Connecting Innovators in Life Sciences and Information Technologies – Lift Basel Conference 2015 – Day 2

LiftBadge

As promised, the summary of the 2nd day. I must admit, it is a bit long but all these topics were fascinating and the speakers really stood out from the “crowd” with excellent ideas. If you do not wish to read it all, just have a look at the headlines by scrolling down and skip to the topic that catches your eye.

Surgeons superpowers

Hans Florian Zeilhofer
Engineering the augmented surgeon

With the current trends in demographic development,more than 2 million people in Switzerland will be over 65 in 2050. What does it mean? More surgery as ageing is very often the synonym of diseases.

Surgery is more and more helped by technological tools, especially for complex cases like facial surgery where augmented reality could be really useful. But, technology has to be human centered and it is the moto of Mimedis, a fab lab for surgeons. Together with small interdisciplinary teams, the company focuses on design and manufacture (3D printing) of patient specific bone implants.

The speaker is not only the founder of Mimedis but also the initiator of MedTech Innovation Partners (MTIP), which helps finance innovative medical technologies. MTIP has a clear focus on innovations within health technologies. It offers business building support as well as continuity of funding and its network to accelerate growth.

More on augmented reality in surgery:

Augmented Reality for CMF-Surgery – Basel University

A Look into the Body – Augmented Reality in Computer Aided Surgery – Munich University

Philippe Cattin
Reinventing bone surgery

Nothing has changed fundamentally on how things are cut in surgery. But laser could be extremely helpful, leading to finer and more precise cuts. Plates will need to be smaller and even resorbable.

This technology also makes it be possible to perform functional cuts in order to avoid pain for the patient. It is a complete new thinking about how surgery is executed. No more straight cuts for an improved healing.

Together with enabling technologies, such as navigation and robots holding laser, surgery will be much more efficient with reduced doses of anesthesia and better recovery time.

The surgeon will not be replaced but empowered and the robot will be part of the surgery team.

AOT is dedicated to the development, manufacturing and sales of medical devices for osteotomy pursuing the vision of contact-free bone surgery using laser, robotics and navigation systems to re-invent bone surgery (osteotomy). 3 lasers are built into the system; one of them is a ruler and will measure across the cut. The main product, Carlo, is a robot, currently tested in animal experiments.

More on laser use in surgery:

Laser-cutting of bones replaces sawing – Nominated for the CTI Swiss Medtech Award 2015

Raimund Erdmann
Human-centered design

Innovation strategy coupled with human-centered design will deliver corporate value. Human-centered design is the primary goal of Erdmann Design.

HCD

For human-centered design to produce worthwile results, several and diverse stakeholders are requested to interact and think on how can you help with low tech simple solutions. Stand where problems occurred helps understand better the real context and will generate more relevant solutions.

More on human-centered design:

Usability results through human centered design and early test models – Medical Cluster Meet the Experts 2014

More on Swiss Med Tech Industry:

Swiss Medical Technology Industry 2014

Doctors and patients revisited

Haig A. Peter
Outcome-based healthcare

It is not big data anymore but it is a tsunami of data. Not only text data but pictures, videos, sensor data… and 90% of the data was created in the last 2 years.

How can we use it? What’s in there?

  • Clinical data only represents 10% of data
  • Genomics factors reprsent 30%
  • Exogenous factors represent 60%. What do we mean when we say exogenous factors? It’s the information about lifestyle (diet, sport, smoking,…), behaviors, drug adherence. It is immensely useful when combined with all the other types of information.

Machine vs. Humans?

Humans are the best machine ever because of feelings such as compassion, intuition, design, value, judgement and common sense. No robot or machine is ever capable of such skills. However, machines have huge learning capabilities, especially deep learning (+ machine learning), discovery, large-scale math and fact checking. The last competency is crucial because, as of today, we do not know exactly what’s true on the internet.

