1. Shannon Oates MD FACE IU Health Arnett 2017 oatess@iuhealth.org
Cool Diabetes Technology 2017
Shannon Oates MD FACE
IU Health Arnett
2017

2. Who am I? Endocrinologist Born in Ann Arbor Raised in W. Lafayette
Undergrad in Bloomington
Med School and medicine residency in Indianapolis
Fellowship at Northwestern

3. 40 minutes on Diabetes – mostly type 1 What is diabetes? Who gets it?
How do we treat it?
Reality of DM type 1
Insulin delivery
New technology– some brand names mentioned
Technology is not a cure
I do not have any ownership in any of the companies.

4. PRE-TEST 1. Insulin can be delivered by Lung insulin pump
Intravenously or Intramuscularly
Transdermally
B and C
All of the above

5. Pre-test 2. Patients who use insulin may have Type 1 Diabetes
cannot be Type 2

6. Pre-test 3. Insulin pumps Use insulin glargine
Can give variable amounts of insulin
Can cure diabetes
Can measure blood sugars

7. Diabetes Mellitus Type 1 Rare—affecting only 1 in 250 (1 in 400 kids)
15,000 new cases per year
Low rates in Black and Asian populations
Type 2
Common
Probably 25 million cases in the US. 1/3 cases undiagnosed
Projected prevalence of 11%
Over age 65, 27% with DM
Diabetes is a huge problem. 14 million Americans and less than 10% of these have Diabetes Type 1.
Incidence of Diabetes is increasing in Europe– especially in Finland.
Cost: $ 218 billion in 2007

8. Susan Barry diagnosed age 30
Type 1 Diabetes can be diagnosed at any age
My mom and sister

9. There are basically kinds of Diabetes *
Type 2 diabetes — Different from T1D in many ways; it may be effectively managed with exercise or meal plan changes, but we use lots of drugs and often insulin
Type 1 diabetes (T1D) — No insulin production. Insulin use is required to live.
Additional Educational Slides – (move these slides into the educational slides section if using)
Differences between type 1 and type 2 diabetes:
The video told us that there are two kinds of diabetes–type 1 and type 2. There are many differences between them even though they both have ‘diabetes’ in the name.
Both types of diabetes are NOT contagious, so you never have to worry about catching it from someone else like you would catch a cold.
Doctors have been able to figure out some of the reasons why people get type 2 diabetes, and they know that sometimes, it can be prevented by making healthy choices and getting the right amount of exercise.
Doctors are still trying to figure out why some people get T1D.
Remember, it isn’t someone’s fault if they have T1D and you can’t get T1D from eating too much sugar.
*actually more…..type 1.5 and gestational and cystic fibrosis related and ..

10. Type 1 diabetes Type 2 Diabetes Requires insulin
Requires lifelong diligence to avoid lows and highs
Requires action many times daily to manage effectively
Talk about daily routines.
Type 2 Diabetes
Insulin resistance
Inadequate insulin production

11. Insulin Pen or Syringe Injections with Multiple daily doses
This is the number of injections that he uses in a week.
Insulin pens are easy to use
Use ONLY on one person
“My shots in one week”
9/18/2018

12. Insulin via Air Injector or Inhaled
Push this device against the skin and it pushes insulin across the skin – transdermal (rarely used now)
Inhaled insulin – as fast as the rapid analog injection insulin and MUCH shorter duration of action
9/18/2018

13. Continuous Subcutaneous insulin infusion- or Insulin Pump
Programmed basal rate of insulin and calculated boluses with carbohydrate intake
Place needle or catheter subcutaneously every 3 days
Short or rapid insulin analog only
Special attention to prevent DKA
Demonstrate the pump. Draw a day of insulin profiles along with carbohydrate intake
THS IS NOT SURGICALLY IMPLANTED. THE PERSON WITH DIABETES DOES THIS.
9/18/2018

14. What is it like to have diabetes?
Medical professionals can help by asking instead of judging– ask about how to help with testing or meals.
Statements like” you can’t eat that” are discouraged
DO NOT refer to them as DIABETICS
Person with Diabetes #PWD
Ask about preferred meal plan
9/18/2018

15. Real life with Diabetes
Find your ice skates
Have a snack
Test sugar
Laugh at your roomie
Test, count, inject
Study
Order insulin by calling the pharmacy
Order pump supplies online
Complain about costs
Go to sleep
Test sugar
Count carbs
Do a shot
Go to class
Test sugar, count carbs, do a shot
Treat a low blood sugar
Drive to doctor appointment
Get blood drawn
A day in the life- one of my college kids.
9/18/2018

