Three studies highlighting the innovative use of technology in the treatment of obesity and diabetes were discussed during Monday’s press conference.
A study at the University of Virginia examined whether their “smart” artificial pancreas system was safe and effective in children ages 5 to 8 and showed that the system improved blood glucose control better than an insulin pump alone, the children’s usual method of home diabetes management.
“Even with an insulin pump, it can be difficult to know how much insulin a child requires because of fluctuations in the carbohydrate content in food and the child’s activity level,” said Mark DeBoer, MD, MSc, MCR, the study’s lead investigator.
The closed loop system, which uses an insulin pump and a continuous glucose monitor (CGM), has previously been found to be effective at improving blood sugar control in adults and adolescents with type 1 diabetes. Insulin delivery is determined through sophisticated computer algorithms with the devices connected via a smart phone. Researchers altered the smart phone technology in this study to include a lock screen device to prevent the children from resetting information that could be detrimental to their health.
The artificial pancreas was tested on 12 children for 68 hours in a controlled camp-like setting. During the study, researchers monitored activity, food intake, blood sugar, and insulin levels. The results were compared to an assessment of 68 hours of the child’s normal home care regimen.
With the artificial pancreas, the children had a longer time in the target blood sugar range, which was 70 to 180 mg/dL. On average, children were in that range 73 percent of the time with the artificial pancreas versus 47 percent with their usual home care, DeBoer reported. The children also had far less time with high blood sugar levels (above 180 mg/dL): 25.8 percent of the time compared with 51.5 percent with usual home care. Also, DeBoer said, there was no increase in episodes of low blood sugar, with an average of only 3.3 low blood sugar episodes with the artificial pancreas and four such episodes with usual home care.
“These results, although in a small number of children, show great promise because similar results have been found in large-scale studies of older individuals with type 1 diabetes,” DeBoer said. “In the future, this type of technology is likely to become the standard of care for type 1 diabetes control for children in this age range.”
Another study looked at the use of deep transcranial magnetic stimulation (dTMS). Researchers in Italy used dTMS to target the prefrontal cortex to influence hedonic hunger and found that the treatment reduced food cravings and induced weight loss in individuals who are obese. The effects continued long after the initial five-week treatment, so researchers at the IRCCS Policlinico San Donato and the University of Milan in Milan, Italy, followed up with a new study that found that dTMS-treated subjects had greatly increased quantities of several beneficial bacterial species with anti-inflammatory properties that correlated with improvement of metabolic and hormonal parameters, including glucose, insulin, several pituitary hormones, and norephinephrine.
“These changes suggest a beneficial effect of dTMS on both weight loss and change in microbiota composition,” said Livio Luzi, MD, principal investigator. “Our research shows the innovative ability of dTMS in exerting anti-obesity effects through alteration of the gut-brain axis.”
The final study examined an innovative videoconferencing educational program in New Mexico designed to address the problems created by a shortage of endocrinologists and diabetes specialists in the state. Only four counties in New Mexico have endocrinologists or diabetes specialists, and the wait is often long to see one of those specialists.
Endo ECHO uses the Extension for Community Healthcare Outcomes (ECHO) model developed in 2003 by the University of New Mexico Health Sciences Center. Endo ECHO, launched in 2014 to improve medical access for patients with type 1 diabetes and complex diabetes cases, connects primary care physicians and community health workers at 10 rural health centers in the state with experts from Project ECHO. During the videoconferencing sessions, the experts provided diabetes education and mentoring on actual cases of de-identified patients with diabetes.
“Our program improves access to specialized care for large numbers of patients through weekly virtual clinics with their primary care providers,” said lead investigator Matthew Bouchonville, MD, CDE, whose study evaluated the success in equipping the care providers with the necessary knowledge and skills and assessed their confidence in providing their patients needed care. “Primary care providers and community health workers who participated in Endo ECHO say they feel better equipped to manage patients with complex diabetes and are more willing to do so instead of referring them to a faraway specialist.”
Respondents reported improvement in all measures of self-efficacy for complex diabetes management, including confidence in managing complex insulin regimens, screening for diabetic complications, and advising on self-care and motivating behavioral change.