Teen advances type 1 research

At 14, Sydney Cohn of Villanova has had a chance to make history. Over the summer, as a teenager with type 1 diabetes, she took part in a trial to test an artificial pancreas under development at the University of Virginia.

She and two other teenage volunteers spent a day letting the artificial pancreas monitor their sugars and adjust their insulin intake, and another day controlling it on their own, so researchers could get a better read on how well the artificial pancreas responded to fluctuating sugar levels.

"To be one of the first teenagers to use the device was an honor," says Cohn, who along with her parents and sister Mackenzie, 12, raised $415,000 last Sunday for the Juvenile Diabetes Research Foundation's Walk to Cure Diabetes.

The artificial pancreas employs a continuous glucose monitor, a small patch on the arm or abdomen that monitors sugars continuously, an insulin pump to deliver insulin beneath the skin, and a smartphone programmed with a sophisticated software algorithm developed by UVA researchers that links the patch and the pump.

The result is a "closed-loop system" that requires limited input from the user.

The UVA system can work independently, but at meals, it asks how many grams of sugar people plan to eat, to get a better indication of how to respond.

"The best thing about the artificial pancreas was being able to eat and not think about it," says Cohn. "A lot of times, I under-bolus [taking too little insulin] by accident. That can create problems later in the day. Not having to think about it was really nice."

"The system isn't perfect," adds Cohn. "It still has problems. I use a lot of insulin, so at one point, the artificial pancreas went into an overdrive mode and shut off. I had a lot of insulin in my system, but my sugars were still high. And you had to be plugged into the [continuous glucose monitor] the whole time. When I had to wash my hands, I kept forgetting to unplug it."

"But the potential I saw was really amazing."

Heading the research is Boris Kovatchev, director of UVA's Center for Diabetes Technology.

The artificial pancreas that Cohn tested is "controlled to range," which means that it is set to keep blood sugars generally at 70 to 100 mg/dL during the day and 80 to 140 mg/dL overnight, a time when many individuals experience dangerous lows that can cause seizures and even death.

The hope is that the artificial pancreas can stabilize blood sugars so an individual can remain asleep.

"Overwhelmingly," says Kovatchev, "the response to the artificial pancreas has been positive."

He says the largest challenge is that, while the pump, monitor, and phone device can "talk" to one another using Bluetooth wireless technology, they are not designed from the ground up to operate as a single system.

"Our goal is to make the communication between the devices more robust," he says.

The artificial pancreas is not yet ready for commercial use.

The JDRF's Artificial Pancreas Project funded the project and, this year alone, has invested $23.8 million in the worldwide effort.

"People with type 1 diabetes have to take insulin. If you don't take insulin, you'll die. It's a 100 percent fatal disease," explains Aaron Kowalski, vice president of treatment therapies for JDRF. "But even with insulin, there are problems: If your sugar goes too high, you can get long-term complications of diabetes. But if you take too much insulin at the wrong time, your blood sugar can go too low, which can lead to incapacitation, passing out, seizures, or death.

"The artificial pancreas," says Kowalski, "will provide not only better glucose levels, but it will lift the burden off individuals and the incredible amount of work that siblings, spouses, and parents do for type 1 individuals."

"When we first launched this project," he said, "some people were upset because they thought JDRF was deviating from our mission to find a cure for type 1." The organization continues to put 60 percent of its funds towards a cure, but "an artificial pancreas could lift the burden of constant care," he said.

As for Cohn, she's in talks with researchers on participating in a second trial to test the effects of exercise and the artificial pancreas. "It needs more work," she says. "But I'm willing to wait until they get it perfect."