The key: Human + Machine – rethink whats possible, what would you do, how could we use it…

Examples:

Memorial Sloan Kettering teams are partnering with IBM to train Watson to interpret cancer patients’ clinical information and identify individualized, evidence-based treatment options that leverage doctors’experience and research. Big data could stimulate the building of knowledge for diseases without current treatment option – what can we do, other medications, which data do we consider,…

Watson will help reduce the time of drug discovery by identifying markers quicker and accelerate the time to market for drug projects.

Welcome to the cognitive era!

More about IBM Watson in healthcare applications:

IBM Watson Health

Watson in Healthcare

IBM pushes Watson into healthcare with new business unit – Barb Darrow – Fortune 2015

Cécile Monteil
The impact of technology on the patient-doctor relationship

Talking with patient was key before, science has now made huge progress. From “medicine is art” to “medicine is a science”. As a result, medicine today is taking the human touch away.

For a patient, talking and having explanations about the results of an exam is as important as undergoing an exam. Technology is here to increase the productivity of tasks but the relationship between the doctor and his patient has to stay and to be developed further. The human part of the process is already key in the healing process.

Technology can connect people. Today, technology allows patients to find information and to empower them. Participation in decision-making about treatment options and pathways is relevant for patients. Moreover, smartphone and connected objects can help track patient symptoms and treatment choices. It is used today for Type 1 Diabetes glucose monitoring.

With connected objects it is easier to monitor body parameters. Furthermore, doctors will be informed of those parameters and will be able to act upon.

The patient has to be at the center of care, beyond simply being part of the loop.

New types of expertise will show up, like medical data scientist, care coordinator, prevention doctor, education nurse,… and whole teams will collaborate in order to take care of the patient for better outcomes.

More about connected health:

Eppocrate

Santé connectée : quelle révolution pour la recherche médicale ? – TEDxUTCompiègne 2015

Patricia Sigam
Digital health – Time for new players
Integrated care – digitalMedLab

Yesterday, the patient-doctor relationship was compassionate, coordinated, comprehensive, continuous, accessible and family-centered. Today, the change is not only technological but also societal.

Patient-centered care is paradigm change, in which patients would like to be considered a they are and not as animals. A whole new ecosystem is emerging and developing itself.

Between a patient and his/her doctor, very often, there is a nurse. Thus, it is more a patient-nurse system or relationship.

But who is the expert?

It is crucial to visit the right expert that will be able to pose the right diagnostic. Provider empowerment (or nurse empowerment in this case) via technology will free time for the doctor while the nurse will do the consultation and collect the data to send them to the doctor. He will then be able to analyze them and act upon.

An interesting example comes from the dietitians of Canada, following obese patients and being their point of contact or new reference to talk to instead of the doctor.

Technology allows patients to stay connected with healthcare professionals following them. In addition, digital technology makes it possible for healthcare professional to be empowered.

Furthermore, caregivers and relatives can use digital technology as well. For example, Alertwatch is a tool giving relatives access to the localization of the loved one on a GPS map. Needless to say that caregivers will have more serenity, increased freedom themselves and improved information on the patient.

Remote support is complementary to human support without replacing it.

More on patient-centered care:

Patient-centered medicine and patient-oriented research: improving health outcomes for individual patients – José A Sacristán – BMC Medical Informatics and Decision Making 2013

Time for a Thorough Evaluation of Patient-Centered Care – Paul A. Heidenreich – Circulation: Cardiovascular Quality and Outcomes 2013

Patient expectations and the paradigm shift of care in emergency medicine – Fatimah Lateef – Journal of Emergencies Trauma and Shock 2011

Global ageing

Alexandra Stolzing
Solving ageing by reprogramming cells

The human metabolism will slowly start to malfunction when we age. This will lead to damage and initiate some age-related pathologies.

The speaker shows us how she works on reprogramming cells.

ReprogrammingCells

Reprogramming is not only reversing aging. It will reboot the cell and it will restart as a fresh cell.

Reversing Ageing

Reprogramming in vivo is the next step. For example in order to repair an infarcted heart.

