internet of things Artificial pancreas uses your phone to counter diabetes

[captain_to_fire]

I don't even know if this thread is appropriate for the forum but LMG made a video about vegan burgers (don't get me started) in a Techquickie episode so I figured why not.

 

Source: American Diabetes Association via Harvard University and Engadget

 

 

12-Week 24/7 Ambulatory Artificial Pancreas With Weekly Adaptation of Insulin Delivery Settings: Effect on Hemoglobin A1c and Hypoglycemia 

ABSTRACT

OBJECTIVE Artificial pancreas (AP) systems are best positioned for optimal treatment of type 1 diabetes (T1D) and are currently being tested in outpatient clinical trials. Our consortium developed and tested a novel adaptive AP in an outpatient, single-arm, uncontrolled multicenter clinical trial lasting 12 weeks.

RESEARCH DESIGN AND METHODS Thirty adults with T1D completed a continuous glucose monitor (CGM)–augmented 1-week sensor-augmented pump (SAP) period. After the AP was started, basal insulin delivery settings used by the AP for initialization were adapted weekly, and carbohydrate ratios were adapted every 4 weeks by an algorithm running on a cloud-based server, with automatic data upload from devices. Adaptations were reviewed by expert study clinicians and patients. The primary end point was change in hemoglobin A_1c (HbA_1c). Outcomes are reported adhering to consensus recommendations on reporting of AP trials.

RESULTS Twenty-nine patients completed the trial. HbA_1c, 7.0 ± 0.8% at the start of AP use, improved to 6.7 ± 0.6% after 12 weeks (−0.3, 95% CI −0.5 to −0.2, P < 0.001). Compared with the SAP run in, CGM time spent in the hypoglycemic range improved during the day from 5.0 to 1.9% (−3.1, 95% CI −4.1 to −2.1, P < 0.001) and overnight from 4.1 to 1.1% (−3.1, 95% CI −4.2 to −1.9, P < 0.001). Whereas carbohydrate ratios were adapted to a larger extent initially with minimal changes thereafter, basal insulin was adapted throughout. Approximately 10% of adaptation recommendations were manually overridden. There were no protocol-related serious adverse events.

Quote

Researchers might have a way to let diabetics focus on their everyday lives instead of pumps and needles. They've successfully trialed an artificial pancreas system that uses an algorithm on a smartphone to automatically deliver appropriate levels of insulin. The mobile software tells the 'organ' (really an insulin pump and glucose monitor) to regulate glucose levels based on criteria like activity, meals and sleep, and it refines its insulin control over time by learning from daily cycles. Effectively, it's trying to behave more like the pancreas of a person without diabetes.

 

The simulated pancreas isn't trying to hit a fixed glucose level, we'd add. Rather, it's trying to keep that level within an acceptable range based on a predictive model.

 

So it's not a machine which functions exactly like a pancreas having beta cells secreting insulin but rather, a smartphone app regulates blood sugar levels to an acceptable range (4.1-5.9 mmol/L or 75-107 mg/dL) which is good since I've seen some of my relatives have to constantly prick their fingers and have a glucose test trip read it everyday.

Quote

The results, published today in the journal Diabetes Care, revealed positive effects on two important indicators: decreased hemoglobin A1c (HbA1c) and reduced time spent in hypoglycemia.

 

The outpatient trial was led by Frank Doyle and Eyal Dassau from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), and included collaborators at the William Sansum Diabetes Center in Santa Barbara, California; Mayo Clinic in Rochester, Minnesota; the University of Virginia’s Center for Diabetes Technology; and the University of Padova.

 

The adaptive control algorithm system used in the trial is based on model-predictive control (MPC), a strategy originally developed by Doyle and colleagues in a seminal paper published in 1996 and, in a 2010 paper, extended to a zone-based version of the MPC algorithm. Rather than regulating glucose levels to a specific point in the same way that a home thermostat keeps the room temperature at a precise setting, zone-MPC defines an acceptable zone for an individual’s glucose levels and controls variables to stay within that range. In addition to the core zone MPC algorithm, the collaborative team introduced adaptive components that allowed the algorithm to “learn” from the repeated daily cycles, leading to improvements in basal control as well as meal compensation.

