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Bruce Bode Part 1, Artificial Pancreas

Dr. Bruce Bode talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the future of the artificial pancreas.

Dr. Bruce Bode, MD, FACE  is a professor of medicine at Emory University School of Medicine in Atlanta, GA. He has a strong affinity for working with children and young adults with diabetes and is considered one of the leading experts in the world on insulin delivery and glucose sensing. He is very active in clinical research on new diabetes products including pharmacological agents to prevent diabetes and control glucose and new insulins and glucose sensors.

Transcript of this video segment:

Steve Freed:  We’re here at the American Diabetes Association 77th Scientific Studies. And we’re here with a very, very special guest. I was just mentioning, he’s the type of guy that when he walks down the halls of these meetings, he never gets to where he wants to go, as everyone wants to talk to him, and probably forgets half the time where he’s going.

Dr. Bode: That’s probably true, I’m getting older.

Steve Freed:  We’re lucky to have him here to ask some questions. He’s also known as the physician, the endocrinologist that knows everything in the world about pumps. You’ve been associated with some pump failures and you’ve been associated with some great pumps out there. I think that’s where we’d like this interview to go. Let’s start out with, in the pump industry, obviously pumps are very effective for type 1s and now we’re learning, probably for type 2s. So let’s first talk about the new artificial pancreas and your thoughts on that, because that’s supposedly making a huge impression. Although it’s really not an artificial pancreas, and maybe you can explain that. But really how do you feel about that particular product and where do you think it’s actually going.

Dr. Bode: So when you really look at the artificial pancreas. It’s really automated insulin delivery by a pump, based on the glucose readings from a glucose sensor. So you have to implant a glucose sensor underneath your skin with an insert. In this case, Medtronic has a new sensor, known as the Guardian 3 which is an 80% smaller sensor and much more accurate and precise. It has a MARD between 9.5 to 10.5% depends upon how often you calibrate it. But it’s also a new pump and it’s a pump that’s able to handle very advance software know as this algorithm auto mode or makes a decision every 5 minutes to bring the sensor glucose to 120. So if you’re below 120 and they’re trying to get you up. If you’re above 120, it’s trying to get you down. The other name for this is called a hybrid-closed loop because you need to announce meals. The only way you can announce in this system is giving grams of carbohydrate. But some people don’t even know what a gram is. You and I probably don’t know what a gram is either. But obviously it’s on the labels, but people need to learn how to carb count. The way this system works when you aren’t eating or at all times, if auto-mode is activated, you can tell by a blue shield. That means you’re always being driven down to 120. We have shown by doing so, and you announce meals by putting in grams of carbohydrate, we have shown that in a pivotal trial of 124 type 1s between the age 14 and 75, they had a .5 drop in A1C from 7.4 to 6.9. This was associated with less lows, less highs, more in range between 70 to 180. This was a safety trial, it was non-randomized. We had the safety endpoint was ketoacidosis and severe hypo and there was 0. In my take of this, it’s a game-changer looking back and if we look back 50 years from now, I’m not going to be here. You might be here, but unlikely. We’re going to look back, the discovery of insulin happened in 1920 but the next biggest step was automated insulin delivery, which happened in 2017, got launched then, because the reason why you can get to goal, you don’t have to worry about lows because you have this predictive low glucose to spend before you ever get to low, you shut off, you’re making a decision every 5 minutes. Every one day it’s a different decision at that time of day. At midnight, one time you could be getting one unit an hour, the next night it might be zero. Then at 12:05 you might be at .5.