roman Hovorka

Screenshot from CamAPS FX app

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New approach to treating type 1 diabetes aims to limit damage caused by our own immune system

cjb250 — Tue, 11 Oct 2016 18:00:47 +0000

Type 1 diabetes is one of the most common chronic diseases in children and there is a rapid increase in the number affected each year. About 400,000 people in the UK are affected, 29,000 of them children. In type 1 diabetes, the body’s own immune system mistakes the insulin producing cells of the pancreas as harmful, attacks and then destroys them. ̽��ֱ��result is a lack of insulin, which is essential for transporting glucose from the blood into cells. Without insulin, glucose levels in the blood rise, causing short term and long term damage: hence patients have to inject themselves several times a day with insulin to compensate.

In a study published today in the open access journal PLOS Medicine, a team led by researchers from the JDRF/Wellcome Trust Diabetes Inflammation Laboratory at the Cambridge Institute of Medical Research used a drug to regulate the immune system with the aim of preventing a patient’s immune cells attacking their insulin-producing cells in the pancreas.

̽��ֱ��drug, aldesleukin, recombinant interleukin -2 (IL-2), is currently used at high doses to treat certain types of kidney tumours and skin cancers. At much lower doses, aldesleukin enhances the ability of immune cells called regulatory T cells (Tregs) to stop the immune system losing control once stimulated and prevent it from damaging the body’s own organs (autoimmunity).

Critical to this approach was to first determine the effects of single doses of aldesleukin on Tregs in patients with type 1 diabetes. To achieve this the team employed a state-of-the-art trial design combined with extensive immune monitoring in 40 participants with type 1 diabetes, and found doses to increase Tregs by between 10-20%. These doses are potentially enough to prevent immune cells from attacking the body, but not so much that they would supress the body’s natural defences, which are essential for protecting us from infection by invading bacteria or viruses.

̽��ֱ��researchers also found that the absence of response of some participants in previous trials may be explained by the daily dosing regimen of aldesleukin used. ̽��ֱ��current trial results suggest that daily dosing results in Tregs becoming less sensitive to the drug, and the recommendation from the study is that the drug should not be administered on a daily basis for optimal immune outcomes.

“Type 1 diabetes is fatal if left untreated, but the current treatment – multiple daily injections of insulin – are at best inconvenient, at worst painful, particularly for children,” says Dr Frank Waldron-Lynch, who led the trial. “Our goal is to develop a treatment that could see the end to the need for these life-long, daily injections by curtailing the early damage caused by the patient’s own immune system.

“Our work is at an early stage, but it uses a drug that occurs naturally within the body to restore the immune system to health in these patients. Whereas previous approaches have focused on suppressing the immune system, we are looking to fine-tune it. Our next step is to find the optimal, ‘Goldilocks’ treatment regimen – too little and it won’t stop the damage, too much and it could impair our natural defences, but just right and it would enhance the body’s own response.”

̽��ֱ��researchers say that any treatment would initially focus on people who are newly-diagnosed with type 1 diabetes, many of whom are still able to produce sufficient insulin to prevent complications from the disease. ̽��ֱ��treatment could then help prevent further damage and help them to continue to produce a small amount of insulin for a longer period of time.

̽��ֱ��research was largely funded by the type 1 diabetes charity JDRF, the Wellcome Trust and the Sir Jules Thorn Charitable Trust, with support from the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre.

Angela Wipperman, Senior Research Communications Manager at JDRF, said: “Immunotherapy research offers the potential to change the lives of those affected by type 1 diabetes. We eagerly await the next steps from this talented research team.”

Reference
Todd JA, Evangelou M, Cutler AJ, Pekalski ML, Walker NM, Stevens HE, et al. PLOS Medicine; 11 Oct 2016; DOI: 10.1371/journal.pmed.1002139

Researchers at the ̽��ֱ�� of Cambridge have taken the first step towards developing a new form of treatment for type 1 diabetes which, if successful, could mean an end to the regular insulin injections endured by people affected by the disease, many of whom are children.