16. Insulin delivery devices
Insulin pens for U500, U300 and U200 concentrated insulins
What it is: This wearable, on-demand delivery system allows people with type 1 or type 2 diabetes to discreetly deliver mealtime insulin dosages anytime, anywhere. Early reports indicated it’s designed to be a slim, water-resistant patch that holds up to 200 units of fast-acting insulin and may be worn for three days at a time. This month, however, changes were submitted to the FDA to reflect changes in the OneTouch Via manufacturing process since the original clearance, so stay tuned for updates on this product.
Expected Launch Date: Mid-Late 2017
One touch Via to deliver meal insulin discreetly holds 200 units of fast- acting insulin
V-go insulin delivery device

17. Insulin smart pens
NovoPen Echo®: has memory function and half-unit dosing
Novopen Echo
Inpen calculators
Humapen memoir–no longer made-- eBay
Blue tooth with calculators and texting alerts

18. Smart cap for insulin pens
Gocap uses light sensing tech
Reads how much insulin was just delivered
Smartphone app via Bluetooth.
Only for lantus solostar and apidra
Right now, people on injections have to manually log how much insulin they take. Gocap uses a light sensing technology to automatically read how much insulin is in a standard disposable pen and how much was just delivered. The data is automatically collected and sent to a paired smartphone app via Bluetooth. This study aims to show that the Gocap collects insulin dose data as expected. Combining the injection data with glucose data (from either a meter or CGM) could eventually drive better and safer use of insulin, particularly if smart algorithms can detect patterns and give advice.
Common Sensing registered Gocap and the smartphone app with the FDA in July The company is searching for a partner that can help bring the product to market; the goal is for users not to have to pay anything for the device.

19. Insulin Pumps Call 1-800 Number if ?? Omnipod Medtronic MiniMed Deltc
These ONLY delivery insulin
Short acting insulin delivered SQ
Deltc
Accu-Chek
Tandem
Animas
9/18/2018

20. Continuous monitors Minimed Freestyle Libre personal
These only measure .glucose. The .#PWD has to do something with the information.
Freestyle Libre personal
FDA APPROVED September 27, 2017
Dexcom

21. Continuous monitors investigational
ThesNovember 11, 2016
Presentation of PRECISE II U.S. Pivotal Trial Data of the Eversense CGM System at the 16th Annual Diabetes Technology Meeting
Results Demonstrate Best-In-Class MARD of 8.8%
GERMANTOWN, Md.--(BUSINESS WIRE)-- Senseonics Holdings, Inc. (NYSE-MKT:SENS), a medical technology company focused on the development and commercialization of a long-term, implantable continuous glucose monitoring (CGM) system for people with diabetes, presented results of the PRECISE II U.S. pivotal trial at this week’s 16th Annual Diabetes Technology Meeting in Bethesda, Maryland.
The primary accuracy results demonstrate a mean absolute relative difference (MARD) of 8.8% over the full glycemic range for the entire 90-day sensor duration. The MAD in the low range (<80 mg/dL) was shown to be 9.6 mg/dL. A large data set of over 16,000 paired data points of sensor and YSI reference glucose values were collected and used in the accuracy analysis.
Significant findings also presented include:
The strong accuracy was sustained throughout the 90-day sensor life. Performance across each of the 30-day intervals from the beginning, middle and end of sensor life remained consistent.
Study results show 93% of readings were within 20% of the YSI reference.
Excellent safety performance with no infections or skin irritation reported during the 9,700 sensor wear days; 14 device or procedure related adverse events in 7 subjects were reported with the most frequent cited (n=8) was mild bruising or erythema.
The detection rate at the hypoglycemia alert setting (70 mg/dL) was 93% and 96% at the hyperglycemia alert setting (180 mg/dL).
The system showed strong sensor survival with 94% of the subjects demonstrating continuous use through 90 days.
Sub-analysis showed no accuracy impact from exercise or sensor compression
Sub-analysis of the dataset if calibrated only 1time/day demonstrated a 9.5% MARD.
“We’re very pleased with the results from this very large and important US trial. We want to thank the very dedicated people with diabetes who participated in the study as well as all of our clinical investigators. We are committed to bringing an accurate, reliable and long-lasting CGM system to people with diabetes in the United States,” said Tim Goodnow, PhD., President and CEO of Senseonics. “We look forward to working with the FDA to receive approval as quickly as possible.”
As previously reported, the PRECISE II U.S. pivotal trial enrolled 90 adults with Type 1 or Type 2 diabetes at eight clinical centers. The objective of the study was to assess the safety and effectiveness of the Eversense® CGM system over 90 days of continuous glucose sensor wear. Participants in the study used the system’s smart transmitter and mobile app at home for the next 90 days. Calibration was performed twice a day, and Sensor glucose readings were calculated prospectively, but real-time glucose readings and trends were not made available to participants. Clinic visits were scheduled at approximately 30-day intervals in order to obtain lab reference glucose values for comparison with the sensor values and to evaluate hyperglycemic and hypoglycemic challenges in a controlled setting.
Senseonics has submitted to the U.S. Food and Drug Administration (FDA) a Premarket Approval (PMA) application for its Eversense® CGM system. Upon receiving FDA regulatory approval, Senseonics plans to initiate sales in the United States. The company received its CE mark in May 2016 and is currently marketing the Eversense CGM System in select European countries.
Eversense® CGM System is an Investigational Device and is limited by United States law to investigational use.
About Senseonics
Senseonics Holdings, Inc. is a medical technology company focused on the design, development and commercialization of glucose monitoring products designed to help people with diabetes confidently live their lives with ease. Senseonics’ first generation continuous glucose monitoring (CGM) system, Eversense®, includes a small sensor, smart transmitter and mobile application. Based on fluorescence sensing technology, the sensor is designed to be inserted subcutaneously and communicate with the smart transmitter to wirelessly transmit glucose levels to a mobile device. After insertion, the sensor is designed to continually and accurately measure glucose levels. For more information on Senseonics, please visit
View source version on businesswire.com:
Senseonics Holdings, Inc. R. Don Elsey, Chief Financial Officer
Source: Senseonics Holdings, Inc.
<< Back to 2016 News Releases
e only measure .glucose. The .#PWD has to do something with the information.
Eversense- implanted in the office, redo every 90 days
NOT FDA approved.

