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Implanted Insulin Pump

implantablepump_full

Update (5/5): Diabetes Mine has posted a lengthy response from Medtronic as to why they aren’t investing in implanted pump technology either.

Update (4/27): I received a lengthy response from JDRF about their stance on implantable pump technology (they obviously had many, many queries about this as a result of the article – good work by Diabetes Health!). In short – the expense to develop it currently seems to outweight the benefits, so they’re not pursuing it. Here it is in full:

Dear Kristin,

Thank you for your support for JDRF.  We appreciate you taking the time to reach out to us directly regarding the recent Diabetes Health article about implantable insulin pumps.  We understand that the article raised questions among people and families living with type 1 diabetes, including some who are seeking information about JDRF’s role.

According to JDRF’s Vice President of Treatment Therapies, Aaron Kowalski, JDRF has closely followed developments with implantable pumps over the past few years.  Over this time, we’ve concluded that there are some challenges to the widespread adoption of this technology that have precluded us from being more involved.  These challenges include: 

  • The pump is quite large.   As the article states, it’s about the size of a hockey puck.  When implanted, the pump has a distinct outline of a hockey puck protruding from the person’s abdomen. (Click here to see a photo).  This would be a major obstacle to widespread use for many people with type 1 diabetes.
  • Miniaturizing such a pump to make it more applicable to more people with diabetes will be time-consuming and costly.  We’ve examined the cost vs. the benefits, when establishing our priorities at JDRF, and we feel that external development will have a significantly greater return on investment and help many more people. 
  • In order to have an implanted pump, concentrated insulin is needed. Currently, the standard amount of insulin used in injections is U100.  The implanted pumps use U400 insulin (four times concentrated) to reduce the time between refills. Among the challenges this presents is that the more concentrated insulin is the potential for crystallization in the system and potential for occlusion. This type of insulin is not yet approved for this application in the United States. 
  • Although an implantable pump may be helpful, we do not have any good data in well-controlled trials that show how much of a benefit this type of insulin delivery will provide compared to subcutaneous delivery of insulin will have for people with type 1 diabetes.
  • People who have the implantable pump must have it refilled every 45 days or so.  This means visiting the doctor every two months or less.  This creates another potential barrier for use by people with type 1 diabetes.

That said, JDRF agrees with the article’s point on better insulins and delivery methods being necessary to help people with type 1 diabetes maintain better control of their blood sugar.  Currently this is a major focus for us and JDRF is prioritizing and funding  the development of novel insulins and delivery approaches that are glucose-responsive, faster-acting, easier to use, and more effective.  We hope to make progress in this area in coming years.  JDRF is also working on other methods to better deliver insulin that might be easier to adopt, such as our partnership with BD focused on microneedle insulin delivery.  In this method, the insulin would work faster and would not be delivered subcutaneously, but rather intradermally.
In sum, JDRF does feel that an implantable pump is an interesting and important area of research; however, due to the challenges outlined above, it is not one of our main priorities at this time.  We will continue to keep a close eye on it as we evaluate our strategies.  In the mean time, you can learn about JDRF’s efforts to treat diabetes through better methods of glucose control on our website.

I hope this explanation has been helpful for you.  Please let me know if I can provide you with any additional information.

Best,
Shana

Shana Vernoia
Coordinator, Public Information
Juvenile Diabetes Research Foundation International
26 Broadway, 14 Floor
New York, NY 10004
www.jdrf.org

Original post (4/20): An Irish co-worker mentioned once, just after Luke was diagnosed, that her sister (with T1) had an implanted insulin resevoir, and maybe we’d want to look into it. In my post-diagnosis daze, I mentally filed that away under “Huh, dunno what that means…”

Today, Diabetes Health ran a great article about this technology (available only in Europe), which Medtronic is considering shelving. Read it, and start asking why we don’t have this technology here – and why it isn’t front and center of the artificial pancreas project: http://www.diabeteshealth.com/read/2011/04/17/7124/a-miracle-technology-for-type-1s-can-it-be-saved-/ 

The article profiles four Americans who fly to Europe every 3 months to get their implanted pumps refilled – life with these implants, they say, is like living without diabetes, and worth the cost of travelling to Europe. Far fewer lows, near normal A1Cs, no more failed sets (a constant struggle), no trying to imitate the pancreas from waaaay outside the body. Dick Cheney has a heart (badly needed) – why can’t my kid have a pancreas?

Very little is available about this online, or whether anyone’s fighting for this in the US. Why is Medtronic shelving this? (A stale summary of their trial in the US gives no information or updates.) Why hasn’t the FDA approved this (created by an American company) in the US? What is JDRF’s stance on this? As one commentator said, the squeaky wheel gets the grease – squeak away!

MEDTRONIC:
United States – World Headquarters
710 Medtronic Parkway
Minneapolis, MN 55432-5604
USA
Phone: (763) 514-4000
Toll-free: 1-800-633-8766
Fax: (763) 514-4879

JDRF:
Juvenile Diabetes Research Foundation International
26 Broadway, 14th Floor
New York, NY 10004
Phone: 1-800-533-CURE (2873)
Fax: (212) 785-9595
E-mail: info@jdrf.org

FDA:
Food and Drug Administration
10903 New Hampshire Ave
Silver Spring, MD 20993-0002
or by telephone:
1-888-INFO-FDA (1-888-463-6332)—main FDA Phone Number (for general inquiries)

One Comment Post a comment
  1. Julie Devine #

    Wow! Your blog has really grown! Such a great resource!

    April 20, 2011

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