The concept isn't new as insulin pumps are readily available now but now, a smartphone is tethered to the insulin pump via Bluetooth. I don't really know how this could be more effective in maintaining normal blood sugar levels than the existing insulin pumps with their own sensors. I think this is good for type 1 diabetics since hypoglycemia is just as bad as hyperglycemia as low blood sugar levels can result to seizures and other symptoms. I'm pretty sure Apple will be one of the first to include this especially with their Health Kit API. While this is not a cure for type 1 diabetes (unless CRISPR research on diabetes was perfected), I hope more manufacturers of insulin pumps and smartphone OEMs support this.

Also, this research was granted a patent by the NIH (DP3-DK-094331). As for me personally, I was glad to not have become type 2 diabetic after being diagnosed with metabolic syndrome thanks to my doctor. I wonder how will older people who are not so accustomed to technology would use a smartphone app to see how their glucose levels fair every hour. Since every person is different and have different insulin needs per day, I'm guessing only a doctors especially endocrinologists will be allowed to set how much glucose is being delivered but the algorithm in the app will send more or less depending on the person's activities or diet. I wish hackers and other pranksters don't hack this and jack up someone else's insulin levels and watch a person get a seizure just for fun.

 

[Dylanc1500]

So when your phone locks up as it is dispensing insulin and dispenses a lethal dose and you go into a diabetic coma, we know why.

[Dylanc1500]

Just now, L.Lawliet said:

hell i would rather drink 100 pills a day (if possible) than getting an injection..

It's possible. Ask me how I know ?. 

[mynameisjuan]

Why the fuck does everything need to be hooked up to the internet in some way.....especially medical equipment. There are more risks of this thing killing you that keeping you alive. 

[Dylanc1500]

Just now, L.Lawliet said:

haha nope i dont wanna know  

How?

~70 a day. It's like meal itself! Lol

 

Really though, insulin pumps themselves are great, however having it connected to a device that is connected the Internet is about idiotic from a personal medical standpoint. There is a reason most medical facilities keep their monitoring equipment on an isolated network.

[RagnarokDel]

1 hour ago, mynameisjuan said:

Why the fuck does everything need to be hooked up to the internet in some way.....especially medical equipment. There are more risks of this thing killing you that keeping you alive. 

That is not a slight exageration at all, am I right?

 

The device itself is built with redundancies. It's not like your phone's gonna get hacked or freeze and suddently it's just going to deliver all the insulin in one go.

59 minutes ago, Dylanc1500 said:

~70 a day. It's like meal itself! Lol

 

Really though, insulin pumps themselves are great, however having it connected to a device that is connected the Internet is about idiotic from a personal medical standpoint. There is a reason most medical facilities keep their monitoring equipment on an isolated network.

[Dylanc1500]

4 minutes ago, RagnarokDel said:

That is not a slight exageration at all, am I right?

 

The device itself is built with redundancies. It's not like your phone's gonna get hacked or freeze and suddently it's just going to deliver all the insulin in one go.

I know, I was more so making a point of they shouldn't give the phone full auto control over the pump as it is a possibility. In the medical field you want to minimize the risk involved. It's a great idea, just build that function into the pump itself instead, and keep the connectivity similar to a pace maker.

 

I mean you never know nowadays!

[jasonvp]

32 minutes ago, Dylanc1500 said:

I know, I was more so making a point of they shouldn't give the phone full auto control over the pump as it is a possibility.

The pump doesn't have the brains to handle that (yet).  Remember that smart phones are, for lack of a better phrase, hand-held computers.  They have enormous processing power as compared to what's available in the pump today.

 

That's today.  At some point, they could make the guts of this small enough and cheap enough that it could be added to the pump.  But it's way easier to write new code (or fix broken code) on something like a smart phone than it is to update an insulin pump's very protected OS.

