The artificial pancreas is closer than we think
The end goal for the treatment of type 1 diabetes – the artificial pancreas – is an integrated, automated system that calculates how much insulin the body needs and then delivers it – in real time.
Dr Elmo Pretorius, an endocrinologist at Mediclinic Vergelegen, says the latest in the ‘pump-and-monitor’ method of care for type 1 diabetics is the continuous glucose monitor (CGM). The CGM inserts a sensor into the skin to monitor glucose, and works with a wearable pump that continuously infuses insulin into the body as required.
Earlier pumps were programmed to release varying amounts of insulin, but required manual adjustments according to glucose levels because the monitor and the pump didn’t communicate. Dr Pretorius explains that a major difference the CGM has made to managing type 1 diabetes is it reduces the number of injections required.
‘It also offers more flexibility to patients because you can make several adjustments per day, whereas if you’re doing injections you’re limited to four,’ he adds.
But the biggest advantage is that the device senses the level of your blood glucose (sugar) and automatically shuts down insulin released from the pump when your sugar levels drop too low or vice versa. Dr Pretorius explains this is an amazing safety feature that’s really helped to reduce hypoglycaemia.
The artificial pancreas to date
For the past decade, researchers have been working on multiple artificial pancreas projects. In September 2016, an insulin pump made by Medtronic automatically adjusted insulin rates based on the automated data analysis of the continuous glucose monitor. It was approved after a trial involving 124 patients.
The largest clinical trial started in 2016 and followed 240 patients in Europe and the US. Led by, among others, Harvard University, the trial tested the safety and efficacy of a system that integrates a smartphone relying on an algorithm to analyse blood sugar readings, and then instructs the pump on how much insulin to release.
‘The pancreas mainly secretes two hormones: insulin and glucagon,’ says Dr Pretorius. He explains that previously the focus was on insulin because it was only possible to deliver a single hormone at a time.
But now Beta Bionics is working on a similar device that administers insulin as well as glucagon, through an algorithm that decides which hormone to release and how much. Trials are due to start this year.
Besides having fewer devices to carry around, Dr Pretorius says a system like this means physicians will have real-time access to their patients’ data, keeping their condition well controlled without impeding their lifestyle.
It also means a patient can simply look at their smartphone at mealtimes and know exactly what their sugar levels are.
‘I think the closer we can get to what the pancreas does under normal conditions, the better we are going to be able to improve the quality of life of our diabetic patients,’ concludes Dr Pretorius.
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