Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Julia Greenstein, Ph.D.
1. 1
Type 1 Diabetes:
Progress Toward its Prevention,
Treatment, and Cure
Julia Greenstein
JDRF VP Cure therapies
jgreenstein@JDRF.org
April 9, 2013
2. JDRF Mission: Cure, Treat, and Prevent T1D
Cure T1D by removing the
disease from the lives of our
loved ones
CureCure
Better ways to Treat T1D so
people can live healthier
lives more conveniently
TreatTreat
Prevent T1D from occurring
& stopping it early
Prevent
3. 3
Our Goal: Life Changing Therapies…
Leading to a World Without T1D
Clinical
Development
Regulatory
ADVOCACY
RESEARCH
ADVOCACY
RESEARCH
ADVOCACY
RESEARCH
Delivery
to Patients
Discovery
Research
Proactively accelerate the discovery, development, and
delivery of drugs and devices to cure, better treat, and
prevent type 1 diabetes and its complications.
4. JDRF Partners
4
Proactively accelerate the discovery, development, and
delivery of drugs and devices to cure, better treat, and
prevent type 1 diabetes and its complications.
5. JDRF Mission: Cure, Treat, and Prevent T1D
Cure T1D by removing the
disease from the lives of our
loved ones
CureCure
Better ways to Treat T1D so
people can live healthier
lives more conveniently
TreatTreat
Prevent T1D from occurring
& stopping it early
Prevent
7. Human Embryonic Stem Cell-Derived Islet
Sources: Progenitors Mature to Islets In-Vivo
8. • Physical barrier to protect islets from immune responses
• Barrier should allow islets to survive and function, sensing glucose
and releasing insulin physiologically
Dr. Tejal A. Desai UCSF
Encapsulation of Islet or Islet Precursor for
Immunoisolation
9. Diabetes 50:2020 (2010)
In this individual, after more than 50 years of type 1 diabetes,
•every islet had at least one insulin positive beta cell (left)
•replicating beta cells cells were also found (right)
After 50 years of type 1 diabetes, beta cells can
still be present
11. JDRF Mission: Cure, Treat, and Prevent T1D
Cure T1D by removing the
disease from the lives of our
loved ones
CureCure
Better ways to Treat T1D so
people can live healthier
lives more conveniently
TreatTreat
Prevent T1D from occurring
& stopping it early
Prevent
12. 12
0
10
20
30
40
50
60
70
1950 1960 1970 1980 1990 2000
Finland
Sweden
Colorado
Germany
Cases/100,000/yr
in children 0-14 yrs
T1D Incidence (# new cases/yr) is doubling
every 20 yrs (~3-4% annual increase)
Burden: Increasing Incidence of T1D
13. Relative Percent Increase of
Type 1 Diabetes Incidence in
Finland 1965-1996 (32 yrs)
Type 1 Diabetes is Occurring Earlier in Life
Projected Age-Incidence of T1D
from 2006-2020 in Finland
Lancet: 371:1777, 2008
14. 14
Rationale for T1D Prevention
Risk of developing T1D can
be diagnosed
T1D develops with a relatively
predictable course with
variable rate of progression
Rate of progression to insulin
dependence can be predicted
Adapted from Eisenbarth
100%
0%
FunctionalBetaCell
Mass
At Risk Pre-Diabetes
Recent
Onset Established Diabetes
Diagnosis
Time
Genetic
Risk +
Environmental
Etiologies
Beta Cell
Autoimmunity
Beta Cell
Loss
Glucose
Intolerance
Insulin
Dependence
15. 15
T1D Prevention Interventions
Adapted from Eisenbarth
100%
0%
FunctionalBetaCell
Mass
At Risk Pre-Diabetes
Recent
Onset Established Diabetes
Diagnosis
Time
Beta Cell
Autoimmunity
Beta Cell
Loss
Glucose
Intolerance
InsulinInsulin
Dependence
Primary
Prevention
Secondary
Prevention
Genetic
Risk +
Environmental
Etiologies
17. JDRF Mission: Cure, Treat, and Prevent T1D
Cure T1D by removing the
disease from the lives of our
loved ones
CureCure
Better ways to Treat T1D so
people can live healthier
lives more conveniently
TreatTreat
Prevent T1D from occurring
& stopping it early
Prevent
18. Mean
HbA1c
2011-2012 data
67 Clinics
n = 24,116
Poor Glucose Control in T1D in USA
Despite Care at State-of-the-Art Clinics
(HbA1c should be <7.0% to avoid complications)
Goal: HbA1C <7.5% Goal: HbA1C <7%
18
19. 19
Closed Loop Artificial Pancreas Systems:
Simulate a normal pancreas
• Requires:
- Improved glucose sensors
- Improved Insulins + other
drugs (glucagon)
- Improved control software
- Dual/multi-chamber pumps
20. 20
11
Very Low Glucose
Insulin Off Pump
Pump Shuts off
when user not
responding to
low-glucose alarm
22
Hypoglycemia
Minimizer
Predictive
hypoglycemia
causes alarms
followed by
reduction or
cessation of
insulin delivery
before someone
gets low
33
Hypoglycemia/
Hyperglycemia
Minimizer
Same as Product
#2 but added
feature allowing
insulin dosing
above high
threshold
(e.g., 200mg/dl)
44
Automated
Basal/Hybrid
Closed Loop
Closed loop at
all times with
meal-time manual
assist bolusing
55
Fully Automated
Insulin Closed
Loop
Manual meal-
time bolus
eliminated
66
Fully Automated
Multi-Hormone
Closed Loop
First
Generation
Second
Generation
Third
Generation
Progression to Artificial Pancreas Systems
There Will Be Multiple Generations: Each Becoming More Automatic
21. Overnight Closed-Loop Control will be Early Success
and Important (55-75% of Severe Hypoglycemia at Night)
• Lowers glucose variability
• Controls to a tight range (71% vs 43% in range)
• Reduces extreme hyperglycemia and
hypoglycemia (2.1% vs 4.1% <70mg/dl).
T1D onset with loss of ~ 70% fx beta cells 70% anatomc loss Insulitisi in 20% of remaining islets with beta cells Can see non inflamed islets lobuar Resiudal explains honeomone oeriod Envirn stimuli—first year of life and second year T1D assoc autoab s—insulin, GAD, IA-2 Znt8--- insulin proisnusl targted in young Single autoab –less than 5% progress—autoimm is not autoimm disesase----progress Only a fraction progress forward With loss of fx betaq cell mass---18 mnths a dx—see decreased beta cell glucsoe sensitivity –ability to recognize and response to a glucose load with insulin secretion; HbA1c rising abn IVGTT OGTT Handling of insulin Heterogeneity Asyx T1D