More on reprogramming cells:

The aging signature: a hallmark of induced pluripotent stem cells? – L. Rohani & al. – Ageing Cell 2013

Aging and reprogramming: a two-way street – S. Mahmoudi – Current Opinion in Cell Biology 2012

Manouchehr Shamsrizi
Gamification for better living

The speaker is the CEO of RetroBrain R&D and trying new approaches promoting people to live healthier. As we all know, it is difficult to incentivize now for long term benefits. The key to have a switch into the behaviors, it to change the way it is percieved: you change your behavior because it is cool and not for long term benefits.

Gamification and videogaming are fundamentally different from the actions you could perform right know. You do not even realize you are changing your own behavior.

How to motivate people? The game is challenging you again and again and when people succeed, they have a dopamine surge. These games influence will stimulate the brain and could delay dementia because of movements, social dimension and brain activity. The game can be personalized with car shapes and music appreciated by the patient.

We should have fun when we are ageing. Interview in German and RetroBrain demo.

More on gamification in health:

Gamification in healthcare isn’t just about playing games – J. Kim – Tech Target Search Health IT 2014

From Fitbit to Fitocracy: The Rise of Health Care Gamification – Knowledge @Wharton 2013

Top Ten Gamified Healthcare Games that will extend your Life – Yu-Kai Chou

Exploring the Potential of Gamification Among Frail Elderly Persons – Gamification Research 2011

Scott Smith
New emerging business models connected to the ageing society

The speaker is the founder of Changeist. For him, it is fundamental to look at the macro picture when it comes to ageing.

He took the interesting example of Paro, a companion cuddle robot. It is a seal puppet therapeutic robot. It has been tested is geriatric facilities to help patients cope with multiple diseases such as dementia.

GreyingWorld

Source

The demographic time bomb challenge is fairly widespread.

Which solutions? Which possibilities?

  • Full automation, robots helping us, freeing time for more leisure
  • Designing our future
  • Human-machine combination – the pairing has to be culturally and socially acceptable
  • Senior Quantified-Self. These technologies will probably transform the way many families care for their loved ones. Estimated market size USD 14.6 bn in 2019.
  • California Life Company – Calico. It will help bring new technologies to the market and promote their adoption for a better management of ageing.

Intervention is easy to develop but the scale up is very difficult mainly for economic reasons.

More on ageing and new business models:

The New Booming Market? Aging Baby Boomers – C. Desmarais – INC 2014

The Economic Conundrum of an Aging Population – WorldWatch Institute 2004

Developing New Business Models in the eALT Sector – Coventry Consumer Models for Assisted Living

Strategic openness in life and data science

Bastian Greshake
Human genome: why sharing is crucial?

We are limited to reading the human genome and making sense of some of the parts today. Genetic testing goes mainstream.

Growth in DTC Genetic Testing

Source

Sequencing vs genotyping? (definitions from 23andMe)

Genotyping is the process of determining which genetic variants an individual possesses. Genotyping can be performed through a variety of different methods, depending on the variants of interest and resources available. For looking at many different variants at once, especially common variants, genotyping chips or arrays are an efficient and accurate option. These do, however, require prior knowledge of the variants you want to analyze.

Sequencing is a method used to determine the exact sequence of a certain length of DNA. You can sequence a short piece, the whole genome, or parts of the genome (such as the “exome,” which are the parts of the genome that contain genes). Depending on the location, a given stretch may include some DNA that varies between individuals, like SNPs, in addition to regions that are constant. Thus, sequencing can be used to genotype someone for known variants, as well as identify variants that may be unique to that person.

With genotyping, we look at SNP. We can then make some predictions with those data. For example: to see whether I will pass some of these genetic characteristics to my children. It is also widely used for ancestry analysis and microbiome exploration.

Why should this data be open?

Snpedia is sharing genomic data and helps determine whether you have higher risk. Connecting data to others can save lives. Big data is needed in this field.

Dna digest is promoting data sharing because of limited publicly available data despite huge sequenced DNA.

Examples for open data: personal genome project, opensnp, openhumans

More on the human genome:

Website: The Human Genome – Poems on the Book of Life

Tiny Genetic Differences between Humans and Other Primates Pervade the Genome – K. Wong – Scientific American 2014

Genomic data sharing for translational research and diagnostics – P. Robinson – Genome Medicine 2014

Marion Colombani & Paul Willis
Open science to advance drug discovery in neglected diseases

Malaria takes it toll on children as 86% of deaths are noted below age 5. Despite the 47% reduction in death since 2000 thank to an UN initiative focused on trying and improving public health in developing countries, the world still needs medicines to tackle the disease.

