The following is taken from an awareness campaign from 2009 in which we attempted to convince the NIH, JDRF and other key decision makers that there are actually 4 legs to the Artificial Pancreas stool. We called this the Remotely Monitored Artificial Pancreas (RMAP) and its sister was the Remote Control Artificial Pancreas (RCAP). Prior to this projects kickoff in 2004 or so everyone thought of the AP as a 3-legged stool: 1) Hormone Infusion Pump(s); 2) CGM; and, 3) software algorithms to link the two. My sense is the pace is finally quickening but there are still many challenges to this based on current gen pumps and sensors. Well need some leapfrog technology before this will become a reality (ie - implanted pumps and sensors). From the former Sweet Kids Network website: ________________________________ As a person with diabetes recently told us, RMAP is like OnStar for the Body. RMAP is defined as a combination of technologies and methods that facilitate real-time remote monitoring and intervention in addition to glucose sensing, mechanized insulin administration and algorithms that connect the two. Imagine being able to turn off the insulin pump via the web as a result of real-time insight into the patients blood glucose levels, atypically large doses of insulin or device diagnostics that show a problem with the insulin pump. This is just one small example of how RMAP will be used to keep the patient safe. Remote monitoring without the ability to impact change does not by itself enhance safety. However, the ability to actively change operation remotely demonstrates RMAPs ability to enhance patient safety and promote artificial pancreas development. For insulin dependent diabetics, the promise of living a more normal life, improving overall health and containing costs is currently restrained by the inability to safely monitor and control artificial pancreas function remotely, hampering future development and clinical approval. The technologies used to implement RMAP are based on two-way long-range wireless transmission as a key enabler including the intelligent separation of computing logic on, in, near and remote from the body.Because of the sophistication of this approach, additional problems are encountered relating to battery life and form factor (e.g. - size, ease of use) to ensure usable technology friendly to the patient. RMAP is needed because after 20 years, the AP still hasnt made it out of the laboratory. Diabetech first identified this gap in the AP roadmap in a patent application and subsequent grant application to a joint initiative of the US Army, the NIH and JDRF back in 2002/2003. While the chemical sensor technology used to determine blood glucose levels has made steady progress since then, very little progress has been made on a real-world Artificial Pancreas. RMAP is establishing itself as a requirement in the field of artificial pancreas research & development. The current focus of JDRF and other funders of AP research is to connect real-time blood glucose data from current generation Continuous Glucose Monitoring (CGM) sensors (i.e. - Medtronic, Abbott, DexCom) to current generation externally worn insulin pumps through a simple mathematical equation that reacts to CGM data which in turn controls the insulin pump. All of this technology currently resides on or next to the patients body. All of the AP research so far is limited to inpatient clinic visits including overnight stays. While these are necessary steps, RMAP is required in order to accelerate the move beyond the walls of the research clinic while safely field testing AP in the real world. The RMAP Research Community There is a growing community of highly respected and knowledgeable artificial pancreas clinical researchers, islet cell transplant surgeons, diabetes behavioral scientists, medical research foundations and pediatric endocrinologists who have already signed on as supporters of Diabetechs RMAP Project. We need more supporters if we are going to be successful in shifting the paradigm of artificial pancreas R&D away from old ways of thinking that started in the clinic over 20 years ago. With RMAP, we will see real people benefitting from automated technology for safely balancing blood glucose levels in people with type 1 diabetes including children. Researchers and clinicians already providing support for RMAP are affiliated with Stanfords Lucile Packard Childrens Hospital, Baylor Health Care System, Baylor College of Medicine/Texas Childrens Hospital, Driscoll Childrens Hospital and the Morris L. Lichtenstein Medical Research Foundation are in full support of the RMAP Project. Participating Advisory Board members have the following to say about RMAP: ... As you know, I am a pediatric endocrinologist with an interest in continuous glucose monitoring and developing an artificial pancreas. I am the principal investigator at Stanford on the DirecNet grant, and I am the principal investigator on three JDRF grants on continuous glucose monitoring and the development of an artificial pancreas. I strongly believe that real-time multi-mode communication is going to be critical in allowing for closed-loop (artificial pancreas) systems to move from the clinical research environment to the home. Adapting your innovative technology for remote