Diabetes tech is booming -- and getting smarter

With the Centers for Disease Control and Prevention estimating that one in three Americans could have diabetes by 2050, researchers are seeking ways to prevent and treat the disease. Boris Kovatchev has focused on diabetes technology for more than a decade.
Written by Christina Hernandez Sherwood, Contributing Writer

With the Centers for Disease Control and Prevention estimating that one in three Americans could have diabetes by 2050, researchers are seeking ways to prevent and treat the disease. Boris Kovatchev, director of the Center for Diabetes Technology at the University of Virginia, has focused on diabetes technology for more than a decade.

Kovatchev, whose work is supported by the Juvenile Diabetes Research Foundation, the National Institutes of Health and various philanthropies, spoke with me last week about his dozens of patents, his current work and the state of the diabetes technology field. Here are excerpts of our interview:

You've been named the Edlich-Henderson Inventor of the Year for your work in diabetes technology. How did you end up in this field?

I ended up in the field a long time ago, back in 1996. There were personal reasons -- family history of the disease -- combined with my training in mathematics. It looked like an attractive area for the application of mathematical skills in a health care topic. It was in its infancy in 1996.

Since then, you've issued 36 patents and you have 62 more pending. What contribution are you most proud of?

There are several classes of technologies used for diabetes care at home. In general, the devices include monitoring of blood glucose levels and delivery of insulin. The monitoring can happen with finger sticks or with the newer generation of continuous glucose monitoring that permanently attach to the person. Insulin delivery, the old-fashioned way, is through injections several times a day. The newer devices are insulin pumps. They attach to the person with little needles under the skin that deliver insulin at continuous rates.

The current problem with even the most advanced treatment of diabetes is these devices don't talk to each other. Even the most sophisticated insulin pumps will keep delivering insulin regardless of the blood sugar level of the person because it doesn't have any information coming from the monitors. That can cause severe reactions. My contribution to this area is to make these devices talk to each other in a smart fashion, to insert an algorithm that can take the reading from the [monitoring] device and tell the insulin pump to deliver insulin in a smart way. This is the thing I find most exciting.

Talk about your latest work with the Artificial Pancreas Project.

The Artificial Pancreas Project is the most advanced application of the device I just told you about. It's connecting a monitoring device to an insulin delivery device. It connects the most advanced continuous monitoring device to the most advanced insulin pumps available. It does that in a continuous fashion -- all the time. This is the top of the line integrated technology -- and that means continuous monitoring of the person's blood sugar levels and the reaction to changes.

This project has been going on since 2006. It was initiated by the Juvenile Diabetes Research Foundation. My group was one of the first to join this project. Since then, they have grown significantly. Now, there are government initiatives in several countries. There are a lot of companies interested in this technology. We've been there from the beginning, so we've had some extensive clinical trials. We've had close to 60 people on that system for short periods of time for testing purposes. It's growing. There are ongoing clinical trials in eight countries. All of these trials use our technology or components of it.

What's the most challenging aspect of your work?

The most challenging aspect is predicting the future. The reason that the future must be predicted accurately in this particular technology is that insulin delivery under the skin and glucose monitoring under the skin have delays. The [monitoring] of the blood sugar level generally works with a one-hour delay. Imagine you're driving a car and you're reacting to oncoming traffic with a one-minute delay. In situations like that, you have outdated data and delayed action. You have to anticipate what is going on in the next hour.

Are we coming up with better ways to predict the near future for diabetes management?

Yes, we are. There is a class of control strategies called model predictive control. Every human is assigned a mathematical model that mimics the functioning of the metabolic system of that person. Based on what that model says, we can predict the future. It's similar to weather forecasts. But instead of weather models, we have models of a particular human.

What's the current state of the diabetes technology field? How have you seen it change?

The state of diabetes technology is very healthy. I can give you some perspective. Back in 1996, the field did not exist. There was no term 'diabetes technology' that could be applied, but there were some things happening. People were coming up with different devices and technologies. But the massive effort of development now did not exist then.

In 1999, the Diabetes Technology Society was born. At the first meeting, there were about 150 people at most. It was in San Francisco. The latest one was close to 2,000. Then the Europeans came on board and started a gathering of their own in 2007. In just the last few years, the number of people in industry and academia interested in the subject has grown several-fold.

Is that growth attributable to the increasing number of diabetes diagnoses?

There are two factors to it. One is what you said. That's my opinion. Diabetes is a growing concern and a growing disease. This is one concern. The other is the realization that biology-based therapies for diabetes are not imminent. They are not going to happen soon. There is hope that they're going to happen, but more long-term research is needed. Technology can be around the corner because we know how to make things quickly. That is the other factor contributing to that growth.

Photo, top: Boris Kovatchev / By Dan Addison

Photo, bottom: A device developed by Kovatchev and collaborators to regulate a patient's insulin levels as part of the Artificial Pancreas Project is shown with a continuous glucose monitor / By Dan Addison

This post was originally published on Smartplanet.com

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