‘Artificial pancreas’ a reality by 2020

Type 1 diabetes

14 Jul 2016

Closed-loop glucose monitoring and insulin delivery systems – the ‘artificial pancreas’ – are likely to become a routine treatment for type 1 diabetes by the end of the decade, a recent review has claimed.

An analysis by the UK National Institute for Health has reported that there is an expectation that the technology will be available even earlier, just two years away in 2018.

Cambridge, UK, endocrinologists Hood Thabit and Roman Hovorka, writing in Diabetologia, said that translation of the technology into practice will depend on regulatory approvals (although authorities’ attitudes seemed to be supportive), and whether infrastructures are in place for the health professionals providing care.

Less obvious challenges include protecting against cybersecurity threats, such as interference with the systems’ wireless control protocols and unauthorised data retrieval.

The feasibility of insulin pump therapy was established in the 1970s. More recently, technologies have evolved to combine pumps with real-time glucose monitoring to adjust insulin therapy.

True closed-loop systems allowed increases in insulin in response to high glucose levels, in addition to the low-glucose insulin suspend systems that are increasingly common.

A key challenge in type 1 diabetes management is the wide intra-individual variability in insulin requirements.

“This can vary from one-third to three times that of planned insulin delivery, even without intercurrent illness,” the review stated.

“Potential reasons include variable meal composition, aberrations in glucose turnover, lability due to physical activity, and changes in insulin sensitivity in women during perimenstrual periods.”

Although it is possible to provide a new biological source of insulin through transplantation of a pancreas or islet cells, the procedures remain complex and are likely to play only a limited role in the future, they said.

Continuing refinement of closed-loop technology is needed if it is to become a widely accepted option. For example, although the accuracy of implanted glucose-sensing devices has improved, there is still a variation of up to 10% from plasma glucose levels.

Faster-acting insulins are also needed: rapid-acting analogues achieve peak plasma concentrations at 0.5 to 2 hours, and have a duration of action of 3-5 hours.

“These delays are compounded by the inherent 5-15 minute lag between glucose values in the interstitial and vascular space,” the review stated.

Longer-lasting devices are also needed. Existing sensors can be worn for only 2 weeks, but work is continuing on implantable sensors that can last for 6 months.

“Efforts are also underway to develop a ‘single-port’ device, which combines sensor glucose measurements with an insulin infusion cannula into a single subcutaneous insulin infusion set,” it stated.

“Simultaneous glucose monitoring at the site of insulin infusion may help to reduce the burden of multiple set insertions by users.”

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