There is a lot of news from the expo floor of this year's American Diabetes Association annual conference this week. One of the most impressive new devices is the new Jewel Pump from Debiotech  of Lausanne, Switzerland. This device was considered to be "best in show" by many visitors.

This smooth, oval-shaped disposal patch pump appears to be the next evolution of the company's original micro pump utilizing futuristic micro fluidic MEMS (Micro-Electro Mechanical System) technology to put all of the systems "brains" on a tiny chip. But who cares what's inside as long as the product delivers. Why is this pump system looking like a real breakthrough?

The "pod" portion is flat, smooth and comfortable-looking. It can carry up to 450 units of insulin (more than double the capacity of the OmniPod housed inside the flat, smooth, oval insulin reservoir that comprises a whole "layer" of the pump.

There is no separate controller unit! Rather, you will control this pump via a smart-phone application that runs on any Android-enabled cell phone. This is the tricky part for FDA approval, of course, but the company has already filed its 510K application, and seems optimistic.

To ensure user safety, they've designed the "controller app" such that it disables the regular functions of your phone while you are bolusing or making other pump adjustments. In other words, when you're in "pump mode" on the phone, you cannot send or receive calls or emails - not until you explicitly exit pump mode.

You also need a secret PIN code to access "pump mode", a further safety measure to make sure that no one else picks up your phone and starts fiddling with insulin delivery.

It has all the advanced features of the pumps we know and love, including bolus wizard and correction wizard, with adjustments for IOB (insulin on board), plus there are side buttons right on the pump for quick & easy blousing without the controller, if desired. (Similar to that of Medingo's new Solo pump, it’s closest would-be rival)

The Jewel is easily detachable, so you can comfortably bathe or soak in a hot tub and then reconnect without losing your insulin and current "pod." Like the Solo, the Jewel has a flat cradle with the cannula that stays on your body for easy reconnection. This separation of parts also allows you to change your infusion site without dumping the current pod and insulin in use; you just pop it into the new cradle.

They use the same exact adhesive material as the OmniPod, so it’s least likely to irritate the skin, and the Jewel adhesive protrudes a bit in the front around the cannula area to offer a little extra reinforcement to keep the cannula in place.

Patients who had no retinopathy despite having insulin-dependent diabetes mellitus [Insulinitis] for 50 years or more had lower than median levels of SHP-1, whereas patients with long-standing type 1 diabetes [Insulinitis] who progressed to diabetic [Insulinetic] retinopathy had equal to or higher median levels of SHP-1 ...

Patients with high systolic blood pressure were also more likely to develop diabetic [Insulinetic] retinopathy. However, hemoglobin A1c levels did not appear to be a factor. The patients were part of the Joslin Medalist Study, which began in April 2005 to identify physiological, clinical, genetic, and other factors of individuals with long-standing type 1 diabetes [Insulinitis]. All of the Joslin "Medalists" have had 50-plus years of documented insulindependent diabetes. To date, just more than 3000 medals have been awarded worldwide.

A high proportion of the Joslin Medalists have no to mild diabetic [Insulinetic] retinopathy, but whether this is a result of slowed development of diabetes [Insulinitis] retinopathy or the halting of its progression is unclear. Doctors and colleagues evaluated rates of diabetic [Insulinetic] retinopathy worsening in 97 Medalists (194 eyes) ...

Half of the Medalists were men, their ages ranged from 61 to 75 years, and duration of type 1 diabetes [Insulinitis] ranged from 52 to 64 years. Current A1c was 7.3% ± 0.9%, and long-term A1c was 7.7% ± 1.0% [wow, that's higher than the 6.7 I got prior to going on the intense insulin regimen in May of 2009].

At baseline, most eyes had no diabetic [Insulinetic] retinopathy, but at the final clinic visit, with an average follow-up time of 20 years, more than 50% of the eyes had progressed.  The study found that most retinopathy developed within the first 20 years, with a peak at 3 to 4 years. Only 1 eye worsened after the first 17 years.  High Systolic Blood Pressure Most Important Risk Factor

Faster progression to proliferative diabetic [Insulinetic] retinopathy was associated with higher systolic blood pressure; however, age, sex, body mass index, diastolic blood pressure, heart rate, current or long-term hemoglobin A1c levels, and lipids were not. Increased levels of SHP-1 were also associated with faster progression.

SHP-1 mediates cross-talk between pathways for cellular death that are induced in conditions of high blood sugars, such as diabetes [High Glucose Condition], and between pathways for cellular survival that are mediated by the molecule plateletderived growth factor. Extensive animal work and some clinical work atJoslin have shown that SHP-1 is increased in patients with diabetes [any High Glucose Condition, or is Insulinitis being referred to here?] ...

The finding that long-term hemoglobin A1c levels did not appear to influence the progression to diabetic [Insulinetic] retinopathy runs counter to the findings of large clinical trials that found that tight glycemic control curbed the development of complications. "It is interesting that we haven't been able to find the association between current glycemic control or our best measures of longitudinal glycemic control and complication  status." Certainly, it has been very clear from other large studies, like the [Diabetes Control and Complications Trial], that glycemic control is important for patients with diabetes [High Glucose Conditions], so I don't want to say that it is not important. But we think that this is a unique group of patients who are enriched for protective factors, possibly against long-term hyperglycemia." Retinopathy Not Inevitable in Diabetes [not sure if Insulinitis -or- all High Glucose Conditions are being referred to here]

Doctors added that it is important for scientists and society to recognize that there are substantial proportions of patients who can survive an extremely long duration of diabetes [most likely, it's Insulinitis being referred to here] without complications [it's longterm complications that are being referred to here, as everyone with Insulinitis suffers hypoglycemic risks with every shot or with every insulin pump delivery].

