Artificial Pancreas- Revolutionary treatment for type 2 diabetes.

Our body is beautifully programmed to maintain the balance of nutrient levels in it. It has a large category of hormones that can be used to balance the amount of diffrent nutrients in our body. Insulin hormone secreted by our pancreas is one of them that works to maintain the levels of sugar in our body. Sugar is the main nutrient that we need for energy production. A large fragment of our energy rich food sources include sugars and its levels in our body are maintained by insulin hormone. When we eat something, it is absorbed into our blood streams and transported to diffrent parts of body for its proper utilization. But sometimes when we eat more sugary cupcakes or other sweet foods, sugar levels in our blood imbalances. It can be harmful for our body. Especially for those people that have diabetes type 2.

What is type 2 diabetes?

Diabetes type 2 is a lifelong disease that blocks the use of  insulin to maintain the level of sugars in our blood stream. These people are said to have insulin resistance. Type 2 diabetes affects kids and teen and that's why it is also called adult-onset diabetes. This is the most common type of diabetes. About 29 million people in U.S. are suffering from this diabetes. It can further advanced into kidney failure. This kidney failure can increase the risk of hypoglycaemia and hyperglycaemia that is abnormally low or high levels of blood sugar respectively. Hyper and hypo glycaemia in turn can cause complications from dizziness to falls and even to coma. So kidney faliur with diabetic patients can be a dangerous condition.

Managing diabetes in patients with kidney failure is challenging for both patients and healthcare professionals. Many aspects of their care are poorly understood, including targets for blood sugar levels and treatments. Most of oral medications available for diabetic people are not recommended to these patients. Insulin injection is the only available therapy used for diabetes type 2. This insulin therapy proceeds though optimal dosing of insulins but regimens are difficult to establish. 

Artificial Pancreas for type 2 diabetes

A revolutionary treatment for diabetes is now available in hospitals known as "artificial pancreas". Previously this device was available for type 1 diabetic patients but now a team of Cambridge university developed an another artificial pancreas available for type 2 diabetic patients. This is a device that can maintain the patient's blood sugar level by secreting insulin from it 

Development of artificial pancreas

A team at the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust has previously developed an artificial pancreas with the aim of replacing insulin injections for patients living with type 1 diabetes. In research published in Nature Medicine, the team working with researchers at Bern University Hospital and University of Bern, Switzerland has shown that the artificial pancreas they developed now can be used to support patients living with both type 2 diabetes and kidney failure.

Components of artificial pancreas

The artificial pancreas is a small, portable medical device designed to carry out the function of a healthy pancreas in controlling blood glucose levels, using digital technology to automate insulin delivery. The system is worn externally on the body, and is made up of three functional components: 

• A glucose sensor
• A computer algorithm to calculate the insulin dose, and 
• An insulin pump. 

Everything is connected with a software installed in patient's smartphone. Software sends a signal to an insulin pump to adjust the level of insulin the patient receives. The glucose sensor measures the patient’s blood sugar levels and sends these back to the smartphone and shows the readings in software.

Testing of artificial pancreas.

The team recruited 26 patients requiring dialysis between October 2019 and November 2020. Thirteen participants were randomised to receive the artificial pancreas first and 13 to receive standard insulin therapy first. The researchers compared how long patients spent in the target blood sugar range (5.6 to 10.0mmol/L) over a 20-day period as outpatients.

Conclusions

Patients using the artificial pancreas spent on average 53% of their time in the target range which means that at that time their blood sugar level is maintained automatically by the device, compared to 38% when they used the control treatment by insulin injections. This equated to around 3.5 additional hours every day spent in the controlled blood sugar range compared with the control therapy of insulin injections.

Mean blood sugar levels were lower with the artificial pancreas (10.1 vs. 11.6 mmol/L). The artificial pancreas reduced the amount of time patients spent with potentially dangerously low blood sugar levels, or ‘hypos’.

The efficacy of the artificial pancreas improved considerably over the study period as the algorithm adapted, and the time spent in the target blood sugar range increased from 36% on day one to over 60% by the twentieth day. This finding highlights the importance of using an adaptive algorithm, which can adjust in response to an individual’s changing insulin requirements over time.

Benifits of artificial pancreas 

Benefits of the artificial pancreas reported by study participants included

• less need for finger-prick blood sugar checks,
• less time required to manage their diabetes resulting in more personal time and freedom, 
• Improved peace of mind and reassurance.

Senior author Professor Roman Hovorka, also from the Wellcome-MRC Institute of Metabolic Science, said: “Not only did the artificial pancreas increase the amount of time patients spent within the target range for the blood sugar levels, it also gave the users peace of mind. They were able to spend less time having to focus on managing their condition and worrying about their blood sugar levels, and more time getting on with their lives.”

Reference

• Material provided by University of Cambridge research article.
• Boughton, CK et al.  Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomised crossover trial. Nat Med; 4 Aug 2021; DOI: 10.1038/s41591-021-01453-z