Research on diabetes complications has come a long way in the quarter-century since the all-hailed Diabetes Complications and Control Trial (DCCT) set the standard for how glucose monitoring and management should happen. Yet this progress doesn't generally get the attention it deserves.
But last year, the T1D Exchange ran an innovation challenge that helped highlight and support innovations for D-Complications. Six semi-finalists shared in a $250,000 cash prize and in-kind services (lab work, legal consulting, biosampling assistance, or other management tasks), and those semi-finalists are being hosted in Boston at T1D Exchange's annual meeting this week on Oct. 3.
New Innovations for Diabetes Complications, by Dan Fleshler
So far so good.
I’ve lived with type 1 diabetes (T1D) since 1962, and I can see what I’m typing now and I can feel my foot tapping on the floor and my heart and kidneys are in good shape. But diabetes increases the risk of these and other dreaded, life-and-limb-threatening complications. And I know they could strike me and other PWDs (people with diabetes) at any time.
That's why I am happy to report on several companies now developing promising new treatments and diagnostic techniques for diabetes complications. This small sampling of innovators happened to be semi-finalists in the T1D Exchange’s Diabetes Innovation Challenge in 2016. It's good to see this kind of anti-complications research and product development getting recognition.
Treating Retinopathy While PWDs Snooze
Although my ophthalmologist tells me “you have no diabetes in your eyes,” I know someone who went blind because of retinopathy and that complication is especially worrisome to me. Between 40 and 45% of PWDs have some form of retinopathy, caused by damaged blood vessels in the retina, and (oh no!) the chances of developing it increase the longer one has diabetes.
So it’s great news that a UK-based company called PolyPhotonix has developed a nifty new treatment for retinopathy and macular edema, a build-up of fluid in the eye that is often caused by retinopathy.
It’s a sleep mask, known as the Noctura 400. This device is a non-invasive, 12-week disposable mask that you wear over your eyes when sleeping to reduce oxygen demand by delivering low levels of light through closed eyelids.
At first glance, Noctura may not seem like a technological marvel, as it's made of fabric and from the front looks pretty much like an ordinary eye mask people wear to help them sleep. But attached to the backside is a battery-powered pod that beams "a precise dose of light therapy" into each retina.
It's designed to treat people with all stages of retinopathy and has shown impressive results in a couple of studies.
The science behind this is simple, as PolyPhotonix explains: It all comes down to oxygen. As retinopathy develops, our eyes become “starved for oxygen.” New blood vessels are created to fix that problem, but they can leak and do all kinds of damage. The mask aims to address this problem by making sure the eyes need less oxygen (ie not starving for it).
This technology has been available for clinical use in the UK and other countries for a few years now, and a company representative said people from the U.S. have been flying to the UK in order to get their hands on it. According to the company site, it costs 125 Euros (or about $147). It’s still being evaluated in clinical trials here in the States, and PolyPhonix says it has been "going back and forth" with the FDA to get its sleep mask approved in the U.S. as soon as possible.
Engineering New Arteries
Another complication I’ve dodged so far: peripheral artery disease (PAD), which strikes one out of three PWDs over the age of 50. It occurs when blood vessels in the legs, fingers, stomach, arms and other parts of the body are narrowed and blood flow decreases. PAD increases the risk of heart attacks and strokes, and can lead to gangrene and amputations.
To try to counter PAD, researchers at New York startup NangioTX are using cell engineering and regenerative technology to create new blood vessels and “preserve muscle tissue usually lost in peripheral artery disease.”
So how are they doing this?
By using an injectable gel known as V-10, developed by Rice University researchers over the course of more than 10 years. This hydrogel stimulates the creation of new blood vessels, according to NangioTX’s website. Once it's injected into the muscle, it creates a biological signal inside the body to begin growing mature blood vessels (known as angiogenesis, in science lingo) in as little as seven days.
While this is currently only tested on lab mice (of course), the beginning stages of research look promising. Everything the company's doing is really fascinating and will be interesting to follow.