22. Continuous Glucose Monitoring
Personal or Professional versions
Personal is shown to reduce A1c
2 main players now – may have more soon.
Really NOT continuous
9/18/2018 22 22

23. Goal: Cure or artificial pancreas
Everyone with diabetes would like a cure.
We are closer to an functional artificial endocrine pancreas solution
Don’t forget the person with diabetes and the family

24. Artificial Pancreas
2006: Launch of the JDRF Artificial Pancreas Project #WeAreNotWaiting grassroots initiative About two dozen Artificial Pancreas projects exist worldwide Probable future systems: Bigfoot Biomedical on the West Coast (utilizing former Asante Snap insulin pump tech) TypeZero Technologies: out of Virginia academic research iLET Bionic Pancreas based in Boston, dual hormones Omnipod with its own algorithm

25. Goal: Cure or artificial pancreas
Don’t forget the person with diabetes and the family
The CAD is the very intelligent mathematician

26. Progress Toward Artificial Pancreas (AP) Systems – A Timeline 9.28.16
2004
2005
2006
2008
2009
2011
2012
2013
2015
2016
2010
2014
1970s: Biostator, a refrigerator- sized hospital based system released
January 2010: JDRF partners with Animas to advance AP systems
November 2010: The first international, multisite closed loop study is published3
March 2011: Based on recommendations from clinical panel, JDRF develops and submits an AP guidance to FDA
April/May 2011: Majority of Congress sends letters to FDA urging next steps in AP development
November 2011: Senate press conference urging FDA to issue clear and reasonable FDA guidance
1983: First insulin pump
March 2012: FDA approves the first outpatient AP trial, funded by JDRF
November 2012: FDA releases final AP guidance based on recommendations from JDRF, providing a clear and reasonable regulatory roadmap
2004: JDRF Yale hypoglycemia grant supports prototype Medtronic AP system
March 2006: FDA adds AP to Critical Path list
May 2006: Majority of Congress sends letters to HHS Secretary on how agency can advance AP
September 2006: JDRF funds CGM Trial and AP Consortium, supporting multiple AP approaches
September 2006: Senate holds hearing on need to develop AP
July 2005: FDA approves first real- time CGM
October 2005: JDRF launches Artificial Pancreas Project
September 2013: FDA approves Medtronic 530G, a first step towards an AP system, which stops insulin delivery when glucose is low
October 2014: FDA approves DexCom Share
November 2014: Smartloop (now Bigfoot) launches
May 2008: Yale research, funded by JDRF and NIH, shows for the first time a hybrid closed loop approach (a precursor to the 670G) can improve glucose overnight as well as at meal-time vs a fully-automated approach1
September 2008: JDRF CGM Trial published in New England Journal of Medicine and private plans start to cover them
February 2015: Tandem announces AP project
June 2015: TypeZero forms
November 2015: Study shows at home use of an AP system improved glucose control and reduced hypoglycemia4
February 2016: Insulet announces AP plans
April 2016: BetaBionics launches
March 2016: JDRF, Helmsley Charitable Trust & T1D Exchange launch health policy initiative
June 2016: Medtronic files for premarket approval for 670G
September 2016: FDA approves 670G – the first hybrid closed loop system – for use for in people with diabetes 14 years and above
May 2009: JDRF partners with Helmsley Charitable Trust to accelerate AP
June 2009: JDRF’s Aaron Kowalski publishes six step roadmap for AP research and development2
September 2009: NIH funds $23 million in AP grants from Special Diabetes Program
3 Kovatchev et al Journal of Diabetes Science and Technology 4(6):
4 Thabit et al New England Journal of Medicine 373(22):
1 Weinzimer et al Diabetes Care 31(5):
2 Kowalski, Aaron J. Diabetes Technol Ther Jun;11 Suppl 1:S113-9