The traditional model of drug development in silos, obsessed by profitability and shareholders value is not working for developing countries. A reassessment on how we do drug discovery in this field is necessary.

A new model with a public health focus should be developed, like product development partnership. Interesting projcts are selected and funded. Advisors work in close collaboration with partners and open source science experienced.

OpenSourceScience

Open innovation is the standard model of MMV.

How do they fund their late stage development candidate? They try to find a willing pharma partner or secure sufficient public funding.

Open Access initiative: empowering research.

20’000 drug discovery starting points have been published, MMV selected 400. They are all commercially available.

Another initiative has been launched in order to enrich the drug discovery database: the Malaria Box. Launched in 2011, it has already been supplied to 30 countries for a total of 218 boxes.

A new project: the Pathogen Box, same initiative for neglected diseases to stimulate further research.

There is an ever increasing role of open source in new drug discovery models.

More on open source drug discovery:

Open Source Drug Discovery in Practice: A Case Study – C. Ardal – PLOS Neglected Tropical Diseases 2012

The Open Source Drug Discovery Project: Need for Global Collaboration – S. Brahmachari – 2015

Gernot Abel
Going open innovation and citizen science in biotech

The speaker sees brand new opportunities for collaborative innovation.

CollaborativeInnovation

How we manage, develop and initiate innovation will shift from traditional to open approaches.

FronTraditionalToOpenInnovation

When you create into a community you not only achieve, you exceed what you achieve.

Hackers want to change something and add a new innovation to existing products. The epicenter is both in US and Europe. Novozymes started recently to collaborate with hackers in an open mode. Biologigaragen is an open space for citizen science in biology. In addition, tools are getting cheaper, easier to use and more powerful.

Examples:

  • Open trons is a USD 3000 full lab available to everyone.
  • Transcriptic is a a fully automated cell and molecular biology laboratory in the cloud.
  • Arcturus BioCloud is a way of sharing biotech experiments.
  • SYNENERGENE is a four-years mobilization and mutual learning action plan (MMLAP) supported by the European Commission under the 7th Framework Programme.

NewHorizons

Joint value capture is fully present when engaging in open innovation.

For Novozyme, open innovation brings a lot:

  • Low cost analytical technologies
  • Evaluation on given technology and opportunities
  • Insight for business development projects
  • Spot the next big theme in biotech
  • Societal impact and mutual learning cycles

Last but not least – a fantastic lesson on how to engage in open innovation.

OpenInnovationTips

Medtronic – The Digital Pancreas – The Future of Diabetes Management? – Fierce Medical Devices

pancreas

A truly interesting article of the transformation of Medtronic Diabetes business

2015 could be a year to remember as the start of a new era in improved diabetes management thank to digital tools.

Diabetes management at Medtronic & deals history

It started several years ago but back in May 2001, a transforming event took place: Medtronic bought Minimed as well as an affiliated company for USD 3.8 billion. Looking only at Minimed, Medtronic paid USD 3.28 billion for USD 400 million in sales (8.2x 2001 sales). Despite its price, quoted as high by some investors and analysts at that time, the deal rationale was pretty compelling as it allowed Medtronic to enter the diabetes management arena. MiniMed offered a beachhead into the field of technological management of diabetes, one of the fastest-growing chronic diseases in the world and one that affects an estimated several millions of people. The devices produced by MiniMed help patients manage their insulin needs and monitor glucose levels.

