Architects of a Cure—Especially for Children
He was supposed to be on his way to a little league tournament. The team’s star pitcher, 13-year-old Derek Kaplan was supposed to lead his club to regional baseball glory. Instead, his mother was dragging him to the pediatrician. She was worried about the 25 pounds he had lost and his seemingly unquenchable thirst, among other symptoms.
The pediatrician listened to Derek’s chest, peered down his throat and sent him on his way. For a moment, it looked like he would play ball after all. But as mother and son were leaving, literally waiting for the elevator, the office nurse caught up with them. “Do you mind coming back in for a minute? The doctor wants to do one more test.”
That test was a finger prick for blood glucose level. The result, a whopping 600 mg (normal before a meal is 70–130 mg), sent Derek straight to the pediatric intensive care unit, where his high blood sugar was treated and he was taught the delicate life-saving task of managing his Type 1 diabetes with insulin injections.
Fast-forward 19 years. Derek is a firefighter in the City of Miami and his mother, Ellen Goodstein, is executive director of William Sansum Diabetes Research Center (WSDC)—a Santa Barbara nonprofit at the forefront of diabetes treatment, research and education. Participating in a series of clinical trials, WSDC helps to develop and test algorithms and other systems that may ultimately be used in an FDA-approved artificial pancreas—the holy grail in Type 1 diabetes management. Most noteworthy is its participation as one of 10 clinical sites in the largest ever long-term clinical trial of this much-anticipated technology, the International Diabetes Closed-Loop Trial, recently funded by the National Institutes of Health.
Jordan Pinsker, M.D., is the pediatric endocrinologist who supervises all of WSDC’s artificial pancreas clinical trials. (Currently, four are ongoing at the center.) Every year, 18,000 children and adolescents are diagnosed with Type 1 and 5,000 children and adolescents are diagnosed with Type 2 diabetes. Learning to manage these life-threatening diseases—by keeping blood glucose levels within a normal range—is the key to staving off dangerous complications. But it takes constant monitoring of blood glucose and careful dosing of insulin and other medicine to accomplish that—a hard task for adults, even harder for children. Although devices like continuous glucose monitors (CGM) and insulin pumps provide the necessary information, the patient still must read the data and gauge insulin dosages. But an artificial pancreas would replace all that, closing the loop, so to speak, as it assumes dosing decisions and releases the appropriate amount of medicine.
Right now, all artificial pancreas trials at WSDC are on adults. But Dr. Pinsker says he hopes to bring some children into them as well. In the meantime, a clinic he runs helps children and adolescents master the use of insulin pumps and glucose monitors—a key service since not every physician is comfortable with these rapidly advancing technologies.
Kristin Castorino, D.O., a research physician at the center, coordinates another important study on the effects of CGM use by women before and during pregnancy. The goal of the so-called CONCEPTT study, funded by the Juvenile Diabetes Research Foundation in Canada, is to improve pregnancy outcomes in women with Type 1 diabetes.
Managing diabetes without a CGM is like driving at night without headlights, explains Castorino. “A CGM helps you see the road,” she says. She also coordinates Type 2 diabetes community outreach and education through a program called Seeds of Change.
“If you see pictures of people before the advent of insulin, you can tell diabetes was a death sentence,” says Goodstein. “The patient just wasted away.” William Sansum, a Santa Barbara physician, was the first doctor in America to manufacture and inject insulin (discovered by Canadian doctors Frederick Banting and Charles Best) into a patient. The center he founded has clearly and vigorously continued his legacy of groundbreaking innovation.
“We have a picture of him in the hall, and I go by that picture and just say thank you all the time,” Goodstein says. “I really do.”
For more information about William Sansum Diabetes Research Center, or to make a donation, visit sansum.org.
This story was originally published in the Fall 2016 issue of Santa Barbara Seasons Magazine.