Our goal is to develop a treatment that could see the end to the need for these life-long, daily injections by curtailing the early damage caused by the patient’s own immune system

Frank Waldron-Lynch

Jill Brown

Diabetes (rotated)

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New study shows artificial pancreas works for length of entire school term

sc604 — Thu, 17 Sep 2015 15:45:00 +0000

An artificial pancreas given to children and adults with type 1 diabetes going about their daily lives has been proven to work for 12 weeks – meaning the technology, developed at the ̽��ֱ�� of Cambridge, can now offer a whole school term of extra freedom for children with the condition.

Artificial pancreas trials for people at home, work and school have previously been limited to short periods of time. But a study, published today in the New England Journal of Medicine, saw the technology safely provide three whole months of use, bringing us closer to the day when the wearable, smartphone-like device can be made available to patients.

̽��ֱ��lives of the 400,000 UK people with type 1 diabetes currently involves a relentless balancing act of controlling their blood glucose levels by finger-prick blood tests and taking insulin via injections or a pump. But the artificial pancreas sees tight blood glucose control achieved automatically.

This latest Cambridge study showed the artificial pancreas significantly improved control of blood glucose levels among participants – lessening their risk of hypoglycaemia. Known as ‘having a hypo,’ hypoglycaemia is a drop in blood glucose levels that can be highly dangerous and is what people with type 1 diabetes hate most.

Susan Walls is mother to Daniel Walls, a 12-year-old with type 1 diabetes who has taken part in the trial. She said: “Daniel goes back to school this month after the summer holidays – so it’s a perfect time to hear this wonderful news that the artificial pancreas is proving reliable, offering a whole school term of support.

“ ̽��ֱ��artificial pancreas could change my son’s life, and the lives of so many others. Daniel has absolutely no hypoglycaemia awareness at night. His blood glucose levels could be very low and he wouldn’t wake up. ̽��ֱ��artificial pancreas could give me the peace of mind that I’ve been missing.”

“ ̽��ֱ��data clearly demonstrate the benefits of the artificial pancreas when used over several months,” said Dr Roman Hovorka, Director of Research at the ̽��ֱ��’s Metabolic Research Laboratories, who developed the artificial pancreas. “We have seen improved glucose control and reduced risk of unwanted low glucose levels.”

̽��ֱ��Cambridge study is being funded by JDRF, the type 1 diabetes charity. Karen Addington, Chief Executive of JDRF, said: “JDRF launched its goal of perfecting the artificial pancreas in 2006. These results today show that we are thrillingly close to what will be a breakthrough in medical science.”

Reference:
Thabit, Hood et al. ‘Free-living Home Use of an Artificial Beta Cell in Type 1 Diabetes.’ New England Journal of Medicine (2015). DOI: 10.1056/NEJMoa1509351

Adapted from a JDRF press release.

Technology assisting people with type 1 diabetes edges closer to perfection.

̽��ֱ��data clearly demonstrate the benefits of the artificial pancreas when used over several months

Roman Hovorka

Study participant Daniel Walls, 12

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Seasonal immunity: Activity of thousands of genes differs from winter to summer

cjb250 — Tue, 12 May 2015 15:00:00 +0000

̽��ֱ��study, published today in the journal Nature Communications, shows that the activity of almost a quarter of our genes (5,136 out of 22,822 genes tested) differs according to the time of year, with some more active in winter and others more active in summer. This seasonality also affects our immune cells and the composition of our blood and adipose tissue (fat).

Scientists have known for some time that various diseases, including cardiovascular disease, autoimmune diseases such as type 1 diabetes and multiple sclerosis, and psychiatric disorders, display seasonal variation, as does vitamin D metabolism. However, this is the first time that researchers have shown that this may be down to seasonal changes in how our immune systems function.

“This is a really surprising – and serendipitous – discovery as it relates to how we identify and characterise the effects of the susceptibility genes for type 1 diabetes,” says Professor John Todd, Director of the JDRF/Wellcome Trust Diabetes and Inflammation Laboratory. “In some ways, it’s obvious – it helps explain why so many diseases, from heart disease to mental illness, are much worse in the winter months – but no one had appreciated the extent to which this actually occurred. ̽��ֱ��implications for how we treat disease like type 1 diabetes, and even how we plan our research studies, could be profound.”

