Health Committee on Nov. 27th, 2012

[Andrew McKee]

That's the goal right now.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

How would that work? Would it be a pump like this, a more sophisticated pump?

[Andrew McKee]

In essence, it would be a more sophisticated version of that pump and a continuous glucose monitor.

Maksim, you're not wearing your CGM right now, are you?

You're wearing your CGM, Marley.

That pump has a continuous glucose monitor connected to it. So the tubing you see is the mechanism for putting insulin into the body. On another spot on her body, Marley will have a patch that is reading her glucose levels. So she can look at the screen on her pump and see what her glucose levels are, whether they're trending up or trending down. She still has to intervene. So there is no automation between those two elements of the pump.

The artificial pancreas project is about automating that process.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

It is coming out of the University of Alberta, I guess. Is that right?

[Andrew McKee]

The University of Alberta is the Edmonton Protocol. The artificial pancreas project has actually been worked on by many corporations and many institutions worldwide. In our trial network, we are working on parts of that too. That's taking an algorithm that can take those glucose readings and predict whether your blood glucose is rising or declining and intervene by dosing....

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

The Edmonton Protocol is the algorithm. Is that right?

[Andrew McKee]

The Edmonton Protocol is the islet cell transplant. That's taking cells from a cadaveric pancreas and transplanting those into an individual who has type 1 diabetes.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

So it's a different parallel process.

[Andrew McKee]

It's a separate process.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Canada is still today at the forefront of this research, would you say?

[Andrew McKee]

Canada remains very much a leader. It is a competitive space for sure, especially in the device market, because those are the treatments that are closest to market, if you like, right now and where it's developing, and there are big international device players that are working that.

In cell therapy or biological therapy, Canada remains a real leader at the forefront of technologies associated with diabetes and the hopes for a biological cure right now.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

There are other partners then. The federal government invested $20 million. I imagine the—

[The Chair, Conservative, Joy Smith]

I'm sorry, sir. I've been very generous with you.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Oh, that's fine. There's no need to apologize.

[The Chair, Conservative, Joy Smith]

We're going to have to go on now. We have Ms. Block and Mr. Lizon. Who's going to begin?

Ms. Block?

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I want to echo all of the comments that have been made this morning about this panel, about your willingness to be here and the excellent presentations you have made to us.

As I look through some of the notes, I notice that many of you were diagnosed at very different stages in your childhood.

Marley, you were 8, and you're 13 now. I'm just wondering if you would be willing to describe for our committee what sorts of things were happening for you health-wise that caused you and your parents to understand that quite possibly you needed to see a doctor, and then this diagnosis was made.

[Marley Greenberg]

I was going to the washroom a lot. I had to pee a lot and I was drinking a lot of water, which are two signs of diabetes, because when your blood sugars are high you're very thirsty and you have to pee a lot. So I told my mom when I got home. Being a diabetic herself, she saw the signs and she decided to take my blood sugar. It told her that I was extremely high. She didn't believe it, so she did it again. Then after that we went to the hospital and I was diagnosed there.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

I've also noticed that all of you seem to be very active, very involved in sports. It doesn't appear that it affects your ability or desire to be involved in sports.

Marley, I want to come back to you and ask you some similar questions to what my colleague asked some of the other presenters about your experience at school. In the activities, do you find there is awareness of the issues that you face when you have type 1 diabetes, or do you have to do a fair bit of explaining?

[Marley Greenberg]

I have to do a lot of explaining, but I'm very open with my diabetes. I actually like being asked questions, unlike Maksim.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

We have opposite ends.

[Marley Greenberg]

I'd rather people understand it than just assume information that's incorrect. So I'm very open with it and I like to tell people and explain it to them. I don't go around announcing it, but if someone asks a question, I always answer it.

No one really understands what's happening. They have some idea, so they know what to do if I need help, that I probably need sugar or that I'll need something else, and all the teachers know that if I ask for something I should be able to leave to go get it. So they're very supportive, but they don't really understand.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you. I'll turn it over to my colleague.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

I would like to congratulate and thank all the participants for coming here today. It's really a very interesting day for all of us. You young people are very courageous, and I wish you all the best. You're aiming high, and I know with your determination you will get there.

Michael, I personally hope that you will play for Manchester United, not the City. With young players like you who are so determined, maybe one day Canada will win the World Cup in soccer. I wish you all the best.

The question I have is on the artificial pancreas. If I understand correctly, it's working towards combining the glucose monitoring with the dosage of the insulin from the pump. Is it going to be an external device, or is there work to develop an internal device that would be implanted in the patient's body?

[Andrew McKee]

There has been work done on both the internal and external devices. The prevailing enterprise right now is on external devices. There are some additional challenges around implantable devices. First and foremost is that you have to be able to refill the pump component of the artificial pancreas with insulin, so you need access through the skin of an individual.

There was an implantable pump that was brought to market in the late nineties, and it's still in use in a few patients in France, but the whole industry has actually moved away from internal devices and is working with external pumps and external glucose monitors. You'll have some kind of control with an external device and a patch, typically, as Marley showed you with her two devices—one attached to her site, which is where she doses insulin, and then the other patch that has the reading.

One of the goals, ultimately, is to try to get those two patches down to one patch, but at the moment it's all external devices that are being looked at for that market.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

If you had to guess, how far would you say we are from getting one on the market?