Integration of clinical records, monitoring and telemedicine with artificial pancreas, pregnancy, diabetes, cardiovascular risk.
C/Mas Casanovas, 90. Hospital Santa Creu i Sant Pau.
Barcelona. CP: 08025.
Entity website: http://www.santpau.es/
Responsable : Alberto Leiva Hidalgo
PREDIRCAM: Plataforma inteligente para la monitorización, tratamiento y prevención personalizada de la Diabetes Mellitus, el riesgo cardiometabólico y la insuficiencia renal. 2008- 2010. ISCIII Fondo de Investigación Sanitaria (FIS)
IDOSING: Herramienta de ayuda a la DOSificación óptima de Insulina para pacientes diabéticos, basada en técnicas de control por aprendizaje iterativo e inteGrada en una plataforma de telemedicina. 2008- 2010. ISCIII Fondo de Investigación Sanitaria (FIS)
Valor Predictivo-Diagnóstico de marcadores moleculares que conforman una firma genética de mal pronóstico en muestras de tiroides y su implicación en el proceso de dsdirenciación tumoal. 2010- 2012. ISCIII Fondo de Investigación Sanitaria (FIS)
Soporte a los grupos consolidados de Investigación de Cataluña (SGR). 2009 SGR 806. 2009-2011. GENERALITAT DE CATALUNYA. Agencia de gestión d'adjuts universitaris y de recerca.
CELL-NANO-THYROID. ISCIII / FIS. CIBER-BBN, Intramural Project. 2010-2012. ISCIII / FIS. CIBER-BBN, Intramural Project
Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention. 1527-B-226 CAIBER 2010 (2011-2013)
Efectividad Clínica Del Páncreas Artificial Telemedico En Pacientes Con Diabetes Mellitus Tipo 1 (Pat-Dia1). 1527-B-257 CAIBER 2010 (2011-2013)
INTERNATIONAL/ EUROPEAN PROJECTS
Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention. Health- F2- 2009-242187. 2010-2012. EC FPVII–Health- F2- 2009. EC FPVII–HealthCONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial. CONCEPTT. 2010-2013. Juvenile Diabetes Research Foundation (JDRF).
CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial. Juvenile Diabetes Research Foundation (JDRF). CONCEPTT (2010-2013)
a) Intelligent Telemedical Artificial Pancreas
Automated control of a therapeutic platform with a closed-loop multi-access system ensuring the continuous metering of insulin and the use of an original intelligent aid system, responding to the information provided by the continuous determination of interstitial glucose with new generation glucosensors. It is a priority project, with years of investigating activity with GBT (UPM). In this initiative, we have already been able to show that the information of the patient at regular intervals, with continuous glucose uptake in continuous 72-hour periods, allows significantly reducing glycated hemoglobin in clinical experiments lasting no more than 4 weeks.
The foregoing determines prospective, controlled and crossover studies with autoimmune and non-autoimmune diabetic patients, with documented insulinopenia.
The procedures for predicting blood sugar levels, based on the simulation and remodeling with neural networks, and synchronous and asynchronous communication between the patient’s station and the healthcare center’s station will be evaluated.
The study will allow analyzing data and displaying continuous glucose profiles and creating tools for the automatic proposal of therapy adjustments; the modeling of the energy consumption of the patient from the ambulatory recording of new physiological parameters such as physical activity and heart rate, integrating portable personal monitoring devices for recording continuous variables. We are especially interested in characterizing the behavior of the hydrocarbon mechanism in the first trimester of pregnancy in healthy women and women with preconceptional and gestational diabetes mellitus.
This information will be compared with the information relating to the endocrine regulation of pregnancy (serial plasma levels of insulin, estradiol, progesterone, prolactin, cortisol, thyroid hormones, chorionic gonadotropin and placental lactogen). A special group will be formed by infertile women requiring artificial insemination due to their partner’s infertility. The importance of the study on the organogenesis regulation and its usefulness for preventing birth defects (main cause for perinatal mortality) represent essential clinical objectives.
The project has the collaboration of the Sansum Diabetes Research Institute, University of Southern California (Santa Barbara), coordinated by Dr. Lois Jovanovic. Glucosensors with real-time reading and subcutaneous implantation for prolonged times (weeks, months) will be used.
b) Pregnancy and Diabetes
Pregnancy associated to uncontrolled diabetes is associated to a high maternofetal morbidity risk and to an increase of fetal/postnatal mortality, mainly associated to malformations. The normalization of glycated hemoglobin is a decisive factor in the optimization of the results of diabetic pregnancy, both in preconceptional and gestational diabetes. The research group has an experience of more than 25 years on the continued improvement of the results of diabetic pregnancy. We have been especially interested in exploring the benefits of new technologies and of intensive insulinization, by different procedures, in the results of pregnancy complicated with diabetes.
c) Cardiovascular Risk
The investigating group has broad experience in the early identification of cardiovascular risk factors, their prevention and their treatment, mainly obesity, hyperlipidemia, hypertension, stop smoking, etc… Interventions on healthy life areas, different pharmacological treatments and telemedicine affect the benefits in this area in a variable degree.
d) Endocrine Neoplasias
For more than 15 years, we have carried out research aimed at the diagnosis and early treatment of the main endocrine neoplasias. We have particularly investigated prognosis markers in epithelial strain thyroid carcinomas, and the analysis of epigenetic alteration of certain neoplasia expression factors which are of interest in prognosis assessment. The studies affect serological, cytologic and biopsy samples. Among other markers, we have studied PTEN/MMCI, telomerase, cyclooxigenases and prostaglandin synthases. More recently, we have developed, in collaboration with the Red de Centros de Genómica del Cáncer (Network of Cancer Genomics Centers) and the Centro Nacional de Investigación Oncológica (National Center for Oncological Research) a large-scale study (more than 6300 genes) with the intention of identifying genetic malignancy markers in thyroid pathology, with the aid of a cDNA-microarray and microcomputer analysis. We have been especially interested in the MEN-1, MEN-2 syndromes, including endocrine neoplasias with a very disperse location (hypophysis, parathyroid, gastrointestinal system and endocrine pancreas, thyroid, suprarenal glands, etc.). In these pathologies, the genetic family screening program and the multidisciplinary approach of the interventions has gained us a reputation as a reference clinical research and care center.
e) Integration of clinical records, imaging, monitoring and telemedicine
For more than 15 years, we have developed multiple projects for using technological progress in information, monitoring and continuous communication systems, linking the hospital telematic units with the telematic units of patients, which we have designed and put into practice. These investigations have benefitted from the financing offered in projects granted by the European Community, ISCIII and MEIC. The integration of these systems in electronic documentation of the patients has made clinical conducting easier through the computerized records. The technological platform has included multi-access (web systems, telephony, palmtops, intelligent modems, Internet), the satisfactory operation of the systems with a proven benefit for the users, demonstrated in intrinsic and extrinsic care quality analysis.