System for providing diabetic therapy

• US 8,634,930 B2
• Filed: 06/30/2006
• Issued: 01/21/2014
• Est. Priority Date: 06/30/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Dalal, Yousufali, Kramer, Andrew P., Mino, Lizbeth M.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): LEE, ERICA SHENGKAI
• Application Number:
  US11/428,070
• Publication Number:
  US 20080004672A1
• Time in Patent Office: 2,762 Days
• Field of Search: 607 2- 6, 607/9, 607/18, 607/22, 607/44, 607/118, 607/40, 607/62, 600/316, 600/319, 600/365, 600/513, 600/517, 600/347, 604/891.1, 604/500, 604503-505, 604 65- 67, 604/890.1
• US Class Current: 607/115
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/36031 using physiological parameters for adjustment
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient

Abstract

Various system embodiments include a glucose control input, a low physical activity input, and a diabetic therapy delivery system adapted to respond to the glucose control input and the low physical activity input to deliver diabetic therapy. According to various embodiments, the diabetic therapy includes an anti-arrhythmia therapy, a hypertension therapy, a neural stimulation therapy adapted to reduce a risk of myocardial infarction, a neural stimulation therapy adapted to be applied after a myocardial infarction to reduce an infarct area, a neural stimulation therapy adapted to reduce a risk of sudden cardiac death, a therapy adapted to secrete insulin, or a therapy to reduce a workload of a diabetic heart. Other aspects and embodiments are provided herein.

Claims

1. A system for providing therapy to a patient, comprising:

a glucose control input configured to receive an indicator that the patient has poor glucose control and a low physical activity input configured to receive an indicator that the patient is experiencing low exertion, wherein the poor glucose control indicates that a heart is a diabetic heart that is less efficient in producing adenosine triphosphate (ATP) energy molecules than a healthy heart, and wherein the low exertion indicates that the patient is in a period of rest; and

a diabetic electrical therapy delivery system configured to reduce a workload of the diabetic heart, wherein reducing the workload of the diabetic heart reduces demand for ATP energy molecules, wherein the diabetic therapy delivery system is connected to the glucose control input and the low physical activity input and configured to use the glucose control input to determine that the patient has poor glucose control and use the low physical activity input to determine that the patient is experiencing low exertion, wherein the diabetic therapy delivery system is configured to reduce the workload of the diabetic heart only on condition that the diabetic therapy delivery system determines that the patient has poor glucose control and is experiencing low exertion.

2. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver an anti-arrhythmia therapy.

3. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver a neural stimulation therapy adapted to provide a hypertension therapy.

4. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver a neural stimulation therapy adapted to reduce a risk of myocardial infarction.

5. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver a neural stimulation therapy adapted to be applied after a myocardial infarction to reduce an infarct area.

6. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver a neural stimulation therapy adapted to reduce a risk of sudden cardiac death.

7. The system of claim 1, wherein the diabetic electrical therapy delivery system is further configured to deliver an electrical therapy adapted to secrete insulin.

8. The system of claim 7, wherein the electrical therapy adapted to secrete insulin includes a neural stimulation therapy.

9. The system of claim 8, wherein the neural stimulation therapy is adapted to respond to the glucose control input to adjust or stop the neural stimulation therapy when a glucose level reaches a high level.

10. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to reduce ventricular contractility to reduce the workload of the diabetic heart.

11. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to reduce norepinephrine release to attenuate ventricular remodeling, reducing the workload of the diabetic heart.

12. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to induce coronary artery vasodilation to reduce the workload of the diabetic heart.

13. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to lower arterial peripheral resistance to reduce the workload of the diabetic heart.

14. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to stimulate insulin release to promote glucose uptake and metabolism to reduce the workload of the diabetic heart.

15. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to stimulate myocardia to reduce the workload of the diabetic heart.

16. The system of claim 1, wherein the diabetic electrical therapy delivery system is configured to slow a heart rate of the diabetic heart to reduce the workload of the diabetic heart.

17. The system of claim 1, wherein the diabetic electrical therapy delivery system includes a neural stimulation therapy system adapted to stimulate a neural target to elicit a parasympathetic response to reduce the workload of the diabetic heart.

18. The system of claim 17, wherein the neural stimulation therapy system is adapted to stimulate a vagus nerve.

19. The system of claim 18, wherein the neural stimulation therapy system is responsive to the glucose control input and the low physical activity input to selectively stimulate the vagus nerve to slow heart rate.

