Introduction
In 1922, a diabetic teenager in a Toronto hospital became the first person to be injected with insulin. Nearly a century later, patients with diabetes are on the verge of being able to set their insulin doses using their smartphones. The progress in tech-based treatment in recent years is staggering, with wireless and implantable technologies emerging that just a few years ago might have seemed like science fiction.
An Artificial Pancreas
People with type 1 diabetes may soon be able to set their insulin doses by smartphone. Researchers from Massachusetts General Hospital and Boston University are testing a “bionic pancreas,” a pump that goes under your skin that when paired with an app and a small chip tracks blood sugar levels and adjusts amounts of insulin and glucagon on its own. In a small study[1]published in the New England Journal of Medicine, among 20 adults and 32 adolescents who were told that they could eat as they wish, the system maintained glucose levels in the acceptable range 79% and 75% of the time, respectively, vs 58% and 65% of the time when participants used their regular monitoring systems. A follow-up study is planned followed by a submission for US Food and Drug Administration (FDA) approval in 2017.
Smart Pills
No more missed doses: Researchers in the United States and the United Kingdom are testing a silicon tablet called Helius (Proteus Digital Health; Redwood City, California) that helps monitor medication adherence. The once-daily “pill” has a sensor resembling a grain of sand; the sensor is covered in magnesium and copper, which generate power by reacting with stomach acid, sending a signal indicating the time of pill ingestion (other pills, that is) to a wearable patch. The patch in turn forwards this information to a patient’s smartphone using Bluetooth. Current studies include patients with heart failure or hypertension; however, the Helius manufacturers plan to study the technology in other chronic health conditions soon.
Cuff That Curbs Heart Failure
An experimental treatment called C-Pulse® (Sunshine Heart; Eden Prairie, Minnesota) has the potential to slow down and possibly even reverse heart failure. The device is implanted through a small incision in the chest; it wraps around the aorta and consists of a cuff that inflates and deflates in rhythm with a patient’s heartbeat, improving blood flow. An external battery powers the C-Pulse.
Dime-Sized Heart Monitor
A tiny device approved last year by the FDA alerts physicians when their patient’s heart failure symptoms are worsening. The CardioMEMS™ HF System (St Jude Medical; St Paul, Minnesota) is inserted through a catheter into the pulmonary artery; it wirelessly measures and monitors pulmonary arterial pressure and uploads the data to a website. Treatment response can also be monitored in real time.
A Disc to Ease Inflammation
Data are mounting supporting a connection between our immune and nervous systems. An investigational iPad®-driven neuromodulation device (SetPoint Medical; Valencia, California) reportedly reduces systemic inflammation by stimulating the vagus nerve via an implantable pulse generator. A small study[2] presented at the 2012 American College of Rheumatology Annual Meeting reported positive results in patients with rheumatoid arthritis; a study in patients with Crohn disease is also planned.
Annual Implants to Treat Diabetes
This matchstick-size pump—currently called the ITCA 650 (Intarcia Therapeutics; Boston, Massachusetts)—could replace pills and injections for type 2 diabetes. It’s implanted under the skin of the abdomen and releases doses of the glucagon-like peptide-1 agonist exenatide (Bydureon®, Byetta®) to help control blood glucose. It must be replaced yearly. Clinical trials are nearing completion, and the maker hopes to bring the device to market in 2016.
A New Option in Sleep Apnea
Many patients with sleep apnea aren’t so keen on cumbersome, often uncomfortable continuous positive airway pressure (CPAP) machines. As an alternative, last year the FDA approved a device called Inspire® (Inspire Medical Systems, Maple Grove, Minnesota) that improves upper airway patency during sleep. Here’s how it works: A respiration sensor in the chest delivers a signal to an implanted generator, which in turn stimulates the hypoglossal nerve in between the end of expiration and the beginning of the next expiratory phase.
Meds via Microchip
New investigational technology from MicroCHIPS (Lexington, Massachusetts) may make long-term, wireless drug delivery possible. The microchip-based implant is placed under the skin and contains 200 microreservoirs that can each store 1 mg of medication. Clinicians can remotely control medication release wirelessly; it can also be outfitted with sensors that release drugs in response to physiologic measures. The first human study[3] of the chip system reported that women receiving teriparitide for osteoporosis absorbed the same therapeutic drug levels as those receiving daily injections. The device also resulted in more dose-to-dose consistency.
An Injectable for Back and Leg Pain
A new treatment for chronic back and leg pain is about the size of a staple. The Stimwave Freedom Spinal Cord Stimulation System (Stimwave; Miami Beach, Florida) is injected and powered by an external battery; the tiny stimulator delivers pulsed electric current to nerve fibers near the dorsal aspect of the spinal column to lessen pain sensation. The FDA approved the device in 2014.
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