Artificial pancreas delivers better diabetes control

A dual-hormone closed-loop system improves blood sugar control and reduces hypoglycemia
Tools
The artificial pancreas consists of a continual glucose monitor, a pump worn on the belt that injects insulin, and a controller (here, a smartphone).--Courtesy of the Institut de recherches cliniques de Montréal

A dual-hormone "artificial pancreas" is better at controlling Type 1 diabetes than a simple insulin pump, which could be good news for the two-thirds of diabetics who don't achieve their blood sugar targets with existing treatments.

Insulin pumps improve quality of life for insulin-dependent diabetics, but still need the patient to monitor blood sugar levels and bump up insulin delivery to take meals into account, which can be awkward, especially in social situations. A team of Canadian and U.S. researchers has created a dual-hormone artificial pancreas (also known as closed-loop delivery). This continuously monitors glucose levels and delivers both insulin and glucagon as required.

"We developed an intelligent dosing algorithm, which is the brain of the system. It can constantly recalculate insulin dosing based on changing glucose levels, in a similar way to the GPS system in a car, which recalculates directions according to traffic or an itinerary change," explains author Ahmad Haidar of the Institut de recherches cliniques de Montréal.

In the study, published in the Canadian Medical Association Journal, 15 adults with Type 1 diabetes tried out both the standard insulin pump and the dual-hormone, closed-loop delivery system at two separate visits. At each visit, they had an exercise session, ate a meal and a snack, and slept overnight. According to the researchers, this is the first study to compare these two types of delivery systems.

The artificial pancreas kept patients' blood sugar levels in the target range longer, and the addition of glucagon cut the blood sugar lows--only one patient had a hypoglycemic event compared with 8 using the insulin pump, and there was a twentyfold reduction of the risk of hypoglycemia during the night.

An artificial pancreas delivering both insulin and glucagon has potential to mimic the patient's pancreas more closely than a simple insulin pump. This could cut diabetic complications, such as blindness and kidney disease, reduce the number of hypoglycemic episodes, and simply make life a little easier for diabetics. The dosing algorithm could eventually be integrated into a smartphone, receiving information from the continual glucose monitor and controlling the pump wirelessly, making the mode of delivery even less conspicuous. The next step for the team is to test the system for longer periods and with different age groups.

- read the press release
- see the abstract

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