Artificial pancreas in final trials

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PancreasTreatment for type 1 diabetes is highly effective but is a relatively troublesome ordeal. Medical News Today reports that patients are required to regularly draw blood, check glucose levels and inject the appropriate amount of insulin. Current interventions leave unwanted opportunity for human error.

They are also fairly unpleasant and inconvenient and, the report says, the hunt for better treatments is ongoing. It says one such improvement showing a great deal of promise is the so-called artificial pancreas. The idea of an artificial pancreas has been discussed for decades, but it is only very recently that it has become a potentially viable option. Designed by Boris Kovatchev and his team at the University of Virginia School of Medicine, this medical innovation has the potential to change millions of lives for the better.

The report says Kovatchev has been working on such a device since 2006. Initially, this type of closed-loop system that could monitor glucose levels and administer insulin appropriately was believed to be impossible and the idea of an artificial pancreas was met with scepticism from the scientific community.

Insulin normally facilitates the absorption of glucose from the blood into the body where it is used. Type 1 diabetes occurs when the pancreas stops making enough insulin. Type 2 diabetes is most often caused by lifestyle choices, such as poor diet and lack of exercise; type 1 diabetes, however, is unrelated to lifestyle. The beta cells within the pancreas that manufacture insulin are attacked by an inappropriate immune system response, rendering them insufficient for the body’s needs.

To make up for this shortfall in biochemistry, patients must frequently prick their fingers, take a blood sample, measure glucose levels and inject themselves with insulin to redress the balance. This regular rigmarole is necessary to keep blood glucose levels within a healthy range.

Aside from the inconvenience and discomfort, as with anything that is reliant on human interaction, the report says there is the possibility of error. Raised glucose levels can, over time, damage the kidneys, nerves, eyes and blood vessels. At the other end of the spectrum, low glucose, or “hypos” can, in extreme circumstances, lead to coma or death.

The report says Kovatchev’s artificial pancreas, also referred to as closed-loop control of blood glucose in diabetes, takes away much of the human interaction that is currently necessary in self-medication. The central hub of the system uses a platform called InControl that runs on a reconfigured smartphone. This handheld device is linked wirelessly to a blood sugar monitor, an insulin pump and a remote monitoring site. The blood sugar monitor takes the glucose levels in the blood every 5 minutes and delivers the readings to the InControl device.

The device is controlled by algorithms and administers the correct amount of insulin through a fine needle without the patient having to spill even a drop of blood. The report says the algorithms are where the real innovation comes in. They are designed to second guess how much insulin is likely to be needed. It is not enough for the technology to simply react to blood levels at any particular moment in time, it must predict glucose spikes, pre-empt changes and adapt to an individual’s insulin sensitivity. This is no mean feat. The human pancreas is able to make these calculations with ease, but to design something as capable as the pancreas is a difficult task indeed.

The report says the artificial pancreas has begun its final trials in nine locations across the US and Europe. For the first phase, 240 patients with type 1 diabetes will trial the system for 6 months. The second run of trials will see 180 patients from the first phase wearing the system for a further 6 months.

Designed in conjunction with TypeZero Technologies in Charlottesville, Virginia, the system will be compared with a standard insulin pump against two major criteria: how well blood sugar levels are managed and whether the risk of hypoglycemia or low blood sugar is reduced.

The artificial pancreas in these trials will be programmed with a new algorithm designed by Dr Francis Doyle III and his team at the Harvard John A Paulson School of Engineering and Applied Sciences.

The report says this innovation looks set to make a huge and positive difference to millions of people. It aims to improve the lives of type 1 diabetics by easing the burden of controlling insulin levels manually. Additionally, thanks to the algorithms, the artificial pancreas should keep blood glucose at more physiologically normal levels.

Kovatchev and collaborators are already sounding out the use of other hormones within the artificial pancreas; his team is also investigating whether the system might only need to be worn at certain times of the day, for instance, at night and/or after meals, the report says.

Full Medical News Today report

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