An international team, led by researchers from the JDRF/Wellcome Trust Diabetes and Inflammation Laboratory in the Department of Medical Genetics, Cambridge Institute for Medical Research, examined samples from over 16,000 people living in both the northern and southern hemispheres, in countries including the UK, USA, Iceland, Australia and ̽��ֱ��Gambia. These samples included a mixture of blood samples and adipose tissue.

̽��ֱ��researchers used a variety of techniques to study the samples, including looking at the cell types found in the blood and measuring the level of expression of the individuals’ genes – a gene is said to be ‘expressed’ when it is active in a particular cell or tissue, usually involving the generation of proteins. They found that the thousands of genes were expressed differently in blood and adipose tissue depending on what time of year the samples were taken. Similarly, they identified seasonal differences in the types of cells found in the blood.

Seasonal differences were present across mixed populations in geographically and ethnically diverse locations – but the seasonal genes displayed opposing patterns in the northern and southern hemispheres. However, the pattern of seasonal activity was not reflected as strongly in Icelandic donors. ̽��ֱ��researchers speculate that this may be due to the near-24 hour daylight during summer and near-24 hour darkness in winter.

One gene of particular interest was ARNTL, which was more active in the summer and less active in the winter. Previous studies have shown that, in mice at least, the gene suppresses inflammation, the body’s response to infection; if the gene has the same function in humans, then levels of inflammation will be higher during winter in the northern hemisphere. Inflammation is a risk factor for a range of diseases and hence in winter, those at greatest risk will likely reach the ‘threshold’ at which the disease becomes a problem much sooner. Drugs that target the mechanisms behind inflammation could offer a way of helping treat these diseases more effectively during the winter periods.

A particularly surprising finding was that a set of genes associated to an individual’s response to vaccination was more active in winter, suggesting that some vaccination programmes might be more effective if carried out during winter months when the immune system is already ‘primed’ to respond.

During European and Australian winters, they argue, the thresholds required to trigger an immune response may be lower as a direct consequence of our coevolution with infectious organisms, which tend to be more prevalent during winter. Interestingly, people from ̽��ֱ��Gambia showed distinct seasonal variation in the numbers of immune cells in the blood that correlated with the rainy season (June-October), during which time infectious diseases, particularly mosquito-borne diseases such as malaria, are more rife.

“We know that humans adapt to changing environments,” says Dr Chris Wallace. “Our paper suggests that human immune systems adapt to show different seasonal variation in equatorial regions with fewer distinct seasons compared to regions at higher and lower latitudes with more pronounced differences between winter and summer.”

It is not clear yet what mechanism maintains the seasonal variation seen in the immune system, though it may be due to environmental cues such as daylight and ambient temperature. Our internal body clock – known as our circadian rhythm – is in part coordinated by changes in daylight, which explains why people in jobs that do not fit with the daily cycle, such as factory shift workers or crews on long haul flights, can be affected by poorer health.

Professor Todd adds: “Given that our immune systems appear to put us at greater risk of disease related to excessive inflammation in colder, darker months, and given the benefits we already understand from vitamin D, it is perhaps understandable that people want to head off for some ‘winter sun’ to improve their health and well-being."

̽��ֱ��research was funded by the Wellcome Trust, the type 1 diabetes charity JDRF and the NIHR Cambridge Biomedical Research Centre.

Professor Mike Turner, Head of Infection and Immunobiology at the Wellcome Trust said: “This is an excellent study which provides real evidence supporting the popular belief that we tend to be healthier in the summer. Seasonal variation to this extent is a fascinating find – the activity of many of our genes, as well as the composition of our blood and fat tissue, varies depending on the seasons. Although we are still unclear of the mechanism that governs this variation, one possible outcome is that treatment for certain diseases could be more effective if tailored to the seasons.”

