Five advancements in diabetes treatment to watch
2. Artificial pancreas
Innovative companies are making great strides in the development of the artificial pancreas. Although these systems do not replace the pancreas, they closely mimic a healthy pancreas’ glucose regulating function. These systems can administer insulin when sugar levels are elevated and discontinue insulin when sugar is low. This minimizes the risk of serious low and high blood sugars.
One advancement debuting in the United States in April is the hybrid artificial pancreas. The system, designed for use with Medtronic's MiniMed 670G insulin pump (approved by the FDA in September 2016), automates basal insulin delivery to maximize the time glucose levels are in a healthy range throughout the day and night. “The system will give many people with diabetes new freedom and peace of mind as for the first time, they may be able to sleep through the night without periodically waking up to check and manage their blood glucose levels,” Lucas says.
A study published in JAMA found that on the 670G system, 124 patients had no episodes of severe hypoglycemia or ketoacidosis over 12,389 patient days. Further, the 670G system kept people with type 1 diabetes within their desired blood sugar range 73.4% of the time, compared to 67.8% without the system. At night, the most dangerous time for blood sugar highs and lows, the difference was even more pronounced—76.4% of readings were in range versus 67.8% without the system.
An artificial pancreas system consists of three devices that closely mimic the glucose regulating function of a healthy pancreas, says Deena Adimoolam, MD, assistant professor of medicine, endocrinology, diabetes, and bone disease at the Icahn School of Medicine at Mount Sinai, New York. These devices include:
· A motorized infusion pump which can deliver two important hormones—insulin and glucagon;
· ACGM to evaluate blood glucose throughout the day; and
· A glucometer, as the patient needs to check fingersticks at least twice daily to calibrate the continuous glucose monitor.
These systems communicate directly with one another through a sophisticated computer-controlled algorithm. “Ultimately, the glucose values detected by the CGM determine whether or not the pump gives the patient insulin to decrease glucose values or glucagon to increase glucose values; therefore, keeping blood glucose values in a target range,” Adimoolam says.
Another type of artificial pancreas under development is the bionic pancreas. This CGM and pump system is scheduled to undergo a large clinical trial, and is not yet approved by the FDA. It consists of an insulin-only system, as well as a system that uses two hormones—glucagon and insulin—within the pump system, in conjunction with the CGM.
“The system controls the patient’s blood sugar; the patient only has to perform a few blood glucose checks per day in order to calibrate the CGM device,” Pantalone says. “Mathematical algorithms use the CGM information to continually adjust the rates of hormone infusion in order to obtain better blood sugar control.”