If you use insulin and find it challenging to get dosing just right — and let’s face it, that can be hard — then you may want to know about new technology underway called the artificial pancreas system.
“An artificial pancreas is a device that controls the glucose level automatically through information about glucose concentrations, insulin delivery and potentially other signals to control the rate of insulin delivery,” says Dr. David Klonoff, a clinical professor of medicine at University of California–San Francisco and medical director of the Diabetes Research Institute at the Mills-Peninsula Medical Center in San Mateo, California.
Typically with diabetes, a patient controls their insulin based on knowledge of their current or future expected glucose level and activities at any given time, such as exercising or eating. “An artificial pancreas system embodies automatic delivery of insulin according to rules that are contained in the software,” Klonoff explains.
[Read: 11 Tips for Testing Your Blood Sugar at Home.]
The term “artificial pancreas” may conjure up images of something implanted inside your body, but the device is actually worn outside your body. It consists of an insulin pump, continuous glucose monitor, special software and a radio system that sends the blood sugar data to a smartphone or other device. “They combine to run automatically,” says Aaron Kowalski, chief mission officer for the Juvenile Diabetes Research Foundation in New York. Most of the research for the device has focused on patients with Type 1 diabetes.
There are approximately 18 artificial pancreas systems under development; the one system already approved by the U.S. Food and Drug Administration is from the company Medtronic.
Klonoff explains how the artificial pancreas system works. “The needed dose of insulin continuously varies, and the rate of insulin delivery is transmitted wirelessly to an insulin infusion system — also known as a pump — which delivers insulin according to the needed rate at any moment,” Klonoff says. Some systems, called fully closed loop systems, are built to recognize the need for more insulin after the glucose level begins to rise sharply. Others are built to require a manual announcement of a meal so the system can deliver a mealtime dose even before a sharp increase in the glucose level, but they deliver insulin automatically between meals and at night to maintain stable glucose levels. The latter are called hybrid closed loop systems.
“No fully automatic closed loop artificial pancreas insulin delivery system exists at this time for patients,” Klonoff says.
The main benefit of an artificial pancreas is more accurate blood sugar control than you can achieve on your own. The more you can reach your blood sugar goals, the greater chance you have of avoiding serious complications of diabetes. Yet another benefit it potentially offers is better quality of life. For instance, the artificial pancreas system can offer better blood sugar control at night, says San Francisco-based Adam Brown, senior editor and columnist at diaTribe and author of “Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me.” “This has a tremendous impact on how well I sleep, on my next-day blood glucose levels, on how much stress I feel and on my overall quality of life,” he says.
Currently, some patients may use insulin pumps to aid with their insulin delivery. The artificial pancreas takes some of the work out of insulin pump use.
With the insulin pump, “patients still need to harness the data from continuous glucose monitors, their finger sticks and their knowledge of diabetes to adjust, as needed, insulin dosing as delivered by the pump,” says Dr. David W. Lam, assistant professor of medicine, diabetes, endocrinology and bone disease at the Icahn School of Medicine at Mount Sinai in New York. “The artificial pancreas system, to a certain extent, automates the insulin delivered according to its input and decreases the amount of patient-directed or initiated modification of insulin delivery.”
Still, the technology isn’t an excuse to eat what you want or forget about checking your blood sugar regularly.
[See: 6 Tips to Keep Diabetics Out of the Hospital.]
For example, before you eat a meal, you need to let the system know how many carbohydrates are in that food so the system will adjust your insulin dosing accordingly.
“Food choices are still mission-critical on an artificial pancreas system, and wearing one doesn’t mean you can eat anything and have in-range blood sugars. For those eating a lot of carbs at one time, blood sugar is still going to go very high, but it will come down with a smoother landing on an artificial pancreas system,” Brown says.
Exercise is also a challenge with the system, Brown says; users need to let the system know ahead of time that they will be exercising or eat something to raise their blood sugar.
Eventually, the systems may offer more automation and less work from patients. However, because of the technicalities currently involved, Klonoff believes the best patients are those who have trouble reaching target hemoglobin A1C levels but who are good about their diabetes care — versus a patient who is not usually compliant with proper insulin use.
When describing the system and the importance of the patient’s role, he makes the analogy of driving a regular car versus a Formula One race car.
“The difference is that the race car can get you to where you want to go but it is quicker, and you must understand how to drive it or you might end up crashing,” he says. That’s why the various trainings on how the system works and how to troubleshoot will be so important.
For example, patients will need to provide user input, change infusion sets, test their blood sugars, announce meals and troubleshoot as needed. If the system stops working, patients must also know to control their blood sugar on their own. “Like any treatment or diagnostic test in medicine, the decision ultimately needs to be personalized to the patient,” Lam says. He also believes that patients need to have realistic expectations about what the system can do.
Despite potential challenges with the artificial pancreas system, research shows it appears to offer better control than patients typically achieve on their own, Kowalski says. And diabetes experts believe it will be a great device for children, he adds — an important point because children tend to have greater blood sugar fluctuations. The currently approved system can be used in patients as young as age 14. Other systems under research are potentially for patients as young as 2 years old, Kowalski says.
[See: The 12 Best Diets to Prevent and Manage Diabetes.]
It’s too early to say what the cost will be for the artificial pancreas systems or what insurance will cover. However, early discussions with insurers appear positive, Kowalski says.
One safety consideration with the artificial pancreas system is the risk for hypoglycemia, or low blood sugar. This is something anyone with diabetes could experience with or without the artificial pancreas.
Future artificial pancreas systems may enable patients to input more information about activity or food for even more refined insulin dosing. “Patients will eventually wear sensors not only for glucose but also for exercise, food intake, stress and location that can all affect the person’s requirements for insulin and their sensitivity to insulin,” Klonoff says.
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What Is the Artificial Pancreas? originally appeared on usnews.com
