An artificial pancreas device may help people with type 2 diabetes

By Dennis Mann, Healthday Reporter

(health day)

FRIDAY, Jan. 13, 2023 (HealthDay News) — An artificial pancreas has long been considered the holy grail for people with type 1 diabetes, and New search It suggests that a more convenient version of this technology could help millions of people with type 2 diabetes.

Type 2 is the most common form of diabetes, and it is closely linked to obesity.

The pancreas produces insulin, the hormone that helps blood sugar (or glucose) enter cells to be used as energy. People with type 1 diabetes make little or no insulin. When insulin is low, glucose builds up, causing extreme fatigue, blurred vision, weight loss and confusion. Some people with type 2 diabetes also need to take insulin daily to keep their blood sugar under control.

Enter the artificial pancreas, an automated insulin delivery system that mimics the function of the pancreas.

“About 20% to 30% of people with type 2 diabetes use insulin therapy to control their diabetes, and we have shown that this closed-loop system insulin delivery method is much more effective than current insulin injections for accessing glucose,” said the study author. Dr. Charlotte BoughtonClinical Lecturer at the University of Cambridge, England.

With closed-loop systems for type 1 diabetes, the user enters information several times a day about the timing and volume of food intake, but insulin delivery between meals and overnight is automated. By contrast, the new regimen for people with type 2 diabetes is completely closed loop. This means that users do not have to enter any information.

It was developed using over-the-counter devices, including an off-the-shelf glucose monitor and insulin pump with an app called CamAPS HX. This software predicts how much insulin is needed to keep blood sugar levels in the target range. Boughton said people wear a blood glucose sensor and insulin pump and carry a smartphone with them for the system to work.

“The fully automated closed-loop system is a safer and more effective way for people living with type 2 diabetes to manage their glucose levels than current standard treatment with insulin,” she said.

Just how effective is it? The researchers found that when people with type 2 diabetes used the new system, they spent twice as much time with glucose levels in the target range than when they tested blood sugar and gave themselves insulin injections.

Boughton said this equates to eight extra hours per day and was achieved without increasing the risk of dangerously low glucose levels.

“We expect that the improvement in glucose control that we have seen may reduce the risk of diabetes complications such as eye disease, kidney disease and amputations, but a much larger study with longer follow-up is required to investigate this,” she added.

The new study included 26 people with type 2 diabetes. One group used an artificial pancreas for eight weeks and then switched to several daily insulin injections. The others were treated in the opposite order.

On average, people using the artificial pancreas were within their target blood sugar range two-thirds of the time. This is double what was seen in standard insulin injections, according to the report.

What’s more, the researchers found that people given insulin by injection spent two-thirds of their time with high glucose levels, compared to 33% when using the artificial pancreas.

The regimen also helped reduce levels of glycated hemoglobin, or HbA1c, which provides a snapshot of blood sugar levels over time.

No one in the study experienced dangerously low blood sugar, or hypoglycemia, which can occur if the device does not maintain blood sugar levels in the target range.

Then there is the improvement in quality of life that comes with not having to constantly check blood sugar levels, inject insulin, or take medication. Nine of the 10 participants said they spent less time managing their diabetes when using the artificial pancreas.

This technology could be a game changer for millions.

“The number of people diagnosed with type 2 diabetes is increasing globally, and people are being diagnosed at younger ages, so they are living with type 2 diabetes longer,” Boughton said. “Anyone with type 2 diabetes who is struggling to keep glucose levels where they should be with insulin injections can benefit from this regimen.”

The devices cost more than standard insulin syringes and glucose testing kits.

“If a closed-loop regimen can reduce the risk of expensive long-term diabetes complications — such as the need for dialysis, poor eyesight, and amputations — it could be cost-effective. A much larger study with a longer investigational follow-up is needed,” Boughton stressed. in this matter.

Researchers have previously shown that an artificial pancreas powered by a similar algorithm is effective for those with type 1 diabetes, and they also tested this system on people with type 2 diabetes who need dialysis.

These regimens can be fairly easy to use: You put on the devices, load them up with insulin, and go about your daily routine, he explains. Dr. John Busschair of the division of endocrinology and director of the Diabetes Center at the University of North Carolina at Chapel Hill.

“No such device is available in the United States or, as far as I know, anywhere in the world,” said Bose, who reviewed the new study.

He said similar research techniques cost about $10,000 a year for devices, supplies, insulin, and provider support. “[They cost] More in the first year at acquisition costs and less over time.”

More research is needed before this device is ready for prime time, Bose added, but the promise is real.

“Keeping glucose in a relatively narrow range holds promise for reducing the long-term complications of diabetes—blindness, kidney failure, amputations, heart attacks, and strokes—as well as reducing the risk of urgent hospitalization associated with high or low glucose, as well as potentially lowering the risk of Infection, cognitive decline and other important issues common in diabetes,” he said.

The results were published online on January 11th Nature medicine.

Sources: Charlotte Boughton, Ph.D., Clinical Lecturer, University of Cambridge, UK; John Buss, MD, PhD, Professor, Medicine, Director, Diabetes Center and North Carolina Institute for Translational and Clinical Sciences, University of North Carolina, Chapel Hill; nature medicine, January 11, 2023, online

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