Karen Addington, Chief Executive of JDRF in the UK, said: “We have long known there are more diagnoses of type 1 diabetes in winter. This study begins to reveal why. It identifies a biological mechanism we didn’t previously know of, which leaves the body seasonally more prone to the autoimmune attack seen in type 1 diabetes.

“While we all love winter sun, flying south for the whole of each winter isn’t something anyone can practically recommend as a way of preventing type 1 diabetes. But this new insight does open new avenues of research that could help untangle the complex web of genetic and environmental factors behind a diagnosis.”

Reference
Dopico, XC et al. Widespread seasonal gene expression reveals annual differences in human immunity and physiology. Nature Communications; 12 May 2015.

Our immune systems vary with the seasons, according to a study led by the ̽��ֱ�� of Cambridge that could help explain why certain conditions such as heart disease and rheumatoid arthritis are aggravated in winter whilst people tend to be healthier in the summer.

In some ways, it’s obvious – it helps explain why so many diseases are much worse in the winter months – but no one had appreciated the extent to which this actually occurred

John Todd

Luke Price

Changing of the seasons

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Using the internet to boost participation in clinical trials

cjb250 — Mon, 27 Apr 2015 23:00:44 +0000

Type 1 diabetes, the disease that I mainly focus on, is relatively common in the UK – around one in 300 people in the UK alone are affected by it and face multiple daily insulin injections. So one might imagine we would have no problem recruiting patients for the trial of an exciting potential new treatment that could mean an end to those injections in the future.

As you may know already, type 1 diabetes is an autoimmune disease – the immune system mistakes cells in the pancreas as harmful and attacks them. When these cells are damaged the pancreas is unable to produce enough insulin, which plays an essential role in transferring glucose out of the bloodstream and into cells to be converted into energy. This is why patients have to regularly inject themselves with insulin to compensate.

Type 1 diabetes is a genetically complex disease – there is no single gene that causes it, but rather dozens of genes that increase the risk of developing the disease. But we do know of one particular set of genes – interleukin-2, or IL-2 – which plays a prominent role, helping regulate the immune system. We wanted to see whether IL-2 in the form of a drug called aldesleukin could halt the damage to the pancreas in people with newly diagnosed type 1 diabetes and, if so, what dose of the drug gives the best results.

̽��ֱ��problem, of course, is that not everyone with type 1 diabetes is aware of these essential studies and the ability to recruit enough patients can make or break a trial – not enough participants and the trial will be dead in the water before it has even begun. ̽��ֱ��solution is the internet, which provides a direct communication route to individuals with type 1 diabetes allowing them to find out about studies and then immediately with ease connect to the specialist teams running these studies. To get our message out on the web we turned to our funders and the ̽��ֱ�� of Cambridge.

We were very excited at the prospect of trialling this drug – and so, too, were our funders. ̽��ֱ��Wellcome Trust and the ̽��ֱ�� issued a joint press release, which they, together with the JDRF, ran on their websites and promoted through social media. When we looked at the number of people visiting our study website, we could see clear peaks of activity immediately after the stories appeared – and what’s more, this translated into people signing up to the trial: registration increased six- to seven-fold.

Recruitment to the study was also helped massively when Wired.co.uk picked up on the press release and ran a story about the trial – in fact, the single biggest peak of traffic to our site by far came from traffic referred to us from Wired.

Diabetes UK, too, posted an article about the trial. Interestingly, this post increased registrations from clinics and registry sources. We think this is because it stimulated interest from clinicians and research nurses, who then encourage enrolment from their patients.

Overall we found that the internet compared to traditional method of recruitment, to be the most successful and popular method for individuals with type 1 diabetes to find out and participate in the DILT1D study. ̽��ֱ��success of the active internet recruitment strategy campaign meant that we were able to successfully complete our study 11 months ahead of schedule and continue the development of the treatment in our next study.