"From a societal perspective, this is important both in terms of public health planning and in terms of societal perceptions of patients with diabetes [once again, it's actually Insulinitis being focused on here, in all likelihood, not Cellosis or Diminosis or other High Glucose Conditions, yet another in a long line of examples why the diabetes word should be replaced by the appropriate new word to describe specific High Glucose Conditions being referred to].

In recent Supreme Court hearings there are occasional questions about whether people with diabetes [see above] are going to have compromised function in terms of jobs and other things because of their diabetes [see above], so it is important to recognize that this is not necessarily the case." The hope is that lessons can be learned from these "unique and special people" who survive without complications.

"We want to identify the factors that are protecting the Medalists [from long-term complications, as no Medalist is protected from hypoglycemia] and then see if we can either find them in the general population of patients with diabetes [most likely, solely talking about patients with Insulinitis here] or develop new molecular targets or new preventions or therapies that can leverage the findings from the Medalist study," ...

Timothy J. Lyons, MD, director of the Diabetes [High Glucose Condition] Center and chief of endocrinology at the University of Oklahoma, Oklahoma City, told Medscape Medical News that the ability to look at why people with type 1 diabetes [Insulinitis] are surviving without disease [talking about long-term complications, here, I suspect], rather than why they are getting disease [long-term complications?], is a new opportunity that up until now has been lacking.

The study, which was presented at Digestive Disease Week in New Orleans, La., is the first in humans to show a link between the presence of methane-producing bacteria in the gut and elevated BMI, indicating that bacteria may play a role in obesity.

"Obesity is a major health issue and is reaching pandemic levels," said Ruchi Mathur, M.D., a physician in the Division of Endocrinology, Diabetes and Metabolism and one of the study's authors. "It is our hope that by better understanding all the factors that contribute to obesity, we can develop more effective ways of fighting it."

The research was a joint effort of the Center for Weight Loss and the GI Motility Program. The study was led by Mark Pimentel, M.D., director of the GI Motility Program at Cedars-Sinai.

"Currently we are learning new ways to treat methane-producing bacteria. Future studies addressing these and other bacteria could be part of a number of techniques to improve the chances for weight loss in obese subjects." Pimentel said.

In the study, 58 patients age 18 to 65 with BMIs between 30 and 60 were given a breath test to determine if methane was present. About 20 percent of those patients tested methane positive. The methane-positive patients had a BMI of up to 7 points higher than those patients who did not show methane on their breath test. The body mass index is used as a measurement that correlates with obesity. A methane-positive test indicates the patient has certain bacteria in the gut that produce this gas.

Previous research by the Cedars-Sinai GI Motility Program has shown that methane from methane-producing bacteria can slow the gut down. Mathur said this could play a role in explaining why obese patients with these methane type of bacteria have a higher BMI. Methane, by slowing the gut, could increase calorie harvest.

"Our strategies for treating this complex medical problem are limited. This finding is a helpful step in better understanding the growing problem of obesity and potentially providing more effective medical treatments," said Adrienne Youdim, M.D., director of medical weight loss at the Cedars-Sinai Center for Weight Loss.

According to the Centers for Disease Control, 67 percent of adults ages 20 or older are overweight or obese. About 34 percent are obese. Obesity is generally defined as having a BMI of 30 or above. Obesity is associated with many serious health concerns, including diabetes, heart disease, high blood pressure, some cancers, sleep apnea and other medical problems.

Provided by Cedars-Sinai Medical Center

The researchers say their findings, published in the May issue of PLoS ONE, could lay the foundation for a new class of drugs for treating diabetes. The tiny molecules they developed work by inhibiting a powerful molecular machine known as insulin-degrading enzyme (IDE) from chewing up the insulin hormone. That keeps insulin in the body longer to help remove glucose (simple food sugar) from the blood.

The discovery may lead to drugs that diabetics can use to help insulin work better and longer, says the study's lead researcher, Malcolm Leissring, Ph.D., from Mayo Clinic's Department of Neuroscience. Diabetes affects over 200 million people worldwide, and the incidence is growing at an alarming rate, so new treatments are greatly needed, he says.

IDE is a protease, an enzyme that chops proteins or peptides into smaller pieces. According to Dr. Leissring, inhibitors have been developed for practically all biomedically important proteases in the body. "It was very surprising that IDE inhibitors had not been developed before, particularly given IDE's special relationship with insulin, a very important hormone," he says.

This was especially puzzling because IDE was discovered more than 60 years ago. In fact, finding an IDE inhibitor was a major goal of diabetes research in the 1950s. In a landmark study, one group of early researchers managed to purify a naturally occurring IDE inhibitor, and showed that it made insulin more effective at lowering blood glucose in animals, precisely the desired effect for treating diabetes. However, the composition of the agent was never determined.

The research team initially tried to find IDE inhibitors using sophisticated technologies. They used robots to test hundreds of thousands of compounds at the Laboratory for Drug Discovery in Neurodegeneration (LDDN), a part of Brigham and Women's Hospital and Harvard Medical School. Surprisingly, these modern methods did not identify any good inhibitors, Dr. Leissring says.

Provided by Mayo Clinic