27. “Artificial Pancreas” 2017
DIY Open Source
Minimed 670G

28. Artificial pancreas – several in the works
Bigfoot
Acquired Snap –insulin pump company, using Dexcom

29. Artificial pancreas – in the works dual hormone
Dual Hormone artificial pancreas, insulin plus glucagon
Initial trials with Dexcom and tslim pumps and dual hormone pumps
iLet
Dexcom G5 CGM integrated inside
proprietary infusion set: two needles and dual-tubing with a single insertion for both glucagon and insulin delivery

30. Artificial pancreas – in the works
Omnipod Insulet
nsulet: Competing with its own insulin control algorithm
Insulet is developing the Omnipod Horizon hybrid closed-loop system, and in February touted data from the 1st feasibility study of the device. Data from the trial indicated that the device’s insulin control algorithm met safety requirements and was able to perform well with minimal incidents of hypoglycemia.
The Billerica, Mass.–based company enrolled 24 patients with type 1 diabetes in the 36-hour study. The feasibility trial used a modified version of Insulet’s Omnipod, a Dexcom continuous glucose monitor and Insulet’s personalized model predictive control algorithm..
Use of the system was associated with significantly less time spent in hypoglycemic blood glucose range, Insulet reported, compared to ranges prior to the study. The study showed that patients hit the target blood glucose control range 69% of the time over the course of the 36 hours and maintained target blood glucose control 90% of the time overnight.
Last year, Insulet inked an initial deal with diabetes developer Mode Automated Glucose Control to develop an artificial pancreas using its flagship Admetsys: An artificial pancreas for hospital settings
Boston-based startup Admetsys has developed what it calls a first-of-its kind artificial pancreas specifically designed for hospital and surgical settings. The company said the device will eliminate the need for nurses to hand check glucose levels for patients at diabetic risk during their hospital stays, and could free up as much as 20% of a nurses time on shift.
OmniPod device.
The deal put into motion the integration of the Mode AGC algorithm into the OmniPod glucose management system, the company said. The algorithm, co-developed by Insulet medical director Dr. Howard Zisser, Francis Doyle and Eval Dassau at UC Santa Barbara, is being studied in a feasibility trial using an OmniPod prototype and a Dexcom continuous glucose monitor.
Admetsys has developed a first-of-its-kind artificial pancreas for hospital and surgical care, leveraging adaptive learning algorithms and counterbalancing treatment of insulin and glucose.
The system has undergone 3 successful FDA-approved clinical trials with 97% control between 80–125 mg/dl and zero incidents of low blood sugar.

