A presentation designed to inform patients on the current status of artificial pancreas research, what they can expect to come along on the way toward realizing its promises and what they can do now to benefit from this field of research.

1. Road to the
Artificial Pancreas
Kevin McMahon
CEO & Founder
Type 1 Technology Ventures, LLC
Advanced Diabetes Management Retreat
Texas Lions Camp - Kerrville, Texas
April 26, 2014

3. ?

4. According to the JDRF:
“An artificial pancreas will integrate two currently available
technologies -- continuous glucose monitors and insulin
pumps -- with a software that provides the right amount of
insulin at the right time. It will enable people with diabetes
to achieve tight blood glucose control avoiding both highs
and dangerous lows, thereby significantly reducing the risk
of the disease's devastating complications.”
Source: http://artificialpancreasproject.com/about/algorithm.html
My observation: JDRF AP website last updated 2012 including several broken links when visited in April 2014.
What is the AP?:

5. AP Trial Sites:
http://j.mp/clinicaltrials-gov-apSearch

6. USA based AP Trial Sites:
http://j.mp/clinicaltrials-gov-apSearch

7. It works!!!
Well, kind of…
Just like a Meter = CGM
(if you’re willing to poke your finger and check blood sugar every 5 minutes)
Current Status of the AP:

8. A. In a very small number of well controlled trials
B. Only under supervision
C. In a controlled setting
D. For well screened patients with good skills
E. For short duration not more than a few days
F. 10s if not 100s of millions $ already invested
G. Always looking for more $
H. Nobody can say when it will be approved
I. Once approved, nobody can say when it will be available
J. Nobody knows how much it will cost
K. Nobody knows what your cost will be (e.g. Insurance)
Status of the AP:

9. An artificial pancreas will integrate many current and yet to
be developed technologies:
1. in-body, on-body and near body sensors.
2. mechanized dosing machines.
3. drugs to affect regulation and counter-regulation of blood sugar
4. software that provides the right amount of dosing & instruction at the right time.
5. communications for remote command and control
It will enable people with diabetes to achieve improved blood glucose control experiencing significantly
fewer highs and lows including shorter duration. In addition to significantly reducing the risk of the
disease's devastating complications, patients and their families will also enjoy a much improved quality
of life while simultaneously reducing the overall cost of care.
Source: Patent applications and grant proposals submitted by Kevin McMahon & Diabetech since 2002.
My View on the AP?:

10. In 2007, according to JDRF:
“There is no need for remote monitoring in the development
of the Artificial Pancreas. Furthermore, there is no business
model to commercialize this feature.”
Source: breakfast meeting in Dallas, Texas between A. Kowalski - AP Director, JDRF and K. McMahon
Remote Command & Control:

11. Perspectives Change:
AP Goes Mobile
2011 JDRF Funds Pilot System
Prior to this study, artificial pancreas tests
had employed laptops wired to continuous
glucose monitors and insulin pumps. The
paper called the old AP “a system limiting
free movement and too cumbersome to be
used beyond hospital confines.” - Boris
Kovatchev, UVA researcher
Source: http://j.mp/mhealthnewsAP; a
story by Neil Versel based on clinical trials
published in Diabetes Care.

12. Inputs ----> Magic ---> Outputs
My AP Equation:

13. Static
patient profile (age, weight, etc…)
type of insulin (ie - u100 vs u400)
ratios (I:C, ISF, etc…)
time of day ratios
anything you program today
Dynamic
command machines to start
blood sugar level (bgl)
rate of change in bgl
nutrition (consumed vs. served)
insulin on board
glucagon on board (* new)
command machines to stop
anything you can observe today
Two Kinds of Inputs:

14. Static
I don’t think there are any
Dynamic
command the pump(s) to dose
command the pump(s) to stop
query the sensor(s)
assess quality of machinery
manage time and synchronize
tell the patient to do something
notify a remote caregiver
Outputs are Dynamic:

15. Devices, Software and Computer Networks that
consider inputs and generate outputs based in their
inherent limitations.
The military refers to this as C4
: command, control,
communications and computers.
When they add the human element they add an i; C4
i
Magic is:
Never underestimate the power of “i”

16. Inputs ----> Magic ---> Outputs
My AP Equation:
repeat

17. Inputs ----> Magic ---> Outputs
My AP Equation:
repeat
predict

18. Inputs ----> Magic ---> Outputs
My AP Equation:
repeat
predict
compare

19. Inputs ----> Magic ---> Outputs
My AP Equation:
repeat
predict
compare
suggest

20. Situational Awareness Assisted by C4
:
● ambient sensors to remind us that it’s hot out (temperature)
● bio sensors to suggest a basal change (activity)
● interfaces that communicate situation to the user better than today’s
screens (glance-ables, beeps, blips and buzzes)
● personalized feedback to address uniqueness (rewards)
● life-like simulators for educational purposes (virtual patients)
Rest Stops On The Road to AP:

21. Make Something:
DexWatch
Don Browne, engineer w/t1
“The interface for a CGM
should be a watch; not
something shoved in your
pocket.”
The key is that it should be
something you can easily
glance at vs. hidden away.

22. 1. Write a check
2. Get others to write checks
3. Register for participation in a future trial:
(http://j.mp/clinicaltrials-gov-apSearch)
4. Learn how to get the most out of what you have available to you today
5. Practice what you’ve learned every day
6. Make something
7. Share your knowledge
8. Support innovation and each other
Eight things you can do:

23. Road to the
Artificial Pancreas
Kevin McMahon
kevin@type1techventures.com
Advanced Diabetes Management Retreat
Texas Lions Camp - Kerrville, Texas
April 26, 2014
Thank You!