Friday, March 19, 2010

The State of the Diabetes Union


I had a fantastic evening last night at the JDRF research symposium in Calgary last night. Good presentations, sensational families. It was great to meet like-minded folks. It's amazing that when we, as diabetes people, always seem surprised when we meet someone in the wild with a similar story. Instant kinship. It kind of reminded me of the dog park, where everyone has something in common and the thirst to say hello and find out about this other human being is insatiable.

I have to say, amid all the research and fundraising talk, there was one presentation that blew the room away. Colton, at the age of 11 controlled the pin-drop. He is the youth ambassador for the JDRF walk to cure diabetes. He gave a 4 minute monologue of why the walk is important for him, being a type1 diabetic. It was, in my opinion, the centrepiece of the evening for generating fundraising interest. Great job Colton!

The research presentations, as mentioned before were overall very good. The JDRF has embraced the idea of investing in people. I thought the bridge financing idea for companies with unique therapy ideas is revolutionary. Level the playing field a bit for research and treatment to succeed or fail based on it's efficacy and less on the financial burden of approval. I also thought the diversity of funding focus a breath of fresh air. The JDRF seems to be a growing snowball, the energy and passion in the room last night was palpable.

The CGM talk...well...seemed planted by the national sponsor to be honest. The data/research presented was outdated, the technology has not progressed in any significant fashion in the last 5 years, nor have the devices to monitor it. The distinction needs to be made that the CGM does NOT measure blood sugar, even though the presenter last night said it did measure "blood glucose". I think CGM is a vital key in the future of Diabetes care, but a couple of breakthroughs need to take place, including a way to directly measure blood sugar...not a calibrated algorithm of intertstitial fluid. For young kids, stable blood sugars are a luxury, the requirement for stable blood sugars in order to calibrate the CGM defeats the very purpose that parents want to use the thing. We wait for a better solution. Secondly, the marry of an infusion site and a CGM site into one unit is crucial for widespread adoption of the technology. Getting around this problem is going to also be a tough one in that the sites themselves will be difficult to produce in a cost effective manner. To explain further, a CGM site is approximately 40.00 per use. An infusion site is approximately 35.00 per use. So you're talking about doubling the cost of one infusion site, plus the fact that you can't guarantee or predict that both the CGM sensor and the cannula will have the same life cycle. At any one point, you will either be without CGM or good infusion. Either requires a site change, again worth 75.00 dolllars or more. I'm having trouble seeing how this is going to work for people but remain full of hope that the technology will progress sooner than later.

The presentation on the Edmonton protocol research was also quite good. They are making significant improvements in the life span of the implanted islet cells and reducing the complication rate of the immune suppression therapy. The overall success rate is improving but still not at a rate to make the procedure appropriate for the masses. I tweeted a question last night regarding whether or not a diabetic, if faced with the decision, would choose insulin or lifelong immune suppressant medication? The response was 100% insulin. Therein lies the elephant in the room. What research is being done to overcome the fundamental problem in type 1 diabetes? What is being done to try and overcome a diabetic's biologic intolerance for their own pancreatic islet cells? Dr. Senior has shown that the therapy works, upon implantation insulin is produced, but it's a matter of time before the cells are killed off. My personal opinion is that gene therapy will be the answer but that's a long way off from a marketable solution. Dr. Senior and his team have dramatically changed the way people look at a cure however and their efforts need to be STRONGLY supported.

If there was ever an opportunity to support the position that now is a great time to diabetic (if you have to be diabetic of course). I hope everyone that reads this post makes an effort to support a team in the JDRF walk to cure diabetes.