31. Artificial pancreas – in the works hospital version
artificial pancreas for hospital and surgical care,
leveraging adaptive learning algorithms
counterbalancing treatment of insulin and glucose.
3 successful clinical trials
97% time 80–125 mg/dl
zero incidents of low blood sugar.
insulet: Competing with its own insulin control algorithm
Insulet is developing the Omnipod Horizon hybrid closed-loop system, and in February touted data from the 1st feasibility study of the device. Data from the trial indicated that the device’s insulin control algorithm met safety requirements and was able to perform well with minimal incidents of hypoglycemia.
The Billerica, Mass.–based company enrolled 24 patients with type 1 diabetes in the 36-hour study. The feasibility trial used a modified version of Insulet’s Omnipod, a Dexcom continuous glucose monitor and Insulet’s personalized model predictive control algorithm..
Use of the system was associated with significantly less time spent in hypoglycemic blood glucose range, Insulet reported, compared to ranges prior to the study. The study showed that patients hit the target blood glucose control range 69% of the time over the course of the 36 hours and maintained target blood glucose control 90% of the time overnight.
Last year, Insulet inked an initial deal with diabetes developer Mode Automated Glucose Control to develop an artificial pancreas using its flagship Admetsys: An artificial pancreas for hospital settings
Boston-based startup Admetsys has developed what it calls a first-of-its kind artificial pancreas specifically designed for hospital and surgical settings. The company said the device will eliminate the need for nurses to hand check glucose levels for patients at diabetic risk during their hospital stays, and could free up as much as 20% of a nurses time on shift.
OmniPod device.
The deal put into motion the integration of the Mode AGC algorithm into the OmniPod glucose management system, the company said. The algorithm, co-developed by Insulet medical director Dr. Howard Zisser, Francis Doyle and Eval Dassau at UC Santa Barbara, is being studied in a feasibility trial using an OmniPod prototype and a Dexcom continuous glucose monitor.
Admetsys has developed a first-of-its-kind artificial pancreas for hospital and surgical care, leveraging adaptive learning algorithms and counterbalancing treatment of insulin and glucose.
The system has undergone 3 successful FDA-approved clinical trials with 97% control between 80–125 mg/dl and zero incidents of low blood sugar.

32. Artificial pancreas (partial) ACTUALLY AVAILABLE
Minimed closed loop 670
NEW! Guardian® sensor 3 continuous glucose monitoring sensor. Introducing the most accurate sensor from Medtronic, now with up to 7 day wear and easy insertion. It is the FIRST and ONLY continuous glucose monitoring sensor FDA approved and trusted to control insulin dosing.
The MiniMed 670G system with SmartGuard® HCL technology offers two new levels of personalization:
NEW! The Suspend before low§ option avoids lows and rebound highs proactively by automatically stopping insulin 30 minutes before you reach your pre-selected low limits, then automatically restarts insulin when your levels recover, all without bothersome alerts.
NEW! The Auto Mode‡ option automatically adjusts your basal insulin delivery every 5 minutes based on your sugar levels to keep you in target range, all day and night.

33. Real Patients with pump, then pump and sensor

34. Closed loop insulin pump

35. Realities of a Closed Loop Insulin Delivery
33 year old: Sleeping through the night and waking up with blood sugars in the sweet spot every day is life changing! Also, the suspend before low in manual mode is unbelievably precise and effective. It’s very encouraging to see that Medtronic implemented as many new features as they could in one device, and they all work extremely well. 
MY EXPERIENCE ON MEDTRONIC’S MINIMED 670G TRIAL WHILE IN COLLEGE
ASHLEE ERNST, REGIS UNIVERSITY, '17
Editors’ Note: Medtronic is a CDN Corporate Member and one of the participants in their MiniMed 670G clinical trial recently shared her experience with us. We recommend students participate in trials – it is a great way to learn more about what is happening in the diabetes sector! You can find trials near you here.
My name is Ashlee and I’m a senior in a university nursing program in Denver, Colorado. I was diagnosed with type one diabetes (T1D) at the age of nine and have had a passion for diabetes treatment and research since a young age.  I participated in the MiniMed 670G trial after being involved in other various Medtronic trials throughout the years. This trial would help Medtronic gain FDA approval on their hybrid closed loop system. (Yes, please!)
I knew this would be a great opportunity but a big commitment. The study consisted of a one-week long overnight stay (with a steep learning curve), frequent downloads of my device data, and multiple check-ins throughout the process. After I completed the first part of the study, I was able to become part of a continuation phase which means I could wear it in the real world.
To me, the hybrid closed loop system is one step closer to replicating the algorithm of the pancreas. The most significant difference that people will see is a change in the basal rate management. If you’ve been a pumper for a long time (like me), you will be going from a set hourly basal rate to a system that gives or suspends insulin based on a sensor reading. For me, sensor accuracy was a big fear of mine since all of this management occurs based on the sensor reading, but I found the sensor to be accurate throughout my experience.
The MiniMed 670G system has a feature called Auto Mode which serves as my safety net. It catches my mistakes in a way. If I over bolus for a meal it suspends the insulin so I don’t drop to dangerous lows. It also gives me more insulin if I don’t bolus enough for a meal. Do I still have high blood sugars from time to time? Yes, but none nearly as high or low as I had before the MiniMed 670G system trial. This is a whole new way of thinking for diabetes management. It still takes effort, but not as much head space.
The biggest impact this system has had is on my college experience. For the past four years I have had a roommate and during the night I felt that I was waking her up multiple times a week with the low and high alarms from my device. Now, I’m less worried about waking her up because I have fewer alarms going off during the night. Being able to sleep through the night the best! (I think most T1D’s would agree that being able to sleep through the night is one of the greatest gifts we could possibly receive.)
I feel that my academics and daily life is stronger by waking up in range. For example, I will never forget my observation day in the operating room. I was shadowing during a multiple hour surgery. As you can imagine, this isn’t the time or place you want to be having a low blood sugar. My sensor was reading 90 with a straight arrow down and I felt that it was just a matter of time before it would alarm a low. I knew my sensor had been suspending my basal but wasn’t sure if it would be enough. Three hours later I left the operating room without a low and my blood sugar in perfect range. I was sold.
College kid: On a scale of on to ten, I’d say it takes a 2.5 of effort instead of 11. I think about diabetes about 75% less than before since the 670g allows the user to be “Proactive vs Reactive”. This pump interaction is slightly more frequent than other pumps, but it does so much work on your behalf that it’s very well justified.
2 of our first 7 patients were so moved at ONE WEEK that they cried.

