Artificial Pancreas Provides Tighter Glucose Control in Type 1 Diabetes

Tight glucose control for patients with type 1 diabetes is a goal that many clinicians promote. Engineers using modern technology have created a number of medical devices to monitor that control, zeroing in on glucose levels associated with fewer long-term complications. Unfortunately, all of the current therapies — which include self-injected and monitored insulin, glucose sensors, insulin pumps, and sensor-augmented pumps — sometimes fail, and then patients experience hypoglycemia. Hypoglycemia can be life-threatening, especially in children, and it often occurs at night. As researchers’ quest is now an infallible system, an artificial pancreas is needed.

The Diabetes Wireless Artificial Pancreas Consortium (DREAM) has been established to aid in the movement from imagining better glucose control to achieving it. Concerned that proposed artificial pancreas devices can work in test settings or hospitals but aren’t useful in real-world settings, the consortium is testing new devices outside of institutions.

Recently, it tested the MD-Logic Artificial Pancreas system — a system that includes an insulin sensor and an insulin pump and runs through a laptop computer — for nocturnal blood glucose control in patients with type 1 diabetes. The group conducted short-term crossover tests at diabetes camps in Israel, Slovenia, and Germany for children and adolescents aged between 10 and 18 years old. The artificial pancreas — which monitors, delivers, and adjusts insulin — was compared to the young patients’ typical form of diabetes control, and it included an alarm device based on algorithms that use insulin delivery data and expected glucose dynamics to alert the system of impending hypoglycemia that cannot be averted and then withhold the insulin dose.

Patients’ overnight glucose control improved significantly while the number of events and duration of hypoglycemia events decreased. Overall, both the amount of insulin provided and its timing improved to create tighter glucose control.

Source: Phillip M, Battelino T, Atlas E, et al. Nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med. 2013;368:824-33.