JDRF is an organization that has been leading efforts to help develop a cure for type 1 diabetes for over forty years now. It is currently sponsoring more than $500 million of research in 17 countries and things are looking pretty good for the future of people with type 1 diabetes. Recently, the organization created a new role of Chief Mission Officer and brought on Aaron Kowalski, PhD to fill it, also naming him Vice President, Research. We had a chance to ask Dr. Kowalski about what JDRF is up to, what the new role entails, and most importantly what people with diabetes can expect in the coming years as new knowledge and technology improve how the disease is treated.
Medgadget: How did you get interested in diabetes research and what have you seen as the major achievements in this field over the past few decades?
Aaron Kowalski: In 1977, my brother Stephen was diagnosed with type 1 diabetes at the age of three and then in 1984, I was diagnosed at age 13. My family had no history of diabetes and it was a real shock. At that time, glucose control was quite poor (the tools to achieve good control were crude or didn’t exist) and diabetes complications were common and seen as a foregone conclusion. Growing up with type 1 at that time wasn’t easy. My brother had many instances of severe hypoglycemia (low blood sugar) that required emergency care and hospitalizations. These experiences motivated me to go into science. I was fortunate that my father is a PhD scientist and was an amazing role model.
Fortunately, since 1977 we’ve seen tremendous advances in diabetes. Through the 1970’s, urine testing of glucose was the only mechanism to measure diabetes control. This was very crude and the end result was the majority of people with diabetes had very high blood sugar levels leading to diabetes complications. Convenient blood sugar testing was an incredible advance and changed diabetes management for the better.
We’ve seen very important advances in the insulin that is used to treat diabetes. In 1977 and through the 1980s, the insulin used was derived from pigs and cows. We now have recombinant human insulin products with improved properties – faster acting, long acting, etc., that have helped improve glucose control with reduced risk of hypoglycemia.
Over the last decade we’ve seen technologies help dramatically improve diabetes care and control. Insulin pump therapy has provided people with diabetes a more physiologic means to dose insulin and continuous glucose monitors now provide real-time glucose data with trend information and alarms that sound when blood sugar goes too high or too low. These tools have been fantastic advances to further improve diabetes care.
Medgadget: What about the near future and what developments do you expect to see in the coming decades?
Kowalski: JDRF is committed to helping accelerate improved treatments until there is a cure for the disease. There are some exciting therapies on the horizon that will further improve the treatment of diabetes – both through better blood sugar control as well as improved quality of life.
In the nearest-term, artificial pancreas systems will be approved by FDA and have an incredible positive impact. These systems will combine insulin pumps and continuous glucose monitors with algorithms (sophisticated computer software that will automate some insulin delivery). JDRF has funded more than $100M in artificial pancreas research and the results from studies have been extremely promising, and we are seeing a drive to commercialize these systems, making them available to people with diabetes.
Another very exciting potential therapy is encapsulated islets. Encapsulation combines incredible advances in stem cell biology with advances in material science. In the past year, the first human studies have begun that are testing encapsulated islet device. This is a small flexible “packet” that contains stem-cell derived islets and is implanted under the skin. The packet protects the cells from the autoimmune response in people with type 1 diabetes destroys cells that produce insulin, allowing the cells to live and make insulin in response to changing glucose levels.
Smart insulin, or glucose-responsive insulin, could be another major advance. Smart insulin would activate in response to high blood glucose levels and then be “inactive” at low glucose levels. JDRF supported a small biotech company, Smartcells, which was developing a smart insulin that was in turn acquired by Merck. Smart insulin would be game-changing and we are working to support multiple approaches to develop smart insulins.
Medgadget: What are the different challenges and technological expectations you see between addressing/treating Type 1 and Type 2 diabetes?
Kowalski: This is a great question. There may be some different challenges for people with type 1 and type 2 diabetes, but I think if you boil it down the key issue is the balance between wearing devices and the benefit derived. Stated more simply, people only choose to wear devices if they feel the benefit is high enough compared to giving themselves insulin injections. A focus of JDRF has been working with device manufacturers to drive innovation and improvements in diabetes devices that make the devices easier to wear and use. I believe that these improvements will impact all people with diabetes who may benefit from new technologies.
Medgadget: You recently took on a new role within JDRF, Chief Mission Officer. Can you tell us what you’re up to and what you’re working on in this new role, and what exactly the position entails?
Kowalski: I’ve been fortunate to be a member of the JDRF research team for the past ten years and my role there will continue. Over the past years, JDRF has focused more on the barriers and obstacles after research advances are made, to the ultimate positive impact to people with diabetes. Research advances must be commercialized, they need regulatory approval, they need to be affordable, and they need to fit into the healthcare system for providers. As Chief Mission Officer, I will be working with teams at JDRF to help accelerate this process and in doing so building strong ties to the broad diabetes community as a champion for the JDRF mission. This will include working and partnering with other diabetes organizations, professional clinical organizations, and diabetes stakeholders to help people with diabetes achieve better outcomes as quickly as possible.
Medgadget: Tell us about the technological goals and projects that JDRF is working on these days. What milestones do you think will be achieved in terms of devices to manage T1D in 2015?
Kowalski: We have a strong focus on artificial pancreas technologies and key components of artificial pancreas (AP) systems. JDRF is supporting research in academic centers around the world as well as working and partnering with diabetes device manufacturers to speed the development of AP technologies. The results of this research have been incredibly positive – systems reduce high and low blood sugar and ease the burden of managing the disease. We have seen advances in infusion sets that are nearing commercial launch, improved continuous glucose sensors are coming to market, and AP systems that reduce hypoglycemia risk will be launched in Europe in 2015 and are being tested for FDA approval in the U.S.
Medgadget: What do you expect the experience of a six-year-old with T1D to be like ten years from now?
Kowalski: There will certainly be advanced artificial pancreas systems that reduce the burden of managing T1D and significantly improve diabetes control. These systems will likely be integrated into cell phones, and the pumps and sensors will be smaller and much easier to wear. Continuous glucose monitors will likely have replaced fingerstick testing to a large degree. In ten years we may be on the cusp of approaches such as encapsulation and smart insulin, which could revolutionize diabetes care. While living with T1D – a 24/7/365 disease – is hard, the future is bright. JDRF will continue to look for opportunities to make treatment advancements a reality as quickly as possible and accelerate progress that makes life healthier and easier for people with type 1 and their loved ones until we find a cure.