 

Also, it looks like the only thing the phone can alter is the basal rate of the pump, which isn't going to do anything bad, short term, to the diabetic.  So if the phone gets hacked, the worse it could do is either stop delivering the long-term basal insulin drip, or increase it to the max allowed by the pump (that's hard-set in the pump's circuitry).  Neither is going to kill the diabetic.  It'll just be... annoying until it's discovered.

 

(FWIW, I'm a T1D and have been for 43 years).

 

My main complaint for all of this is the CGM, which is, and has been broken by design since it was launched.  All CGMs that I'm aware of still rely on reading the interstitial fluid and attempting to test the blood glucose level from that.  For some people, that's accurate enough.  For others (such as myself), it's so far out of accuracy that it's unusable.  And there's no way mathematically, code-wise, or sensor-wise to change that.  The panacea (not pancreas... ;-)) will be when they can figure out a way to directly test the blood glucose levels without causing some sort of infection or scarring.

 

Until such time, I'll keep poking my finger.  Owie.

[Misanthrope]

2 hours ago, L.Lawliet said:

I am not gonna have some weird piece of electronics plugged into my bodies.

I have needle trauma..hell i would rather drink 100 pills a day (if possible) than getting an injection..

Are you aware that the only way to take insulin is either a pump or getting an injection every day? Several times per day in fact. Not counting pinching your fingers to draw blood for the glucose testing.

 

So this thing is actually a promising development when the alternative is either what I just mentioned or getting your feel cut off, going blind, having your kidneys fail and ultimately dying of a stroke or heart attack.

 

I'll take the weird device hooked up to the phone with bluetooth, thanks.

[Misanthrope]

Just now, L.Lawliet said:

Not if its has to be connected to the freaking internet..i mean they can collect our data to make the next gen mutant or some creepy shits..

 

I still prefer the old ways.

Well this is indeed the first step to:

 

Spoiler

 

 

[Taf the Ghost]

It's a fine-scale responsive system that they just happen to have put into a mobile app. The App part isn't actually interesting. What's a Medical Device but a computer-controlled system? It just happens to be on common hardware.

 

I am happy to see this research is working out. I first heard of this a while ago, but they needed a larger base of research to see if it was worthwhile. Glad to see it's paying off and I hope it helps a lot of people.

 

However, outside communication ability to medical devices is a bad idea.

[Dylanc1500]

1 hour ago, jasonvp said:

The pump doesn't have the brains to handle that (yet).  Remember that smart phones are, for lack of a better phrase, hand-held computers.  They have enormous processing power as compared to what's available in the pump today.

 

That's today.  At some point, they could make the guts of this small enough and cheap enough that it could be added to the pump.  But it's way easier to write new code (or fix broken code) on something like a smart phone than it is to update an insulin pump's very protected OS.

 

Also, it looks like the only thing the phone can alter is the basal rate of the pump, which isn't going to do anything bad, short term, to the diabetic.  So if the phone gets hacked, the worse it could do is either stop delivering the long-term basal insulin drip, or increase it to the max allowed by the pump (that's hard-set in the pump's circuitry).  Neither is going to kill the diabetic.  It'll just be... annoying until it's discovered.

 

(FWIW, I'm a T1D and have been for 43 years).

 

My main complaint for all of this is the CGM, which is, and has been broken by design since it was launched.  All CGMs that I'm aware of still rely on reading the interstitial fluid and attempting to test the blood glucose level from that.  For some people, that's accurate enough.  For others (such as myself), it's so far out of accuracy that it's unusable.  And there's no way mathematically, code-wise, or sensor-wise to change that.  The panacea (not pancreas... ;-)) will be when they can figure out a way to directly test the blood glucose levels without causing some sort of infection or scarring.

 

Until such time, I'll keep poking my finger.  Owie.

I'll have respond with shorter responses than I'd like as I'm on mobile and in a conference call. (Yay!)

 

 I know current pumps don't have the brains in them, there aren't much are much more than remedial circuits in them. However, with SOCs we have now it wouldn't be hard to give it the ability to it on its own, as it would have a very specific task and could be made extremely efficient.  So it is entirely possible, and as far as the OS goes, it would be best for it to be as locked out as possible, you really want minimal access.

