As researchers continue to pursue a cure for type 1 diabetes, by 2018 technology will ease the burden of those who suffer from it: with an artificial pancreas. Researchers at the University of Cambridge Metabolic Research Laboratories recently published a literature review in the journal Diabetologia of a dozen studies that document the efficacy of the artificial pancreas in outpatient adults, adolescents, and children.
An artificial pancreas isn't a replacement organ. It's a closed-loop system of blood glucose monitoring and insulin delivery, controlled by a special smartphone app, which can essentially take over the job of the pancreas. An algorithm helps two devices work together almost seamlessly: a continuous glucose monitor (CGM), which measures glucose in subcutaneous tissue, and an insulin pump, which administers insulin automatically.
The review looked at 12 early trials of the artificial pancreas that included nearly 340 people in different settings, such as participants' homes and diabetes camps. The review found that connecting the insulin pump to the glucose monitor is a game changer for diabetic patients, who spend much of their time monitoring and correcting their blood sugar. The pancreas automates these formerly manual tasks.
In current conventional therapy, diabetes patients use two separate devices to monitor and adjust their insulin levels: a CGM and an insulin pump, usually worn at the waist or hip, where it connects subcutaneously. This system requires constant attention, especially because, as the review points out, the insulin requirements of someone with type 1 diabetes vary considerably in a 24-hour period, changing on average by 20 percent during waking hours and 30 percent overnight. It's also influenced by what a person eats.
“So you have the patient who still has to do all the calculations themselves and to manually give a bolus depending on what they eat, and adjust the infusion rate if they’re going low or increase it if they’re sick,” study author Hood Thabit, a diabetologist, tells mental_floss.
With the artificial pancreas system, however, the glucose sensor is attached to the pump and then blood glucose information is relayed to the smartphone app algorithm "automatically and wirelessly," Thabit says. In response to the data, the algorithm controls the amount of insulin released by the pump.
Thabit and colleague Roman Hovorka developed one of the algorithms that make this system possible—one of several that different manufacturers can use to build their devices. Thabit's testing of this algorithm and the artificial pancreas system is one of the 12 studies included in his Diabetologia literature review. In that 2015 study, published in the New England Journal of Medicine, “we used the system in our patients day and night for three months, and it actually showed an improvement in [hemoglobin levels] and a reduction of hypoglycemia, and that has never been shown before by using conventional pump therapy or even injection therapy,” Thabit describes.
By improving glucose control, the artificial pancreas "will be a very cost-effective way of treating your condition because you will avoid having complications, which make you unable to work, go to school, et cetera,” Thabit says.
Currently, the medical devices, which are made by several companies, are in a medical device trial with the FDA awaiting approval, which may come by 2018. Thabit is hopeful about the outcome because the FDA "has been very supportive of this whole field.”
While this is very exciting for the future of type 1 diabetes care, Thabit makes clear that “this is not a cure. This is something that patients have been waiting for for a very long time because managing their diabetes is very challenging. It’s a lot of work. This is, at least at the moment, a bridge to a cure until a biological cure is found.”