An artificial pancreas has long been considered the holy grail for people with type 1 diabetes, and new research suggests a more convenient version of this technology may help the millions of people living with type 2 diabetes.
Type 2 is the more common form of diabetes, and 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 to no insulin. When insulin is in short supply, glucose builds up, causing extreme fatigue, blurry vision, weight loss and confusion. Some people with type 2 diabetes also need to take daily insulin to keep their blood sugar in check.
Enter the artificial pancreas, an automated insulin delivery system that mimics the pancreas' function.
"About 20% to 30% of people living with type 2 diabetes use insulin therapy to manage their diabetes, and we have shown that this way of delivering insulin with a closed-loop system is much more effective than their current insulin injections at reaching glucose targets," said study author Dr. Charlotte Boughton, a clinical lecturer at the University of Cambridge in England.
With closed-loop systems for type 1 diabetes, the user enters information several times a day about the timing and size of their food intake, but insulin delivery between meals and overnight is automated. By contrast, the new system for people with type 2 diabetes is a fully closed loop. This means users don't have to input any information.
It was developed using over-the-counter devices, including an off-the-shelf glucose monitor and an 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. People wear the blood sugar sensor and insulin pump and carry a smartphone with them for the system to work, Boughton said.
"This fully automated closed-loop system is a safe and much 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 was it? 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 shots, the investigators found.
Boughton said this is equivalent to an additional eight hours a day and was achieved without increasing the risk of dangerously low glucose levels.
"We anticipate that the improvement in glucose control 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 the artificial pancreas for eight weeks and then switched to multiple 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 with standard insulin shots, according to the report.
What's more, people delivering insulin via shots spent two-thirds of their time with high glucose levels, compared with 33% when using the artificial pancreas, the researchers found.
The system 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 doesn't keep blood sugar levels in the target range.
And then there is the quality-of-life improvement that comes with not needing to constantly check blood sugar levels, inject insulin or take medication. Nine of 10 participants said they spent less time managing their diabetes when they used the artificial pancreas.
This technology could be game-changing for millions.
"The number of people diagnosed with type 2 diabetes is increasing globally, and people are diagnosed at a younger age, so they are living with type 2 diabetes for longer," Boughton said. "Anyone with type 2 diabetes who struggles to keep glucose levels where they should be with insulin injections could benefit from this system."
The devices do cost more than standard insulin injections and glucose testing kits.
"If the closed-loop system can reduce the risk of very expensive diabetes complications in the long-term — such as the need for dialysis, visual impairment and amputations — then they may be cost-effective. But a much larger study with longer follow-up is required to investigate this," Boughton stressed.
The researchers have previously shown that an artificial pancreas run by a similar algorithm is effective for those with type 1 diabetes and have also tested this system in people with type 2 diabetes who require kidney dialysis.
These systems can be fairly simple to use: You wear the devices, load them with insulin and go about your daily routine, explained Dr. John Buse, chief of endocrinology and director of the Diabetes Center at the University of North Carolina at Chapel Hill.
"No such device is available in the U.S. or, to my knowledge, anywhere in the world," said Buse, who reviewed the new study.
Similar investigational technologies cost about $10,000 per year for the devices, supplies, insulin and provider support, he said. "[They cost] more in the first year with acquisition costs and less over time," he explained.
More research is needed before this device is ready for prime time, but the promise is real, Buse added.
"Keeping glucose in a relatively narrow range holds the promise of reducing long-term complications of diabetes — blindness, kidney failure, amputations, heart attacks, strokes, as well as minimizing the risk of urgent hospitalization related to high or low glucose, as well as potentially reduced risk of infection, cognitive decline and other important issues common in diabetes," he said.
The findings were published online Jan. 11 in Nature Medicine.