 

I knew there was a lock out I was just being facetious lol.

 

I have CF related diabetes, so I understand.

 

pokes don't really bother me all that much (32 gauge FTW! Lol).

[Ryujin2003]

5 hours ago, Dylanc1500 said:

So when your phone locks up as it is dispensing insulin and dispenses a lethal dose and you go into a diabetic coma, we know why.

It's a smartphone that's specifically designed for this. It wouldn't be an app downloaded from Google Play or iTunes.

3 hours ago, L.Lawliet said:

Not if its has to be connected to the freaking internet..i mean they can collect our data to make the next gen mutant or some creepy shits..

 

I still prefer the old ways.

It is kind of connected to the internet.

 

My kid had something like this to monitor issues with his heart. It's not a standard smart phone, and is ONLY designed to work with it's paired devices. It is controlled by a medical company that monitors the data. They aren't data mining, but if it gets disconnected, they call you. If your levels go wrong, they call you. And if they cannot get a hold of you, they have your last known area t send medical crew. So if it malfunctions and you go into diabetic shock, they can still get to you.

 

This stuff is really cool. And the tech is made by real medical companies. My son's gear was manufactures and programmed by WelchAllyn.

 

Yes it's a smart phone. No it cannot play Candy Crush (or Crysis)

[Dylanc1500]

16 minutes ago, Ryujin2003 said:

It's a smartphone that's specifically designed for this. It wouldn't be an app downloaded from Google Play or iTunes.

It is kind of connected to the internet.

 

My kid had something like this to monitor issues with his heart. It's not a standard smart phone, and is ONLY designed to work with it's paired devices. It is controlled by a medical company that monitors the data. They aren't data mining, but if it gets disconnected, they call you. If your levels go wrong, they call you. And if they cannot get a hold of you, they have your last known area t send medical crew. So if it malfunctions and you go into diabetic shock, they can still get to you.

 

This stuff is really cool. And the tech is made by real medical companies. My son's gear was manufactures and programmed by WelchAllyn.

 

Yes it's a smart phone. No it cannot play Candy Crush (or Crysis)

I know I was just being facetious. It is similar to the life alert and other mobile monitoring solutions for those that have medical issues that need constant monitoring but they don't want to force to have a person with them at all times. Whether that be in te hospital or at home or wherever.

 

I have a pieces of medical equipment from WelchAllyn. Also have some from Respritech, Philips, PARI, and others. All of which I send in for updates and factory maintenance yearly.

 

With the price of this equipment I couldn't hurt to come with candy crush! ?

[Ryujin2003]

46 minutes ago, Dylanc1500 said:

I know I was just being facetious. It is similar to the life alert and other mobile monitoring solutions for those that have medical issues that need constant monitoring but they don't want to force to have a person with them at all times. Whether that be in te hospital or at home or wherever.

 

I have a pieces of medical equipment from WelchAllyn. Also have some from Respritech, Philips, PARI, and others. All of which I send in for updates and factory maintenance yearly.

 

With the price of this equipment I couldn't hurt to come with candy crush! ?

I do like the idea of Blue-tooth though! My son had a smart phone for his heart monitor, but still had to have everything else strapped to his body, connected to a pager looking thing with BT to the smart-phone. Maybe Apple can share the wireless ear-bud tech for this. Less wires, less hassle. The experience with my son makes me really curious about the tech. Maybe one day during my career I'll take a couple years to work for one of those medical tech companies and help code their systems. Learn how they work.

 

And sorry for not picking up the sarcasm. Words and connotation are a hoot.

[Dylanc1500]

Just now, Ryujin2003 said:

I do like the idea of Blue-tooth though! My son had a smart phone for his heart monitor, but still had to have everything else strapped to his body, connected to a pager looking thing with BT to the smart-phone. Maybe Apple can share the wireless ear-bud tech for this. Less wires, less hassle. The experience with my son makes me really curious about the tech. Maybe one day during my career I'll take a couple years to work for one of those medical tech companies and help code their systems. Learn how they work.