36. Closed loop Minimed 670
Glucose values in pink– after closed loop turned on

37. Other cool stuff iBGstar Dario iHealth Dexcom G6
Maybe no calibration
These 3 meters use your smart phone’s battery and memory with an app to measure glucose with a small add on device.

38. Bio-Artificial Pancreas
Defymed® is a company that aims to develop and market implantable bio-artificial medical devices for diverse therapeutic applications.
In development is a bio-artificial pancreas, named MAILPAN® (MAcro-encapsulation of PANcreatic Islets).
Defymed® is a company that aims to develop and market implantable bio-artificial medical devices for diverse therapeutic applications.
Defymed® is a company that develops implantable bio-artificial medical devices for diverse therapeutic applications, with a first focus on type 1 diabetes. The blockbuster product is a bio-artificial pancreas, named MAILPAN® (MAcro-encapsulation of PANcreatic Islets). Defymed® is a spin-off of the CeeD (Centre European d’etude du Diabete) which has been working on an innovative concept of a bio-artificial pancreas since This work of conception of a macro-encapsulation device of insulin-secretory cells was carried out in collaboration with STATICE and the CTTM (Centre de Transfert de Technologies du Mans) in the frame of two European programs: 4th PCRD ( ) and 6th PCRD ( ).
Key dates of the project:
1996: Co-funding of the BARP project by the European commission under the 4th Framework Program (FP4). This project has been coordinated by the CeeD in tight collaboration with 10 European team
2004: Co-funding of the BARP+ project by the European commission under the 6th Framework Program (FP6) with a grant of 3 Million euros. This project has been coordinated by the CeeD in tight collaboration with 18 European teams and has led to the development of MAILPAN prototype
December 2006: End of the BARP+ European project
March 2007: BARP+ project recognized as one of the FP6 success stories
November 2008: MAILPAN Project co-labeled by the Alsace Biovalley (Strasbourg) and Microtechnics (Besançon) competitivity poles
April 2010: MAILPAN project incubated by the Alsace incubator SEMIA
June 2010: MAILPAN project granted under the national innovation contest « Emergence » organized by the French research ministry and coordinated by Oseo
June 2010: MAILPAN project granted by the region of Alsace
March 2011: Foundation of Defymed

39. References and Links https://openaps.org/
3 Kovatchev et al Journal of Diabetes Science and Technology 4(6):
4 Thabit et al New England Journal of Medicine 373(22):
1 Weinzimer et al Diabetes Care 31(5):
2 Kowalski, Aaron J. Diabetes Technol Ther Jun;11 Suppl 1:S113-9

40. POST-TEST 1. Insulin can be delivered by Lung insulin pump
Intravenously or Intramuscularly
Transdermally
B and C
All of the above

41. POST-TEST 2. Patients who use insulin may have Type 1 Diabetes
cannot be Type 2

42. POST-TEST 3. Insulin pumps Use insulin glargine
Can give variable amounts of insulin
Can cure diabetes
Can measure blood sugars

43. Questions?

46. Sensor data – how to read it