Research finds artificial pancreas improves glucose control

by Barbara Hewitt on January 31, 2013

Research finds artificial pancreas improves glucose control

An external artificial pancreas has been found to improve glucose control by 15% compared to a conventional insulin pump and is being hailed as the way forward for type 1 diabetics. Researchers at the Institut de Recherches Cliniques de Montréal (IRCM) in Canada have become the first scientific team to conduct a trial comparing a dual hormone artificial pancreas with conventional diabetes treatment using an insulin pump.

Their results showed improved glucose levels and lower risks of hypoglycaemia and they said it will have a major impact on the treatment of type 1 diabetes. The artificial pancreas is an automated system that simulates the normal pancreas by continuously adapting insulin delivery based on changes in glucose levels. The dual hormone artificial pancreas tested at the IRCM controls glucose levels by automatically delivering insulin and glucagon, if necessary, based on continuous glucose monitor (CGM) readings and guided by an advanced algorithm.

‘We found that the artificial pancreas improved glucose control by 15% and significantly reduced the risk of hypoglycaemia as compared with conventional insulin pump therapy,’ said Ahmad Haidar, first author of the study and doctoral student in Dr. Rémi Rabasa-Lhoret’s research unit at the IRCM and at the Department of Electrical and Computer Engineering at McGill University. ‘The artificial pancreas also resulted in an eight fold reduction of the overall risk of hypoglycaemia, and a 20 fold reduction of the risk of nocturnal hypoglycaemia,’ he added.

People living with type 1 diabetes must carefully manage their blood glucose levels to ensure they remain within a target range. Blood glucose control is the key to preventing serious long term complications related to high glucose levels such as blindness or kidney failure, and reduces the risk of hypoglycaemia as dangerously low blood glucose that can lead to confusion, disorientation and, if severe, loss of consciousness.

Approximately two thirds of patients don’t achieve their target range with current treatments, according to Dr. Rabasa-Lhoret, director of the Obesity, Metabolism and Diabetes research clinic at the IRCM. ‘The artificial pancreas could help them reach these targets and reduce the risk of hypoglycaemia, which is feared by most patients and remains the most common adverse effect of insulin therapy. In fact, nocturnal hypoglycaemia is the main barrier to reaching glycaemic targets,’ he said.

Quote from : “Leading British charity Diabetes UK is funding two ground breaking research projects which aim to develop and test an artificial pancreas device for use in adults with type 1 diabetes.”

Haider pointed out that infusion pumps and glucose sensors are already commercially available but patients must frequently check the sensor and adjust the pump’s output. ‘To free them from this sizable challenge, we needed to find a way for the sensor to talk to the pump directly. So 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,’ he explained.

The researchers’ algorithm, which could eventually be integrated as software into a smart phone, receives data from the CGM, calculates the required insulin, and glucagon, if needed, and wirelessly controls the pump to automatically administer the proper doses without intervention by the patient.

‘The system we tested more closely mimics a normal pancreas by secreting both insulin and glucagon. While insulin lowers blood glucose levels, glucagon has the opposite effect and raises glucose levels. Glucagon can protect against hypoglycaemia if a patient with diabetes miscalculates the necessary insulin dose,’ said Dr. Laurent Legault, paediatric endocrinologist and outgoing director of the Insulin Pump Centre at the Montreal Children’s Hospital, and co-author of the study.

Dr. Rabasa-Lhoret said that the team will now undertake further clinical trials to test the system for longer periods and with different age groups. It will then probably be introduced gradually to clinical practice, using insulin alone, with early systems focusing on overnight glucose controls. ‘Our work is exciting because the artificial pancreas has the potential to substantially improve the management of diabetes and reduce daily frustrations for patients,’ he added.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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