The Rise of the Machines
Thursday, 06 February 2020
Ms Joan Ingram OBE, Patient/journalist
The Rise of the Machines - and How Ready is the Medical Establishment for Technological Transformation in Type 1 Care?
Joan Ingram graduated from Dundee University in 1981, with an MA in Politics and Jurisprudence. She embarked on a career as a journalist, becoming one of Scotland’s leading television politics presenters; hosting a variety of high profile programmes such as Crossfire, and Scotland 500. After obtaining an MBA from Aberdeen University, she moved into the business world, establishing The Fifth Business Ltd.
Meeting notes from 6/2/2020
The President, Dr Reith, welcomed everyone to the meeting and noted the apologies. He welcomed Dr Kulkarni to membership and notified members of the death of Professor Graham Page (Emergency Medicine). Members were reminded about the forthcoming President’s Medal lecture on 20th February, to be delivered by Professor Neva Haites, and the next monthly meeting on 5th March, where the talk will be given by Professor Sir Lewis Ritchie.
Dr Reith then introduced the speaker for the evening, Ms Joan Ingram, and highlighted her biography (as above).
Ms Ingram thanked the President for his welcome and began her talk by providing background information about her interest in diabetes and her active support of the Juvenile Diabetes Research Foundation (JDRF). She has relatives with Type 1 diabetes and has also discovered many challenging stories of people in the UK, and across the globe, who deal with the impact of diabetes on a daily basis. She used a video at the beginning of her talk, about a five-year-old who died of undiagnosed Type 1 diabetes, to show the potentially tragic impact of the disease.
She described difficulties a family will encounter when a child is diagnosed with Type 1 diabetes; testing, insulin injections (often with fear of adjusting insulin doses in the early days after diagnosis), counting carbohydrates and fears for the future if HbA1C is poorly controlled e.g. potential for problems with eyesight and foot problems by the age of 30. Currently, a Scottish child with Type 1 diabetes has a life expectancy of 13 years less than a healthy child. A diagnosis in the teenage years can be especially difficult as the young person has experienced life without the regime of insulin, testing and diet.
Ms Ingram knows of instances where it has been advised that an insulin pump would be helpful for diabetic control, but none were available unless purchased privately. She is also aware of instances where a child/family has declined an insulin pump and opted for standard insulin injections, highlighting the importance of personal choice.
The JDRF is working to find a cure for Type 1 diabetes and the organisation also works with families affected by diabetes to provide information and guidance. They are a global organisation with research currently taking place in 17 countries and $530 million invested in that research. There are short, medium and long-term projects; a common area of research across all of these is the “artificial pancreas”.
Artificial pancreas-a glucose monitor “talks to” an insulin pump to regulate the dose of insulin. These are currently available in USA and clinical trials are underway in the UK. Patients still need to count carbohydrates and still require blood glucose testing.
Glucose responsive insulin-a form of insulin which is activated when blood glucose levels start to rise.
Encapsulation-implantable beta cells or pancreatic islets (within a protective “teabag” covering to hide them from the immune system).
Regeneration-focuses on finding ways to grow, or encourage the body to grow, brand new beta cells in order to replace those destroyed by the immune system in Type 1 diabetes. Regenerative treatments could one day cure people with type 1 by allowing them to make insulin on demand again.
Current research in Scotland
- Professor Yannick Crow - immune research
- Professor Rory McCrimmon - researching effect of high intensity exercise on increasing awareness of hypoglycaemia
- Professor Helen Colhoun - epidemiological research in to diabetes and its complication eg. retinopathy, renal disease
Ms Ingram noted that 15-25 year-olds are the hardest group to reach to support in chronic illness. Of all the countries where figures are available, Scotland currently has the highest proportion of Type 1 diabetics in the most dangerous zone of diabetic control in this age group. Learning from the experience of other countries with better results is important. She expressed the opinion that the NHS providing a free service at the point of need is very important to the diabetic community.
Ms Ingram mentioned the discovery of insulin in 1921 by a team led by JJR Macleod (Aberdeen Grammar School/Aberdeen University). The patent for insulin was sold to the Canadian Government for $1. She highlighted that, despite the intention that this would promote production and make it accessible for all who required it, this has not been the case. In the USA, the cost of insulin can be up to 43 cents per unit. Buying insulin can cost more than buying food and there have been deaths resulting from patients rationing their insulin.
She then highlighted the positive impact she feels insulin pumps have in the management of Type 1 diabetes. Users of insulin pumps have a death rate 29% lower than that of patients receiving standard insulin injections (study of 18000 patients). Tubeless and wireless pumps are now available e.g. Omnipod. Until approximately two years ago, patients opting for this system required to be self-funding. Only 12% of Scottish Type 1 diabetics use an insulin pump. In some countries, all newly diagnosed Type 1 diabetics commence treatment with a pump. There is now a trial in Edinburgh where newly diagnosed children commence treatment with an insulin pump. The #wearenotwaiting movement is trying to progress an algorithm for an open-loop system with an artificial pancreas e.g. the patient could receive an alert or phone call if they were becoming hypoglycaemic. There are also self-help groups which aim to promote and support use of insulin pumps.
Ms Ingram highlighted that whether patients use a pump or standard insulin injections, it is imperative that their “insulin kit” goes everywhere with them. She related the story of an 11-year-old from Aleppo with diabetes. Her father, a pharmacist, had paid traffickers to help the family flee the Syrian war. Whilst on an overcrowded boat, the child’s insulin kit was thrown overboard and she died. She concluded her talk by showing a JDRF video: A world without Type 1 diabetes is not a dream.
The evening concluded with Ms Ingram answering questions and receiving thanks from the President. During questions, the extensive work of Professor John McKnight with the Scottish Diabetes Survey was highlighted.