Since 2001, several deals and partnerships paved the way up to where Medtronic is today. After having a look at my deals database, I can say that some of them clearly stand out:

November 2004: agreement with Novo Nordisk on prefilled insulin cartridges;

– August 2007: co-promotion & co-marketing with Lifescan and Bayer of blood glucose meters (in USA together with Lifescan and outside USA with Bayer extended in 2011). These devices had wireless data transmission to insulin pums;

May 2009: strategic marketing collaboration with Eli Lilly on patient education and disease management;

June 2009: acquisition of PreciSense, a medical device company developing CGM (continuous glucose monitoring) technology. A step forward for “closed loop” systems dedicated to insulin delivery;

January 2013: research collaboration with GI Dynamics on EndoBarrier;

August 2013: acquisition of Cardiocom, a developer and provider of integrated telehealth and patient services for the management of chronic diseases;

June 2014: global strategic alliance with Sanofi, aimed at improving patient experience and outcomes for people with diabetes around the world. The priority is the development of drug-device combinations and delivery of care management services to improve adherence as well as simplify insulin treatment.

Medtronic has built its Diabetes franchise over the last several years and is still fully committed to be the leader in this field. This pledge could lead to the achievement of the digital pancreas, a fully autonomous device (closed loop system) monitoring blood glucose continuously and adjusting insulin doses as perfectly as the biological pancreas without human interaction. Some researchers already have prototypes, studies are ongoing, universities and hospitals are teaming up. The field is really at its boiling point!

Deals and partnerships in 2015

In this FierceMedicalDevices article, we can see Medtronic advancing its franchise by investing with determination and dedication in new technologies.

Many partnerships have been signed in 2015: Diabeter (a diabetes clinic and research center dedicated to providing comprehensive and individualized care for children and young adults with diabetes), DreaMed (artificial pancreas technology for integration into future Medtronic insulin pumps). Beyond healthcare companies, Medtronic is also expanding its network into consumer electronics with Samsung (integration of mobile and wearable devices to improve disease management with an Android mobile app) and diabetes data with a startup called Glooko. It also partnered with IBM Watson Health for next-generation disease management solutions.

All these deals are clearly accelerating innovation at Medtronic but in a patient-centric fashion as in every deal we can see the benefits for them and the management of their disease. What could be the next step? A deal with Apple in order to nearly fully cover all the mobile OS in the world.

For my conclusion I will quote Medtronic CFO, Gary Ellis: “We’re focused on transforming our diabetes group from a market-leading pump and sensor company into a holistic diabetes management company focused on making a real difference in outcomes and costs,” summed up Medtronic CFO Gary Ellis on the most recent quarterly conference call.

 

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The Vaccine for Type-1 Diabetes Is Moving Forward

Fascinating use of the BCG vaccine – it could bring hope for Type 1 diabetes patients in reversing their disease. Looking forward to seeing the results in 5 years! A story to follow!

TIME

A promising vaccine that has the potential to reverse the symptoms of type I diabetes—an autoimmune disease often diagnosed in childhood—is heading on to a phase II trial, which will test the vaccine on humans with the chronic disease.

The vaccine, called bacillus Calmette-Guérin (BCG) has succeed in reversing type 1 diabetes in a trial among mice and in a phase I trial in 103 humans. The new trial, which the researchers announced on Sunday at the Scientific Sessions of the American Diabetes Association, will last for five years and will test the effect of the vaccine on people with type 1 diabetes among adults between ages 18 to 60. The vaccine may be able to improve the disease in people who have small but detectable levels of insulin coming from their pancreas. Lead researcher Dr. Denise Faustman, director of immunobiology at Massachusetts General Hospital (MGH), estimates that about one…

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Hacking the Human OS – IEEE

health_keyboard

A mind-blowing report from IEEE about the human body’s operating system

Can we harvest digital health data from trackers and sensors to improve our health and well-being? I summarized below what you will find on the IEEE dedicated web page. I was amazed by the variety and depth of all the innovations presented in these pages. Some of them have certainly the power to be game changers in the health care world. I’m looking forward to seeing all the advances coming to life!

Reading the Code

Several technologies are close to the market and will help us monitor our health. A very good example is the biostamps developed by John Rogers from the University of Illinois. These tiny, stretchable and skin-like sensors are able to send information and data to our smartphone alerting us whether something is happening in our body. More and more complex data could be sensed such as blood oxygen, blood glucose and even muscle weakness or sleep patterns.

