A quiet revolution is underway in the treatment and management of type 1 diabetes, largely due to novel technologies like the artificial pancreas.
Currently, patients with type 1 diabetes walk an endless tightrope, striving to prevent their glucose levels from veering too high or too low. Now, thanks to new miniaturized automated computer technology, researchers are perfecting devices designed to change type 1 diabetes management.
These devices, including new artificial pancreas and bionic pancreas systems, may be able to eliminate the enormous emotional and practical burden of continually using fingerstick tests and delivering insulin.
“The endocrinologist’s job will be changing a lot,” said Shubhada Jagasia, MD, medical director of the Vanderbilt Eskind Diabetes Clinic at Vanderbilt University in Nashville, Tennessee. “The new implants are going to make management much more accurate for diabetes, and they are also going to make management of the disease less patient-dependent, which is a big issue with the disease. The new devices should improve outcomes because of decreased complications and better blood sugar control.”
Status of the Artificial Pancreas
Dr. Jagasia has been working with the MiniMed 530G with Enlite, a first generation artificial pancreas system. The FDA approved the device in September 2013. The device is a threshold suspend automation system that can automatically stop insulin delivery when sensor glucose values reach a preset level and the patient with diabetes has not responded to the threshold suspend alarm.
“The patients have done very well with this technology,” Dr. Jagasia said.
The MiniMed 530G is much more accurate and considerably smaller than previous generations of the device. The first artificial pancreas systems were built in the 1960s, and over the last 50 years, computer technology has helped usher in a new generation of devices that offer the hope of requiring little or no interaction by the patient.
Researchers at Tel Aviv University recently reported on an artificial pancreas system that could improve glucose control and reduce nocturnal hypoglycemia.1 They conducted a multicenter, multinational, randomized, crossover trial with 56 patients aged 10 to 18 years with type 1 diabetes.
The patients participated in two consecutive overnight sessions in which they randomly received treatment with an artificial pancreas on the first night and a sensor-augmented insulin pump on the second night.
The artificial pancreas was associated with significantly fewer episodes of nighttime glucose levels below 63 mg/dL, with seven episodes compared with 22, according to the study results.
Overall, patients with diabetes treated with the artificial pancreas system experienced less nocturnal hypoglycemia and tighter glucose control than when treated with the sensor-augmented pump.
Bionic Pancreas Shows Promise
On June 15, 2014, researchers reported in the New England Journal of Medicine that a wearable, automated, bihormonal bionic pancreas could improve mean glycemic levels with less frequent hypoglycemic episodes in both adults and adolescents with type 1 diabetes, as compared with an insulin pump.2
The study included 20 adults and 32 adolescents. Both groups were monitored for 5 days while wearing their own conventional insulin pumps and then monitored while wearing a bihormonal bionic pancreas.
In adults, the bionic pancreas resulted in 37% fewer interventions for hypoglycemia and a more than twofold reduction in the time spent in hypoglycemia, as compared with the manual insulin pump, according to the data.
In adolescents, the researchers noted a twofold reduction in the need for interventions for hypoglycemia.
Additionally, both groups experienced significant improvements in glucose levels at night with the bionic pancreas vs. the manual insulin pump.