Dr Frank Waldron-Lynch is Head of Experimental Medicine at the JDRF/Wellcome Trust Diabetes and Inflammation Laboratory in the Cambridge Institute for Medical Research

Reference
Heywood, J et al. Effective recruitment of participants to a phase I study using the internet and publicity releases through charities and patient organisations: analysis of the adaptive study of IL-2 dose on regulatory T cells in type 1 diabetes (DILT1D). Trials; 11 March 2015

̽��ֱ��success of a clinical trial hinges on its ability to recruit enough patients. Dr Frank Waldron-Lynch from the Cambridge Institute for Medical Research explains how the use of the internet to directly contact patients with type 1 diabetes greatly accelerated the recruitment leading to the early completion of his team’s study of a potential new treatment for type 1 diabetes.

̽��ֱ��ability to recruit enough patients can make or break a trial – not enough participants and the trial will be dead in the water before it has even begun

Frank Waldron-Lynch

rachellynnae©

High blood glucose

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Overnight home use of artificial pancreas ‘feasible and beneficial’

cjb250 — Tue, 22 Apr 2014 19:00:00 +0000

̽��ֱ��artificial pancreas promises to dramatically improve the quality of life for people with type 1 diabetes, which typically develops in childhood. All previous artificial pancreas trials, in hospitals and in home environments, have seen researchers strictly monitor patients. ̽��ֱ��latest trial, funded by JDRF, has shown for the first time that unsupervised use of the artificial pancreas overnight can be safe. ̽��ֱ��results of the trial are published today in the journal Diabetes Care.

Type 1 diabetes is an autoimmune condition in which the pancreas is unable to produce insulin, a hormone which regulates blood glucose levels. High levels of glucose can seriously damage the body's organs. People with type 1 diabetes currently rely on multiple insulin injections or pump infusions every day; a child diagnosed at the age of five faces up to 19,000 injections and 50,000 finger prick blood tests by the time they are 18.

Participants in the trial, all aged between 12 and 18, saw improved blood glucose control during the trial, experiencing fewer nights with hypoglycaemic episodes, generally known as ‘hypos’. A hypo occurs when the blood glucose level of someone living with type 1 diabetes falls dangerously low. Without proper treatment, it may cause unconsciousness and even death.

A real-time information haul of more than 10,000 UK residents with type 1 diabetes, released to JDRF from the mySugr app, suggests that UK people living with the condition experience an average of ten hypos per week.

Actor Jeremy Irvine, star of the Stephen Spielberg film War Horse, has lived with type 1 diabetes since the age of six. He said: “When the chance came for me to take part in early artificial pancreas trials a few years ago, I jumped at the opportunity. I wanted to play my own very small part in moving the artificial pancreas closer to reality. I’m really excited to hear of this latest progress – the scientists behind it are my heroes.”

Dr Roman Hovorka from the ̽��ֱ�� of Cambridge, who is leading the UK effort to develop an effective artificial pancreas, said: “ ̽��ֱ��study is an important stepping stone for the wider use of an artificial pancreas. We have shown that overnight home use is feasible and beneficial – allowing people to live their life more freely.

“ ̽��ֱ��artificial pancreas is expected to transform the treatment of type 1 diabetes and we have proven that this promise holds. ̽��ֱ��success of this trial means that larger and longer studies are already in the pipeline.”

Katharine Barnard, from the Human Development and Health Academic Unit at the ̽��ֱ�� of Southampton, worked with Dr Hovorka on the trial to evaluate psychosocial impact. She said: “Hypoglycaemia – particularly at night – is a common fear among those living with type 1 diabetes and a major obstacle in achieving optimal blood glucose levels. ̽��ֱ��findings from this study are positive and are certainly worth investigating further.

“Reassurance, confidence and improved diabetes control are just some of the psychological and physical benefits that patients may witness as artificial pancreas technology continues to develop."

Children with type 1 diabetes have been able to use pioneering artificial pancreas technology, developed at the ̽��ֱ�� of Cambridge, for the first time overnight at home without the supervision of researchers.

̽��ֱ��artificial pancreas is expected to transform the treatment of type 1 diabetes and we have proven that this promise holds

Roman Hovorka

Alisha Vargas

Diabetes

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