Another fascinating example that could change the life of Type 1 diabetes patients is the artificial pancreas. It links “data from an implanted blood-sugar sensor to a computer, which then controls how a pump worn on the hip dribbles insulin under the skin through a pipette. In its fully realized form, the machine would take the patient out of the decision-making loop”. Advanced versions of the system are currently in clinical trials. Continuous monitoring is a huge advance in the field of disease management. It could strongly lighten the daily burden of each patient.

Another field where wearable are very popular: athletes. They are always eager to test the last innovation in the wearables arena. Physiological measurements can be extremely useful to optimize training and rest periods, improve performance and avoid injuries. Sleeves, wristbands, sensors equipped with highest technology can really make a difference in the way we monitor and track performance.

A device rapidly diagnosing any medical condition or disorder… Sounds like science fiction, right? Like in Star Trek… Some of you may recall the tricorder. And guess what? It’s about to become reality thank to a competition launched by Qualcomm. 300 teams registered, 10 finalists which are about to deliver their prototypes very soon. Once the winner has been chosen, real life clinical trials will start and we will know if it’s really working as expected. It’s a huge step forward as it will allow the diagnosis (and maybe the start of a treatment) for a lot of people, not only in US or Europe but also in emerging countries where the lack of medical infrastructure is killing human beings…

 

Analyzing the Code

Technology companies showed their interest in healthcare only recently… It’s welcomed because without technology you cannot do anything with data sets. However, some people are afraid of their data becoming public and being hacked. I think that between these two extreme opinions, we can take the good from both sides and see what this can bring us. “Apple, Google, Microsoft, and Samsung, have all launched e-health initiatives, mostly based around smartphones and wearables. Indeed, the fast-growing health care business would seem a natural next step for the tech giants”. A lot of deals have been signed between pharmaceutical companies and technology firms: Google and Novartis; IBM, Apple, Medtronic & JNJ… These are deals to follow in order to analyze the outcomes. Great initiatives could really emerge and I think we are at the beginning of a new era!

Long term analysis could help us understand in a more detailed way how we get sick, how the disease develop and how we could have anticipated it by looking at biomarkers trends.

The new era of precision medicine is making a big difference for patients. An open-source platform has transformed the way patients are being treated. Surgery is not always the best option in oncology for example and sometimes drug treatment is much more effective. A thorough and careful analysis of all the parameters will help doctors taking the right decision for the right patient at the right time.

Real-time epidemics modelling could have saved lives. Building treatment centers at the right locations, anticipating the spread of the disease (in this case, Ebola) and how to limit the contagion were several of the criteria used to run the model. We will never know what would have happen without such a model but globally we can say that modelling is critical in disease management. Additionally, it is not the use of a single model that will be helpful but the customized and accurate modelling for each and every epidemic, according to its characteristics.

 

Changing the Code

Performing surgical interventions at very small scales is becoming a reality. “Thanks to developments in microfabrication and other areas, researchers are pushing the limits on the size and capabilities of objects small enough to move through the human body”. “With the right design, researchers say, a microrobot—or a swarm of them—could deliver a highly targeted dose of drugs or radioactive seeds, clear a blood clot, perform a tissue biopsy, or even build a scaffold on which new cells could grow”. For the time being, tests have only been run in animals.

A new emerging medical field: electrical therapy. Vagus nerve stimulation has the potential to treat several conditions from migraine to asthma, even immune diseases. Progress is very slow and several failures have made history… but new startups are created and renew the interest in this type of technology.

W like Watson, the digital MD. Watson is based on machine learning: “bringing together computer scientists and clinicians to assemble a reference database, enter case studies, and ask thousands of questions. When the program makes mistakes, it self-adjusts. Researchers also evaluate the answers and manually tweak Watson’s underlying algorithms to generate better output. Here there’s a gulf between medicine as something that can be extrapolated in a straightforward manner from textbooks, journal articles, and clinical guidelines, and the much more complicated challenge of also codifying how a good doctor thinks.” Progress is under way.

 

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Immunology or Metabolism – What can we say about Type 1 Diabetes?