tracking of blood glucose monitoring and insulin delivery will be critical in optimizing the safety and glycemic control of youth, particularly adolescents, although your technology has broad application across the lifespan of persons living with diabetes. - Bruce Buckingham MD ... I am a pediatric psychologist and behavioral scientist in the section of Endocrinology & Metabolism at Texas Childrens Hospital and Baylor College of Medicine and I have been enthusiastic about adapting your innovative technology for remote tracking of blood glucose monitoring results in order to optimize the safety and glycemic control of youth who are living with the demands of Type 1 diabetes. I am excited to contribute my expertise in the measurement of human behavior - especially behaviors related to adherence to the diabetes treatment regimen and quality of life... - Barbara Anderson, PhD ...I am deeply committed to work on the RMAP project as both a patient living with Type 1 diabetes and a health care provider who sees patients with diabetes and works on a variety of research projects using various diabetes technologies to improve the lives of people impacted by this disease. Diabetes is a very challenging disease to manage and has many physical, emotional and social impacts and it is my belief that an artificial pancreas and work towards this end holds the greatest promise to improving the lives of people living with diabetes. As we work towards improving the closed loop or artificial pancreas there are many crucial points that need to be addressed. The RMAP technology offers assistance with many of these technical issues both in making research in this field more feasible and in the long term in sustaining the adaptability and success of the technology. As increasing numbers of patients rely on the technology needed for an artificial pancreas (ie - sensor data inputs, algorithm calculations and frequent regulation and counter-regulation actions including interaction with the patient, remote monitoring to include detection/alert/correction re: device failure as as individually relevant and population-based learning is essential. The automated remote connection will facilitate updates to software/firmware and personal algorithms. It will also offer the capability of device technology upgrades, may help reduce the cost of technology support and improve clinical diabetes management. The ability to manage the technology remotely is critical for many reasons including quality, safety supportability and efficiency. There is also the additional research value of remote monitoring and control that may also be applied in support of research related to therapeutics developments in the care of type 1 diabetes. It is my impression that Diabetech has the experience needed to help bring this concept to fruition. I have committed my time and energy to Diabetech in support of these goals. - Jennifer Martin Block RN, CDE As the principal investigator for pancreatic islet cell transplantation research at Baylor Healthcare System, I have extensive experience in remote glucose monitoring and diabetes management for both our pancreatic islet cell transplant candidates as well as our transplanted study subjects. Given greater than 20-year experience with clinical trials, including for the last decade, trials that are extremely closely monitored by the Food and Drug Administration and by Pharma, I am excited for this opportunity and very much look forward to contributing my clinical and research expertise to your expert team. - Marlon Levy MD, FACS ... The Morris L. Lichtenstein, Jr., Medical Research Foundation supports that the (RMAP) remote monitoring feature is critical to the successful development and use of the Artificial Pancreas... - Melissa Wilson MD ... As a practicing pediatric endocrinologist, I have extensive clinical experience in remote glucose monitoring and diabetes management. I currently serve as a principal investigator for various research and have been investigating the impact of remote glycemic monitoring systems on clinical and behavioral outcomes in preteen children with type 1 diabetes for the past 6 years. There is a critical need to create a robust mobile communication network in order for any closed loop insulin delivery device to be successful. The wireless, real-time communication technology that your team has developed represents one major missing link in the genesis of a true artificial pancreas. - Stephen Ponder MD, CDE, FAAP Get Involved You too can sign on as a supporter of the Remotely Monitored Artificial Pancreas Project and be a part of bringing a modern approach to accelerate advancements so desperately needed by people living with the most severe form of diabetes. Be sure to let us know if you are also a qualified researcher or clinician and would like to be considered for inclusion in one of the future clinical trials of RMAP technology. _______________________________ Are we moving fast enough? In the meantime, get smart and stay engaged. Thats Sugar Surfing Full Throttle! Please share your story about how you have used something you learned here and we might include your quote in the book :) Have a great Holiday everyone!
Posted on: Sat, 20 Dec 2014 22:18:32 +0000
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