Honestly with medical equipment I would prefer some kind of proprietary wireless solution. Maybe even in wireless bands that aren't for normal civilian use. It would allow for them to have less interference and less accessibility. Which has always been a huge concern in the medical field.

[Ryujin2003]

6 minutes ago, Dylanc1500 said:

Honestly with medical equipment I would prefer some kind of proprietary wireless solution. Maybe even in wireless bands that aren't for normal civilian use. It would allow for them to have less interference and less accessibility. Which has always been a huge concern in the medical field.

My main concern is power. If it's holding a lithium-ion battery, count me out. Wonder if these things can be powered by the human body? I'm not sure about bands outside of standard civilian use. Aren't those already polluted for the most part? I mean, I'm sure some are being held for future developments in 8G WiFi solutions or something.

[Dylanc1500]

Just now, Ryujin2003 said:

My main concern is power. If it's holding a lithium-ion battery, count me out. Wonder if these things can be powered by the human body? I'm not sure about bands outside of standard civilian use. Aren't those already polluted for the most part? I mean, I'm sure some are being held for future developments in 8G WiFi solutions or something.

There are large amounts of unused spectrum that could be set aside for those uses specifically. I think it would most likely better to go with a communication frequency something in the lower frequency bands as they would less power to communicate Plus there is a ton of interference in the ultra high and super high frequency bands . I have similar feelings in regards to the lithium battery lol. Time will tell I suppose

[Drak3]

There was a movie about a rogue AI sending assassins to kill its creators, then it takes the CIA director's(?) daughter as hostage via her wireless capable pace maker. 

 

These people did not see this movie.

[Misanthrope]

Guys I seriously don't think the government is interested in mind controlling mostly very elderly citizens and the morbidly obese.

[Sniperfox47]

16 minutes ago, Dylanc1500 said:

There are large amounts of unused spectrum that could be set aside for those uses specifically. I think it would most likely better to go with a communication frequency something in the lower frequency bands as they would less power to communicate Plus there is a ton of interference in the ultra high and super high frequency bands . I have similar feelings in regards to the lithium battery lol. Time will tell I suppose

To be fair, a lot of wireless medical equipment is already in the low frequency 33cm/900mhz frequency, talking to a control device that then uses Bluetooth or something else. The whole point is to cut down power use as low as it can possibly go specifically to avoid big batteries and other hazards, and even Bluetooth smart isn't well suited for that.

 

WiFi HaLow, 900mhz WiFi with sleep mode and other low power additions, is being pushed as a potential standardized format for this. This would allow for medical companies to standardize controllers and interfaces around a simple IP based protocol with long range and low power use.

 

The idea is to either use HaLow to communicate with a control device which uses Bluetooth to talk to a traditional cellular device, or even design specialized medical cellular devices with HaLow built in to help cut out these middling control devices.

[captain_to_fire]

8 hours ago, L.Lawliet said:

I am not gonna have some weird piece of electronics plugged into my bodies.

I have needle trauma..hell i would rather drink 100 pills a day (if possible) than getting an injection..

That's how type 1 diabetics live. They have to constantly monitor their glucose levels by pricking their fingers and have that droplet monitored by a glucose test strip and inject themselves with insulin. Unfortunately, there's no cure for type 1 diabetes just yet as it is an autoimmune disease but unlike other autoimmune diseases like Systemic Lupus Erythemathosus and Multiple Scleorosis that requires corticosteroids like prednisone, type 1 can't be treated with prednisone as it will exacerbate the disease by increasing glucose. Type 1 means that there aren't enough beta cells in the pancreas or they produce way too little insulin.

 

Type 2 diabetes on the other hand is the reversible but much more rampant that type 1 due to obesity caused mostly by excessive intake of refined carbohydrates. This one requires mostly oral medications, modified diet and exercise. This one means you have plenty of insulin in your blood but your cells are rejecting it (insulin resistance), hence blood sugar levels increase and lead to the same symptoms and complications as type 1 like decreased immune function and reduced sex drive unless treated.

7 hours ago, mynameisjuan said:

Why the fuck does everything need to be hooked up to the internet in some way.....especially medical equipment. There are more risks of this thing killing you that keeping you alive. 