Diabetes

Not always easy to categorize this disorder. What is being said today? An overview of opinions around the litterature

I conducted a small litterature search with the keywords “Type 1 Diabetes”, “Immunology”, “Metabolism”, “Metabolic”. PubMed returned 534 results. Google Search returned over 5 million…

I will start with some definition as well as resources and then try to answer the question.

 

Definition

Diabetes is not a single disease.

An excellent starting point is the Diabetes Journal Article: Diagnosis and Classification of Diabetes Mellitus. It says that “Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action.” We have a good point here saying its origins are coming from an immune system dysfunction.

The American Diabetes Association provides in-depth overview of the symptoms, diagnosis, Type 1 and Type 2 as well as gestational. The website is full of stats and resources.

The CDC also contributes to knowledge and awareness with this comprehensive infographics. The IDF – International Diabetes Federation – is another source of information together with the WHO dedicated page on diabetes and the European Foundation for the Study of Diabètes.

CDC_diabetes-infographic

 

Some possible answers – Immunology vs. Metabolism

Coming back to Type 1 diabetes and my quick litterature search. From the 534 articles, I selected 5 among them seeming more relevant to start answering the question.

One of the first article I read is clearly stating that “Type 1 diabetes mellitus (T1DM) is a T cell-mediated autoimmune disease characterized by the destruction of pancreatic β cells”. But authors of another article insist on the metabolic abnormalities in Type 1 diabetes: “Clinical onset of type 1 diabetes (T1D) is thought to result from a combination of overt beta cell loss and beta cell dysfunction. However, our understanding of how beta cell metabolic abnormalities arise during the pathogenesis of disease remains incomplete. Despite extensive research on the autoimmune nature of T1D, questions remain regarding the time frame and nature of beta cell destruction and dysfunction.” “Determining the time frame of beta cell destruction and identifying metabolic mechanisms that drive beta cell dysfunction has high potential for successful interventions to maintain insulin secretion for individuals with established T1D as well as those with prediabetes.”

A study has been done to see whether any genetic link could justify the apparition and severity of T1D in children by looking at autoimmune diseases in the extended family. The short conclusion is that approximately 30% of children with newly diagnosed T1D have a 1st and or 2nd-degree relative affected by an autoimmune disease like autoimmune thyroiditis, celiac disease, Addison’s disease, pernicious anemia, rheumatoid arthritis and multiple sclerosis. Moreover, between 9 and 19% of the children with T1D have another autoimmune disease.

An interesting point is made about the influence of the microbiome both on metabolism and immune system. For the time being only mice have been used but the results have good chances to be extrapolable to humans. “Emerging evidence suggests that both host metabolism and immune function is crucially regulated by the intestinal microbiome. Recently, we showed that in the non-obese diabetic (NOD) mouse model of Type 1 Diabetes (T1D), the gut commensal microbial community strongly impacts the pronounced sex bias in T1D risk by controlling serum testosterone and metabolic phenotypes”.

Additionally, LADA (Latent Autoimmune Diabetes of the Adult), Type 1 diabetes diagnosed during adulthood seems to have a mix of genetic characteristics from childhood-onset Type 1 diabetes and Type 2 diabetes. “Metabolic changes at diagnosis reflect a broad clinical phenotype ranging from diabetic ketoacidosis to mild non-insulin-requiring diabetes”, as said in the article. In this case, we probably have a mix of immunological and metabolic changes leading to the disease.

I’m not sure whether one day we will be able to really discover the autoimmune or metabolic origins of T1D. It is probably a mix of both as complex disruptions and dysfunctions in the human body are leading to T1D onset.

 

Selected articles used

Latent autoimmune diabetes of the adult: current knowledge and uncertainty – 2015

Alteration of regulatory T cells in type 1 diabetes mellitus: a comprehensive review – 2015

Metabolic abnormalities in the pathogenesis of type 1 diabetes – 2014

Microbiome manipulation modifies sex-specific risk for autoimmunity – 2014

Extended family history of autoimmune diseases and phenotype and genotype of children with newly diagnosed type 1 diabetes – 2013

 

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