Vanessa M. Justino, Dr. of Pharmacy Candidate University of Florida had an opportunity to spend some time at the Advanced Diabetes Treatment Center in Tampa where they use a therapy called MATS to help reverse the effects of diabetes. She was fascinated by what she learned and has prepared a report on how this therapy works and how it might help your patients.
Hope for Advanced Diabetic Patients- Metabolic Activation Therapy
Current Therapies Review by
Vanessa M. Justino, Dr. of Pharmacy Candidate University of Florida
The glimmer of hope for patients experiencing complications due to the advancement of their diabetes, both Type I & II, is called Metabolic Activation Therapy, (MAT). Chronic intermittent intravenous insulin therapy (CIIIT), pulsatile therapy, pulse insulin therapy (PIT), pulsatile intravenous insulin therapy (PIVIT), and hepatic activation are other names that are used to describe the same therapy. This patented procedure was developed by Dr. Thomas T. Aoki while doing research at the Joslin Research Laboratory, an affiliation of Harvard Medical School.
Although the name sounds like a holistic spa wrap it is far from it, and has been the subject of scientific-based studies which still continues to this day. MAT doesn’t claim to be the cure but a chronic therapy to stop the advancement of diabetic complication or to control A1c values when all other therapeutic options have failed. It is important to note that MAT does not reverse tissue damage so it is important for patients to start therapy before late stages of advancement are seen. Complications remain under control as long as patients continue with therapy.
The idea of MAT is to activate the cells in the liver and elsewhere to synthesize glucokinase and other insulin-dependent enzymes with the delivery of insulin at a target level equal to that of a non-diabetic person, 200-1,000 microU/mL. It is this higher level at the portal vein in conjunction with the pulsatile fashion, 10 pulses per hour, that mimics the body’s first phase of insulin secretion, as opposed to a basal rate.
This enhances the liver’s processing of glucose or activating it to maintain a metabolic homeostasis. Other tissues of the body are affected also. Since the insulin signals are received throughout the body other major organs that normally require the break down of fatty acids recognize glucose as an alternate source of energy. Since the glucose uses less oxygen for its utilization, it allows tissues with decreased circulation to function with less demand for oxygen allowing normal functioning, damage repair, and healing.
The process is either a weekly protocol of 6 or 4 hour sessions. For one hour, the patient receives regular insulin IV in a pulsatile manner, after which they are given 20 minutes and enough carbohydrates to keep their blood glucose at a target between 150-250mg/dL. Most of the carbohydrates given, 75%, are given in liquids to ensure that the majority of the load gets burned during the session. These two phases are repeated twice. The activation is confirmed by using the patient’s respiratory quotient. A target range of 0.9 – 1.0 ensures that the therapy has activated the patient’s metabolism and is actively burning glucose.
All blood drawn from the Florida-based Advanced Diabetes Treatment Centers (ADTC) is sent to Berkley in California to ensure uniformity in laboratory methods and reported values. The results are different for everyone, but all respond to therapy. The habits of the patients haven’t changed, but yet their A1c values are lowered. Many patients are gastroparetic and have neuropathy. These complications also seem to stop advancing. Reports of feeling a cold tile floor, discontinued use of canes and wheelchairs, and regulation of the gastrointestinal tract are not uncommon. The amount of insulin patients’ use daily suddenly and rapidly declines in addition to the amount of insulin needed during MAT to activate the patient.
Each ADTC clinic is operated differently and is dependent on the knowledge of the nurses providing therapy. The ADTC located in Tampa, Florida also participates with Harvard in ongoing studies with special interest in neuropathy. Laurie Pechilis, RN and Lead Activator of the ADTC located in Tampa, has a thorough understanding of MAT and insulin therapy. As a result aggressive therapy is possible and metabolic activation is usually achieved by the second weekly session. She works in collaboration with the referring endocrinologist and writes individualized insulin orders for each patient to accommodate any necessary changes that may come about due to MAT.
Treatment is open to adults aged 18 and up. Currently the patients range from early 30’s into their 80’s. Although some patients do not continue with therapy, it is mainly due to the time investment required. Being that MAT is a fairly new breakthrough in diabetes management, insurance coverage varies from plan to plan. A majority of the patients are covered through Medicare Part B; an insurance company with out-of-network benefits is another option. At this time, they are not accepting Blue Cross Blue Shield. ADTC does work with patients in trying to minimize the out of pocket expenses that may be incurred due to co-payments and deductibles. Studies are ongoing and patients should contact ADTC to see about enrolling. A list of locations is available on the web at: www.adtcusa.com.
There are just a few licensed clinics that offer MAT. Dr. Aoki, a professor of medicine at the University of California-Davis, has many injunctions against other unlicensed clinics that claim to perform the patented procedure. As far as clinical benefits, improvements of blood glucose control, restoration of hypoglycemia awareness, decreased episodes of severe hypoglycemia by approximately 97%, slowing the progression of diabetic kidney disease, and improvement of both hypertension & orthostatic hypotension are all reported in studies. A list of published studies is available on the web at: www.metabolicactivationtherapy.com/research.htm.
In the future, it is perceivable that MAT could be used as a way to prevent the use of insulin by sensitizing patients who may be approaching maximum doses on oral medications. Studies on how MAT effects glucose utilization in the brain and its possible link to Alzheimer’s disease is underway also. MAT requires serious consideration as a legitimate therapy of advanced diabetes. Its use may provide hope to those who have lost it.