Revolutionary ‘Artificial Pancreas’ Is Proving to Be Incredible For Type 1 Diabetics


A new study on the efficiency of the so-called ‘artificial pancreas’ suggests it’s a huge leap in the right direction for people with diabetes who are in constant need of monitoring their blood glucose.

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The technology works through a sort of closed loop system that monitors a person’s blood’s glucose while delivering doses of the right hormones – and for many this device is a dream come true.

In a systematic review of the evidence to date, a team led by researchers from the Aristotle University of Thessaloniki has evaluated 41 studies on the safety and efficacy of two types of artificial pancreas used by more than 1,000 volunteers.

The team found that volunteers trialling this class of device spent roughly 10 percent more time within a healthy range of blood glucose levels over any given 24 hour period.

That’s encouraging news, showing medicine is heading in the right direction, but more questions will need to be answered about balancing the risks, costs, and benefits of this amazing device.

Diabetes describes a class of conditions that make it difficult for the body to manage its sugar levels, either due to problems producing the insulin needed for cells to absorb glucose, such as type-1 diabetes, or resistance to insulin, like type-2.

This requires those with type-1 diabetes to check their blood levels and monitor their diet while potentially administering specially calculated doses of insulin.

While this sounds simple in principle, for millions of people this is a finicky task that can feel like balancing an egg in an earthquake, as a wide range of variables make it virtually impossible to maintain that perfect level of glucose.

Modern technology has helped in many ways, providing pumps that can accurately administer insulin and continuous monitoring devices that keep a careful minute-by-minute watch on blood glucose.

But these tools still require a human in between to make key judgements.

That’s what makes the ‘artificial pancreas’ tech so awesome – it aims to take the burden of decision making by having algorithms determine how much insulin or another balancing hormone called glucagon to inject in response to measurements of glucose in the blood.

While it’s not quite the same thing as a functional pancreas, for those with the condition it can reduce stress while providing some peace of mind at night.

A terrifying consequence of diabetes – especially among young people – is the risk of dying while asleep, possibly due to missing vital signs of critically low blood sugar.

It’s easy to see why many of those dealing with diabetes are keen to get their hands on this kind of tech, and this latest review shows it has potential to live up to its hype.

But the team conducting the research is also calling for higher quality studies – for example, none of the trials on young people with diabetes included children under five years old.

Three quarters of the trials evaluated were also just a week long, which provides limited information on the longer term effects of these closed-loop delivery systems.

What this means is we still have some way to go for artificial pancreas technology to conclusively prove its worth.

For policy makers, this is important stuff. New technology is often expensive, forcing many people to rely on insurance and government subsidies to afford these treatments.

If the evidence is scant on cost-benefit-ratios, only the wealthiest can afford that extra comfort. Importantly, without extensive studies, it’s possible some people with complications or slight variations in their condition might miss out on important caveats.

“Patients with particular problems, such as hypoglycaemia without warning symptoms, could benefit more,” says medical researcher Norman Waugh from the University of Warwick, whose commentary on the research calls for better studies.

“For children, we need data on parents’ quality of life. We need a trial of the dual insulin and glucagon system in cystic fibrosis related diabetes, where pancreatic and hepatic damage impairs responses to both hypoglycaemia and hyperglycaemia.”

Each year, research on this life-changing condition gives us hope of better ways to prevent, treat, or even cure diabetes.

We have every reason to celebrate the progress we make, but after the excitement dies down there is still a need to collect as much evidence as possible to make sure it really does live up to our expectations.

 

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How Insulin Pumps Are Helping Type 1 Diabetics Live Longer


Great news for those who love their insulin pumps: a recent study done in Sweden reports that people with type 1 diabetes who use insulin pumps have a much lower risk of dying prematurelyfrom stroke or heart disease compared to those taking their insulin via multiple daily injections (which includes insulin pens).

“As done in Sweden at the time of this study, insulin pump treatment almost halved cardiovascular mortality,” said study author Dr. Isabelle Steineck, from Aarhus University Hospital in Denmark.

The study consisted of approximately 18,000 people with type 1 diabetes from the Swedish National Diabetes Register. Only 2,500 of the participants wore insulin pumps.

The detailed results concluded that insulin pumpers have:

  • a 45 percent lower risk of dying from heart disease
  • a 42 percent lower risk of dying from stroke
  • a 27 percent lower risk of all-cause death

The data was taken from a 7-year period of time.

The average age of those on pumps was 38 years old, and 41 years old for those taking injections. Approximately 1,200 participants died during the study.

Like many (or most) studies these days, this was an observational study which means the researchers can’t claim for certain that it is truly the use of an insulin pump that reduced participants’ risk of death. In order to claim firmly that the reduced death rates were from using a pump, the study would have had to control many other aspects of the participants lives and daily management, rather than just noting which method they used to deliver their insulin doses.

One aspect of the study worth noting, however, is that no funding for the study came from insulin pump manufacturers, explained Dr. Steineck.

For everyone living with type 1 diabetes, the risk of heart disease and stroke is nearly twice as high compared to the risk of someone in the general population.

Why does an insulin pump reduce risk of death?

The first theory, explains the Dr. Steineck, on why insulin pumps are reducing premature death is that pumps lead to fewer severe low blood sugar episodes.

The second theory suggests that when a patient chooses to go onto an insulin pump they inevitably receive more in-depth education around their diabetes management because the settings for an insulin pump are more in-depth than the “settings” for multiple daily injections. This theory perhaps points out a huge hole (and area for much-needed improvement) in general diabetes management education within the healthcare system.

“We evaluated the patients who used insulin pump therapy and do not know if the observed effect is attributable to continuous infusion of insulin or that some, if not all, of the effect is attributable to intensified glucose monitoring, increased motivation to control blood glucose, or a better knowledge about having type 1 diabetes,” she explained.

However, Vincent Crabtree from the JDRF feels the results aren’t actually conclusive.

“Continuous insulin infusion, otherwise known as pump therapy, is a more physiologic approach that has been shown in many analyses to be beneficial,” said Vincent Crabtree, director of research business development for JDRF. “This paper is intriguing, but will need more research to draw definitive conclusions.”

Crabtree reports less than half of the Americans with type 1 diabetes are actually using insulin pumps, but Steineck hopes her recent study will increase that percentage. Even more importantly, she also hopes it will encourage health insurance companies to be more agreeable when it comes to providing coverage for insulin pumps and the expensive supplies required to continue using one on a regular basis.

What do you think? How has your insulin pump changed your life with diabetes?