Uhm, machine learning? Just imagine having a portable ultrasound or a portable X-ray connected to the cloud thanks to 5G and doctors especially radiologists and OB/GYNs can interpret a fracture or a placenta previa even if the patient is in a remote island. A closed fracture is dangerous as it is leaking bone marrow than can cause fat emboli and lead to stroke and pulmonary embolism. Same goes for a placenta previa that can endanger both the mother and the baby.

5 hours ago, L.Lawliet said:

Not if its has to be connected to the freaking internet..i mean they can collect our data to make the next gen mutant or some creepy shits..

 

I still prefer the old ways.

No. Insulin pumps do not have the ways of sequencing DNA. First of all, to sequence DNA it requires a step by step process and bulky instruments like ELISA and PCR. Internet connected medical devices might be creepy because of the constant hacking but machine learning can be way more beneficial to patients who have to constantly worry if their glucose levels are normal or not. 

 

Both hyperglycemia and hypoglycemia are dangerous.

38 minutes ago, Misanthrope said:

Guys I seriously don't think the government is interested in mind controlling mostly very elderly citizens and the morbidly obese.

Leave it to Alex Jones and other tin foil hat wearing nutjobs who thinks that substances in the water can turn frogs gay or that 5G or any existing wireless spectrum can cause cancer. 

[Dylanc1500]

41 minutes ago, Sniperfox47 said:

To be fair, a lot of wireless medical equipment is already in the low frequency 33cm/900mhz frequency, talking to a control device that then uses Bluetooth or something else. The whole point is to cut down power use as low as it can possibly go specifically to avoid big batteries and other hazards, and even Bluetooth smart isn't well suited for that.

 

WiFi HaLow, 900mhz WiFi with sleep mode and other low power additions, is being pushed as a potential standardized format for this. This would allow for medical companies to standardize controllers and interfaces around a simple IP based protocol with long range and low power use.

 

The idea is to either use HaLow to communicate with a control device which uses Bluetooth to talk to a traditional cellular device, or even design specialized medical cellular devices with HaLow built in to help cut out these middling control devices.

Which is exactly why I made that as a recommendation, I just don't like to type out when on mobile, I just think that the FCC should set aside a spectrum specifically for that. Because as far as I am aware it isn't set aside for only medical use. I could very well be wrong, and if so more than welcome to correction.

[captain_to_fire]

Just now, Dylanc1500 said:

I just think that the FCC should set aside a spectrum specifically for that.

5G I think has a big focus for IoT devices and connected medical equipment by using millimeter waves 30 to 300 GHz. Those frequencies are never been used before until now as the current spectrum used by phones are becoming congested now.

 

 

[Sniperfox47]

19 minutes ago, hey_yo_ said:

5G I think has a big focus for IoT devices and connected medical equipment by using millimeter waves 30 to 300 GHz. Those frequencies are never been used before until now as the current spectrum used by phones are becoming congested now.

 

IoT isn't a good application for millimeter wave networks. Higher bandwidth and more signal processing means higher power consumption. That's the whole reason why Wifi HaLow is a thing, you want lower frequency, not higher, for IoT.

 

Wearables and other connected wearables may be a good fit with 5G, but you definitely don't want a medical wearable with a tiny battery to kill itself transmitting at insanely high amounts of power. There's a reason Bluetooth hasn't ever expanded into 5GHz, except when using existing WiFi connections as a carrier signal (Bluetooth 3.0+HS).

 

P.S. you say never used before, but WiGig uses 60Ghz.

 

25 minutes ago, Dylanc1500 said:

I just think that the FCC should set aside a spectrum specifically for that. Because as far as I am aware it isn't set aside for only medical use. I could very well be wrong, and if so more than welcome to correction.

It's not set aside for just medical use, but why would you? There are a ton of other emerging markets that could desperately use this spectrum. If anything we should be increasing the amount of unregulated spectrum for industry driven technologies like WiFi, LTE-U, Z-wave/zigbee, Weave, and Bluetooth.