Research overview with Dr. Rabasa-Lhoret
Leading endocrinologist explains his research on the artificial pancreas
Closed-loop technology – often referred to as ‘artificial pancreas’ – is a major medical breakthrough that enables people with type 1 diabetes (T1D) to reach target blood sugar range. Consisting of an insulin pump, a continuous glucose monitor and a control algorithm, the externally placed device constantly modifies insulin infusion to maintain normal blood glucose, thereby decreasing both the risk of chronic T1D complications and hypoglycemia.
Dr. Rémi Rabasa-Lhoret, an endocrinologist at the Institut de recherches cliniques de Montréal, and his team are currently testing two configurations of artificial pancreas. The first device infuses insulin, and the second infuses both insulin and glucagon (a hormone that can help raise blood sugar). While the artificial pancreas (the Medtronic System) has already been launched in the United States, Dr. Rabasa-Lhoret’s research team is going one step further as one of the first in the world to develop a dual hormone system.
“We are examining the viability of a dual hormone system because we believe that hypoglycemia is harder to alleviate solely with current insulin,” explains Dr. Rabasa-Lhoret. “The ideal goal is to prevent low blood sugar in a patient, while also improving overall glucose control.”
Though still in its infancy, the dual hormone system increases hypoglycemia prevention at night as observed in trials among adults and children. Ranging from 24 hours to three months long, the trials showed that the infusion of glucagon offers better glucose control and an additional “safety net” to deter hypoglycemia. This system could, in the future, provide a more feasible treatment option for patients who struggle with single hormone artificial pancreas.
While Dr. Rabasa-Lhoret’s research shows great promise, there are still a number of factors to consider before this system is ready for regulatory approval. For example, the long-term safety of glucagon – including its target effects on the heart, kidneys, liver and lungs – needs to be further assessed, along with the use of other hormones as a substitute for glucagon. Also, there are additional costs associated with a dual system and provincial eligibility for coverage that needs to be determined.
JDRF Canada has opened a dialogue with Health Canada, with device manufacturers and with policy makers to bring the artificial pancreas to Canada. Ensuring that Canadians have access to these kinds of life-changing technologies within a reasonable time frame, while still guaranteeing their safety and effectiveness, is a primary focus for JDRF.
“We have no established timeline regarding the introduction of the artificial pancreas in Canada,” says Dr. Rabasa-Lhoret. “Glucagon is expensive and its potential benefits are still being studied. Also the approved artificial pancreas in the US is based on pumps not yet approved here.”
With T1D currently affecting over 300,000 Canadians, the artificial pancreas offers incredible promise because it could significantly reduce the 24/7 burden of managing the disease.
“We must continue to explain the disease and lobby the government to better recognize the situation of patients with T1D in Canada,” says Dr. Rabasa-Lhoret. “We still hear that T1D is caused by eating too much sugar in childhood and that hypoglycemia is not a real problem. Given such assumptions, we have to first educate decision makers. In an ideal scenario, artificial pancreas will make treatment simpler, safer and more efficient. We need to make this happen at an affordable cost.”