NangioTx has been trying to find seed funding and hopes to start preclinical trials soon, according to company founder Vivek Kumar, a biomedical engineering professor at the New Jersey Institute of Technology. In the meantime, in the laboratory, they’ve discovered that the V10 also shows promise in combating foot ulcers -- another big problem for PWDs.
It’s not clear how long it will take to find out whether V10 works in humans, but I want to extend to NangioTx my heartfelt (sorry, couldn’t resist) wishes for success.
Identifying Bacteria in Infected Wounds
Compared to the rest of the population, PWDs are more susceptible to infections, including infections in wounds. And our infections are more likely to be undetected and to become serious problems. Yet using current testing methods, it takes much too long -- generally more than 24 hours -- for health care providers to identify the specific bacteria that cause wound infections. It’s important to find the right treatments for wounds much more quickly, in order to foster healing and avoid the problem of drug resistance.
Enter QSM Diagnostics, a Boston startup that has created a disposable sensor designed to identify molecules produced by specific bacteria. Amazingly, using what the company calls an “electrochemical detection strategy,” it takes only one minute for this portable, battery-powered technology to analyze a tiny blood or urine sample.
So far, the sensor has been used to identify one kind of bacteria. But QSM is working to “expand the platform” for its sensor and “to improve accuracy and identify other bacteria,” says Edgar Goluch, a company founder and chemical engineering professor at Northeastern. Plus, he says they are “closing in on seed funding.”
Please, hurry up!
Detecting Unnoticed Neuropathy
Whenever I stub my toe and feel pain, one way to comfort myself is to remember I’m lucky to feel it. People with diabetic neuropathy often don’t feel pain and end up ignoring infections and other problems -- about 60% to 70% of PWDs have some form of this nerve disease.
Sadly, most diabetes experts agree that neuropathy is grossly under-diagnosed and untreated. It can be difficult to detect, especially in its early stages. There may be a way to address that problem, thanks to New Hampshire company Prosenex that has developed a Dynamic Neuroscreening Device (DND).
The DND is an “objective foot screening tool” designed to help clinicians diagnose “peripheral neuropathy,” both before patients show any symptoms and in its later stages. It uses two temperature pads to gauge a patient’s sensitivity to temperature and vibrations, touching the pads in succession to the same part of the foot to test whether the patient can tell the difference. It uses a tip that vibrates at five different rates, much like a standard tuning fork.
For those of us who have our feet checked for neuropathy at the doctor's office, think of this as a higher-tech version of the vibrating "tuning fork" or similar handheld tool used on our feet to determine if we can feel those vibrations.
This Prosenex device would eliminate the subjectivity, both for the patient and physician, providing actual data to guage the neuropathy. Doctors can use it to better establish a baseline and detect changes over time in either the feet or other extremities, the company website points out.
Prosenex could not be reached for comment, but the device is available to physicians in the U.S. and elsewhere -- at a whopping $1,495, that is! With Prosenex named as a semi-finalist in the T1D Exchange challenge last year, the Diabetes Community may see this particular tool become more affordable and easily accessible for physicians' offices who might need it.
Bigger Focus Needed on D-Complications
These and other tools and technology targeting complications aren’t just important to T1D codgers like me; complications associated with diabetes also descend on PWDs of all ages -- including kids with type 2 who are developing kidney, nerve, and eye disease more often than those with T1D, believe it or not. All of these innovations are important to keep note of, and should definitely be given the attention they deserve.
For the sake of everyone with diabetes, the general media and Diabetes Online Community ought to pay more attention to research that focuses on D-complications. That tends to generate less buzz and excitement than new apps and gizmos for monitoring blood glucose, the rapidly evolving Artificial Pancreas, and potential cures and vaccines.
Yet we should collectively give more “props” and thanks to the smart scientists who are finding new ways to tackle the life-threatening, debilitating health problems that too often accompany diabetes.