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Bruce Bode Part 3, Customizing the Artificial Pancreas

Dr. Bruce Bode talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about what’s next in the efforts to perfect 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: What if you had a young patient with type 2 diabetes and you think it would be appropriate to have his average below 120mg/dL? Right now I understand that the base level is now set at 120mg/dl. and cannot be changed?

Dr. Bode: So, as of right now, the next step, as you know people are frustrated being 120, you came in your A1C was 6, we allowed people in at 5 into this trial. They’d say, “I used to wake up at 80, but now I’m waking up at 110 or 115 and I don’t like that.” But I said, how about your lows? “I don’t have those anymore but I really want to wake up at 90 again.” Well, it’s going to be hard to wake up at 90. The next trial, where they’re making changes to the obviously there were bugs in the original software and those are hopefully cleaned up. The next step is sponsored by NIH, it’s called 690G versus 670G. The 690G is they’re putting in some fuzzy logic, known as MD logic, it’s how we prescribe meds and how we treat patients, it’s fuzzy, to the outsider. This is an Israeli algorithm. What they did, is if say you didn’t cover enough for your meal, you miss your meal, it will give you an auto-correction, continually trying to get it down to 120. Anytime, it’s always trying to get it down, even a correction bolus is down to 120, where now it’s at 150 when you give a correction bolus pricking your figure. Then they have some other fuzzy logic in there that maybe can be a little more aggressive but still right now at 120. If they want to go lower than 120, they’re going to have to go back and develop and go to the FDA and say we’re going to try this lower level. I think eventually it’s going to happen.

Steve Freed: Because 120 isn’t good for every single person.

Dr. Bode: No, and obviously the one contraindication to this is pregnancy. You want to be 80 to 90 fasting. Obviously if you get pregnant and you’re on this, you go back into manual mode, you can still wear the pump, but you need to have the sensor. You have this ability to suspend glucose before a low happens. That would be very beneficial also in pregnancy.