Artificial Pancreas

Maintaining good blood glucose control is incredibly important in the management of diabetes. Whether the body is not responding to insulin (type 2 diabetes) or not making enough insulin (type 1 diabetes), controlling blood glucose (sugar) is key to preventing diabetes-related complications and living as healthy a life as possible.

Many advancements have been made in diabetes care over the past several decades. One of these exciting advancements is the artificial pancreas.

The elements of glucose control

Controlling blood sugar is often a balance of several factors that require careful monitoring. A person with diabetes needs to check their blood sugar often to determine if they need to change their insulin dosage to stay in a safe sugar range. Sugar that is too low can be dangerous and lead to seizures or other life-threatening complications. Sugar that is too high can lead to damage throughout the body, including to the eyes, kidneys, and more.1

In the past, it may have been necessary for a person to “stick” their finger with a needle several times a day and use a glucose monitor to track their sugar manually. In recent years, however, continuous glucose monitors (CGMs) have been developed that automatically check blood sugars throughout the day and require many fewer finger stick checks.1

As mentioned, once a person knows their blood sugar levels, they may need to adjust their insulin dose. For example, if blood sugar is too high, a dose of insulin may be required to help lower glucose levels. This requires close, constant monitoring by a person with diabetes. This can be challenging at any time, especially overnight, when a person is sleeping. Insulin pumps have been developed to help with the dosing and administration of insulin; however, these pumps require input from their user in response to changes in blood sugar.2

The danger in “hacking” CGMs and insulin pumps

It is possible for some people using currently available CGMs and insulin pumps to “hack” their systems and use experimental apps to allow the devices to communicate. While this may be helpful, these apps and at-home DIY device linkages are not approved by the U.S. Food and Drug Administration (FDA). There is a risk of failure with these approaches, which can lead to significant health consequences.2

This is where artificial pancreas systems that are in development and undergoing approval from the FDA can come in.2

What is an artificial pancreas?

Despite its name, the artificial pancreas is not a replica of the pancreas that is inserted into the body. It is a device that is used outside the body and coordinates blood sugar monitoring and insulin delivery. An artificial pancreas system allows elements of CGMs and insulin pumps to communicate with one another with minimal input from the user. They are often called hybrid closed-loop systems.1-3

CGMs can detect changes in blood sugar and “talk” to insulin pumps to adjust doses and administer insulin automatically. This is the closed-loop. The “hybrid” in the name refers to the fact that even though it is a self-communicating system, it may still require occasional input and adjustments from the user. However, the amount of user input is much less than before.1,3

Who can use an artificial pancreas?

At this time, the currently available artificial pancreas systems are intended to be used by those with type 1 diabetes. Further research is needed to determine their potential benefit in those with type 2 diabetes.1

What does the research say?

Several artificial pancreas systems are in development or have been approved for use in the United States. Overall, research on these systems is promising. One major study completed is called the International Diabetes Closed-Loop (iDCL) Study.3

This study took place across 10 research centers in the United States and Europe and involved people with type 1 diabetes. The study lasted 6 months and observed blood sugar control while using either an artificial pancreas system or a CGM and insulin pump that did not communicate with one another. Both groups were able to download and share their blood sugar data with researchers every few weeks.3

Overall, those using the artificial pancreas system spent more time in the normal blood sugar range (70 to 180 mg/dL) than those not using the system. The amount of time in the normal blood sugar range was unchanged in the non-artificial pancreas group across the whole study. Those using the artificial pancreas system also spent less time in high and low blood glucose ranges and experienced improvements in their HbA1c levels.3

These results suggest that artificial pancreas systems may have the potential to improve quality of life and day-to-day blood sugar control in people with diabetes.3

The future of artificial pancreas systems

As mentioned, future research and development in artificial pancreas systems may focus on expanding their use to those with type 2 diabetes. Other developments in artificial pancreases will be directed at reducing the need for user input and creating a truly automatic closed-loop system. This means glucose monitoring and insulin dosing will be balanced and handled without any help from the person wearing the devices.1-3

Another area of interest in this field involves the bionic pancreas or the 2-hormone artificial pancreas. In addition to insulin, these bionic pancreas systems will also be able to administer glucagon. Glucagon is the hormone released by the pancreas when blood sugars are low. It acts as a balance to insulin and leads to a rise in blood sugar rather than the decrease that comes with insulin.1,2

Some experts believe that good glucose control can be achieved with just the one-hormone artificial pancreas systems; however, further study into the two-hormone system is ongoing.1,2

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