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edical innovation in the
treatment of type 1 diabetes takes a huge leap forward with the invention and
trial of an artificial pancreas. Could this algorithm-based smartphone device
change diabetics' lives for the better?
Share on PinterestThe
treatment of type 1 diabetes could be changed forever by the artificial
pancreas.
Image credit: UVA Health
Image credit: UVA Health
According to the Centers
for Disease Control and Prevention (CDC), almost 1 in 10 Americans has diabetes. Of these, roughly 5% are type 1 diabetics, which
equates to 1.5 million Americans.
Treatment for type 1 diabetes is
highly effective but is a relatively troublesome ordeal. Patients are required
to regularly draw blood, check glucose levels and inject the appropriate amount
of insulin.
Current interventions leave
unwanted opportunity for human error. They are also fairly unpleasant and
inconvenient; the hunt for better treatments is ongoing.
One such improvement
showing a great deal of promise is the so-called artificial pancreas. The idea
of an artificial pancreas has been discussed for decades, but it is only very
recently that it has become a potentially viable option.
Designed by Boris Kovatchev
and his team at the University of Virginia School of Medicine, this medical
innovation has the potential to change millions of lives for the better.
Kovatchev has been working
on such a device since 2006. Initially, this type of closed-loop system that
could monitor glucose levels and administer insulin appropriately was believed
to be impossible.
The idea of an artificial
pancreas was met with skepticism from the scientific community but, thankfully,
Kovatchev continued unabated:
"We show that it's not
only possible, but it can run on a smartphone."
What is type 1 diabetes?
Insulin normally
facilitates the absorption of glucose from the blood into the body where it is
used. Type 1 diabetes occurs when the pancreas stops making enough insulin.
Type 2 diabetes is
most often caused by lifestyle choices, such as poor diet and lack of exercise;
type 1 diabetes, however, is unrelated to lifestyle. The beta cells within the
pancreas that manufacture insulin are attacked by an inappropriate immune
system response, rendering them insufficient for the body's needs.
To make up for this
shortfall in biochemistry, patients must frequently prick their fingers, take a
blood sample, measure glucose levels and inject themselves with insulin to
redress the balance. This regular rigmarole is necessary to keep blood glucose
levels within a healthy range.
Aside from the
inconvenience and discomfort, as with anything that is reliant on human
interaction, there is the possibility of error. Raised glucose levels can, over
time, damage the kidneys, nerves, eyes and blood vessels. At the other end of
the spectrum, low glucose, or "hypos" can, in extreme circumstances,
lead to coma or death.
Anything to remove the
possibility of user error will be of obvious benefit.
How the artificial pancreas works
Kovatchev's artificial
pancreas, also referred to as closed-loop control of blood glucose in diabetes,
takes away much of the human interaction that is currently necessary in
self-medication.
The central hub of the
system uses a platform called InControl that runs on a reconfigured smartphone.
This handheld device is linked wirelessly to a blood sugar monitor, an insulin
pump and a remote monitoring site. The blood sugar monitor takes the glucose
levels in the blood every 5 minutes and delivers the readings to the InControl
device.
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The
device is controlled by algorithms and administers the correct amount of
insulin through a fine needle without the patient having to spill even a drop
of blood.
The algorithms are where
the real innovation comes in. They are designed to second guess how much
insulin is likely to be needed. It is not enough for the technology to simply
react to blood levels at any particular moment in time, it must predict glucose
spikes, preempt changes and adapt to an individual's insulin sensitivity. This
is no mean feat.
The human pancreas is able
to make these calculations with ease, but to design something as capable as the
pancreas is a difficult task indeed.
When asked about the
algorithms, Kovatchev told Medical
News Today:
"The algorithms are based on a model of
the human metabolic system which uses data from continuous glucose monitoring,
past insulin delivery and, possibly, other available signals, to recognize
patterns of blood sugar fluctuations and predict where the blood sugar of the
patient in heading.
Then
the algorithm delivers insulin based on predicted glucose values. Special
attention is paid to the prediction and mitigation of hypoglycemia -
a separate algorithm (we call it Safety Supervision System) is specifically
tuned for that, and it is quite good at this task."
He told us the Safety
System is their most tested algorithm; it has been in use for many years.
Kovatchev further explains
how the artificial pancreas works in the video below:
Trialing the groundbreaking organ
The National Institute of
Diabetes and Digestive and Kidney Diseases are supporting this vital research
to the tune of $12.6 million.
The artificial pancreas has
begun its final trials in nine locations across the US and Europe. For the
first phase, 240 patients with type 1 diabetes will trial the system for 6
months. The second run of trials will see 180 patients from the first phase wearing
the system for a further 6 months.
Designed in conjunction
with TypeZero Technologies in Charlottesville, VA, the system will be compared
with a standard insulin pump against two major criteria: how well blood sugar
levels are managed and whether the risk of hypoglycemia or low blood sugar is
reduced.
Kovatchev explains his aims
for the artificial pancreas:
"To be ultimately successful as an
optimal treatment for diabetes, the artificial pancreas needs to prove its
safety and efficacy in long-term pivotal trials in the patient's natural
environment.
Our
foremost goal is to establish a new diabetes treatment paradigm: the artificial
pancreas is not a single-function device; it is an adaptable, wearable network
surrounding the patient in a digital treatment ecosystem."
Further improvements on the horizon
This innovation looks set
to make a huge and positive difference to millions of people. It aims to
improve the lives of type 1 diabetics by easing the burden of controlling
insulin levels manually. Additionally, thanks to the algorithms, the artificial
pancreas should keep blood glucose at more physiologically normal levels.
Of course, every medical
advance brings with it a new set of horizons to aim for. MNY asked Kovatchev whether
there are any adaptations or improvements he would like to make to the
artificial pancreas further down the line:
"Multi-signal and multi-hormone systems
are being explored to use additional signals such as heart rate or motion
sensing, and additional hormones such as amylin. We believe the technology will
be evolving in these directions."
Kovatchev and collaborators
are already sounding out the use of other hormones within the artificial
pancreas; his team is also investigating whether the system might only need to
be worn at certain times of the day, for instance, at night and/or after meals.
The artificial pancreas
looks likely to go from strength to strength. In conjunction with the other
technologies currently being investigated, diabetes will soon be beating a
hasty retreat. Medical News Today recently
covered research into the possibility of transplanting insulin-secreting cells into diabetic patients.
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