20. The system of claim 18, wherein the neural stimulation therapy system is responsive to the glucose control input and the low physical activity input to stimulate the vagus nerve to secrete insulin.

21. The system of claim 18, wherein the neural stimulation therapy system is responsive to the glucose control input and the low physical activity input to stimulate the vagus nerve to slow heart rate and secrete insulin.

22. The system of claim 1, wherein the glucose control input, the low physical activity input, and the diabetic electrical therapy delivery system are contained within at least one external device.

23. The system of claim 1, wherein the glucose control input is in an external glucose monitor, and the diabetic electrical therapy delivery system is in an external neural stimulation device, the neural stimulation device and the glucose monitor being adapted to communicate.

24. The system of claim 23, further comprising an implantable cardiac rhythm management (CRM) device, the CRM device being adapted to communicate to the external glucose monitor, the external neural stimulation device, or both the external glucose monitor and the external neural stimulation device.

25. The system of claim 23, wherein the external neural stimulation device is adapted to stimulate a neural target using a transcutaneous electrode.

26. The system of claim 1, wherein the glucose control input is derived using a heart failure status parameter.

27. The system of claim 26, wherein the heart failure status parameter includes a heart rate variability (HRV) parameter, a heart rate turbulence (HRT) parameter, a heart sound parameter, an ECG feature, an activity parameter or a respiration feature.

28. The system of claim 1, wherein the glucose control input is derived using a trended heart rate.

29. The system of claim 1, wherein the low physical activity input is derived using an activity sensor, a posture sensor, or a timer.

30. The system of claim 1, wherein the diabetic electrical therapy delivery system is adapted to be responsive to a therapy control feedback.

31. The system of claim 30, wherein the therapy control feedback includes a detected bradycardia.

32. The system of claim 30, wherein the therapy control feedback includes a measured glucose level.

33. A method, comprising:

determining if a diabetic patient has poor glucose control, wherein the poor glucose control indicates that a heart is a diabetic heart that is less efficient in producing adenosine triphosphate (ATP) energy molecules than a healthy heart;

determining when the diabetic patient is experiencing low physical exertion, wherein the low exertion indicates that the patient is in a period of rest; and

delivering diabetic electrical therapy to reduce a workload of the diabetic heart only on condition that it is determined that the diabetic patient has poor glucose control and is experiencing low physical exertion, wherein reducing the workload of the diabetic heart reduces demand for ATP energy molecules.

34. The method of claim 33, further comprising delivering an anti-arrhythmia therapy, delivering a hypertension therapy, reducing a risk of myocardial infarction, applying the diabetic therapy after a myocardial infarction to reduce an infarct area, or reducing a risk of sudden cardiac death.

35. The method of claim 33, further comprising delivering or secreting insulin to promote glucose uptake and metabolism to reduce the workload of the diabetic heart.

36. The method of claim 33, wherein determining when the diabetic patient is experiencing low physical exertion includes determining when the diabetic patient is sleeping, determining when the diabetic patient is lying down, or determining when the diabetic patient is sitting.

37. The method of claim 33, wherein delivering diabetic electrical therapy to reduce a workload of a diabetic heart includes delivering neural stimulation to elicit a parasympathetic response, including delivering neural stimulation to stimulate parasympathetic nerve activity or delivering neural stimulation to inhibit sympathetic nerve activity.

38. The method of claim 37, wherein delivering neural stimulation to elicit the parasympathetic response includes delivering neural stimulation to slow a heart rate.

39. The method of claim 38, wherein delivering neural stimulation to slow the heart rate includes delivering neural stimulation to a vagus nerve.

40. The method of claim 39, wherein delivering neural stimulation to the vagus nerve includes stimulating insulin secretion.

41. The method of claim 39, wherein delivering neural stimulation to the vagus nerve includes selectively stimulating the vagus nerve to slow heart rate.

42. The method of claim 33, wherein delivering diabetic electrical therapy includes delivering neural stimulation to secrete insulin, delivering neural stimulation to reduce ventricular contractility, delivering neural stimulation to reduce norepinephrine release to attenuate ventricular remodeling, delivering neural stimulation to induce coronary artery vasodilation, delivering neural stimulation to lower arterial peripheral resistance, or delivering neural stimulation to stimulate insulin release to promote glucose uptake and metabolism.