For Now, Artificial Pancreas May Be Next Best Thing to a Cure
When we think about curing diabetes, we hear a lot about stem cells, regeneration of beta cells, and other ways to restore the insulin-producing cells that have been destroyed or burned out in diabetes. And while research into these areas is exciting, there may be ways to effectively cure diabetes in the nearer future using technology through the creation of an artificial pancreas. After all, we have pacemakers to provide the electrical signaling in an irregular heart and dialysis machines to perform the function of a failing kidney, so why not an artificial pancreas? It's important for us to note at the outset that this has been discussed for years and years; while we strongly believe that a "true" artificial pancreas (which requires no input by patients) is still probably at least a decade off, there may be other "versions" that can provide much help to patients perhaps around the end of this decade. Still awhile off, no doubt, but we want to provide you with the latest thinking!
At the Diabetes Technology and Therapeutics Meeting in San Francisco in November, the prospects for an artificial pancreas were further explored. After independent continuous glucose sensing, the integrated artificial pancreas looks to be another rich area of progress on the diabetes technology front; as such, it is on the minds of industry, physicians, and patients alike. The Juvenile Diabetes Research Foundation (JDRF), for example, has named as one of its major goals the creation of an artificial pancreas and we believe support from this important organization is a notable reflection on what might be possible in the coming years. The progress made in continuous glucose sensors—as discussed in our last column—has renewed interest in the idea of an artificial pancreas, as this is one of three key components of an artificial pancreas.
In addition to a continuous glucose sensor, an artificial pancreas will require a method of continuous insulin delivery, an algorithm to connect the glucose sensing to the insulin delivery, and some sort of counter-regulatory hormone (glucagon comes to mind). Since the advent of the insulin pump in the late 1970s, we have had a way to deliver insulin continuously, but accurate, real-time, user-friendly continuous glucose sensing is just catching up. To be used in an artificial pancreas, a continuous glucose sensor must be highly accurate, of course, and as noted in last month's column on continuous glucose sensing, accuracy has been a challenge, especially at hypoglycemic levels. Perspective is critical, however! The first insulin pump was the size of a backpack! See Fig. A. We believe continuous glucose sensors will only continue to improve and at the moment, we're very excited about clinical utility and value offered by the newest generation.
In an artificial pancreas, sometimes referred to as a "closed loop" system, the continuous glucose sensor would report the blood glucose value to the insulin pump, which would then calculate and deliver the appropriate dosage of insulin. In sharp contrast to diabetes therapy today, the person with diabetes would in no way be involved with decision-making. ("How great would that be?!" we're thinking … "If you can figure it out, leave us out of it!") This would eliminate problems with user errors, mis-estimations and carb counting, and perhaps most importantly, would alleviate the lion's share of the daily burden of diabetes. Healthcare providers working on this problem acknowledge this as a key reason to move to a closed-loop system. At the Diabetes Technology Meeting, for example, Dr. Moshe Philip of the National Center for Childhood Diabetes in Israel stressed that an artificial pancreas would mean freedom from thinking about diabetes constantly. We understand that … and bet you do too!
An artificial pancreas is also expected to have the power to eliminate debilitating episodes of hypoglycemia, particularly nighttime hypoglycemia. In fact, JDRF scientist Dr. Aaron Kowalski (who was featured on dLife on July 10, 2005) has suggested that the first step in moving toward an artificial pancreas might be a simple turn-off feature in which a rapidly dropping or low blood glucose value halts the delivery of insulin to prevent hypoglycemia.
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I no longer wear an insulin pump. Nor do I wear a CGM. I wish the latter were different, as I think a CGM would be quite useful, but the welts that it leaves on my skin - in spite of multiple efforts to fight that welts - are just unacceptable. I am, however, still interested in when people remove their pumps and why. I've seen some recent discussion around folks being asked to remove their pump for mammogram procedure, so I figured I'd ask around the hospital I work to...