Optimizing Screening and Diagnosis of Type 1 Diabetes - Episode 7

Monitoring Type 1 Diabetes

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Elaine M. Apperson, MD, addresses early intervention and technologies for monitoring type 1 diabetes for disease management.

Elaine M. Apperson, MD: Nothing has been approved by the FDA to use as an intervention. When you monkey around with giving something that would alter, be an immune modulator, you better have some long-term data showing safety. We don’t have that yet. The idea most likely is that it’s going to look something like chemotherapy where you have multiple immune modulators at the same time to thwart the immune system’s attack. By the time you’re showing signs of elevated blood sugar, you’ve lost about 90% of your beta cell function. That doesn’t leave you a whole lot of room to operate. So by the time you’re requiring insulin and that sick, you’ve only got a small margin of working beta cells. We don’t have anything that is out on the market to do anything at stage 1 or 2. That’s why we keep working.

Even when they tried to transplant pancreatic cells from cadavers, the immune system would tear those up. The hard part was shutting down the immune system and the morbidity from that. With immunosuppressant drugs the outcomes were terrible, and the immune system would, even if you tried suppressing it, the cells would not thrive. Patients could go sometimes insulin free or with very reduced insulin for a few years, but overall, in general, it was not a successful endeavor.

Right now, to be honest, where we are with hooking up sensors to insulin pumps and automating those systems where the sensor tells the pump how much insulin to deliver every 5 minutes, and having the patient put in the amount of carbohydrates they eat and having the insulin pump be programmed with their insulin needs for carbohydrates and for high blood sugar, and have that happen, essentially automatically like an external pancreas, is our quasi cure. And the good thing about technology is that you can press stop, you can take it off, and you haven’t monkeyed around with your physiology internally. That’s where we are, essentially, and it’s producing great outcomes. Would it be nice to have a biological cure right away? Sure, but in the meantime, 75% or more of our patients are on a pump, a CGM [continuous glucose monitor], or both, and they do pretty well.

Transcript Edited for Clarity