What Is An Artificial Pancreas?
Dr. Nancy Tout explains this life-altering technology for type 1 diabetes
In September of 2016, the U.S. Food and Drug Administration approved the first system to automatically monitor glucose and adjust basal insulin doses in people 14 years of age and older with type 1 diabetes (T1D). Medtronic’s artificial pancreas uses an insulin pump, sensor and a control algorithm to more accurately manage basal insulin delivery between meals and during sleep, keeping glucose levels in a healthy range throughout the day and night.
“The improved quality of life offered by the artificial pancreas is significant; not only does it ease the burden all day, it also allow users to sleep safely and with peace of mind,” says Nancy Tout, whose son Alex was diagnosed with type 1 diabetes at age two. “For the 14 past years, we have had to wake Alex up in the middle of every night to test his blood glucose; this would no longer be necessary with an artificial pancreas.”
Dr. Tout, who has a PhD in microbiology and immunology, is a research information volunteer at JDRF. As a scientist and a mother, she has been watching the evolution of the artificial pancreas research with interest. Significant progress has been made since JDRF announced the Artificial Pancreas Consortium in 2006 – a group made up of leading endocrinologists, mathematicians, and engineers from academic institutions, research organizations and industry.
JDRF’s leadership and advocacy in the artificial pancreas field accelerated the development and approval of the first hybrid closed loop system in the United States. JDRF invested more than $116 million in research – including important foundational investigation – and facilitated information sharing and collaboration, shaping the pathway for regulatory approvals.
Medtronic’s new artificial pancreas system is not yet available in Canada, but Tout is optimistic. She explains that approval by prestigious regulatory agencies like the Food and Drug Administration is a positive sign, influencing other governments around the world.
JDRF Canada has opened a dialogue with Health Canada, with device manufacturers and with policy makers to see if we can’t play a similar role in Canada. Ensuring that Canadians have access to these kinds of life-changing technologies within a reasonable time frame, while still ensuring their safety and effectiveness, is a focus for JDRF.
Moving toward a fully closed-loop system
“The artificial pancreas does part of the thinking for the person since its algorithm takes information about blood glucose and delivers insulin to stay in the optimal range,” says Tout. “However, the current Medtronic system is what you would call a ‘hybrid closed-loop system’: it is not fully closed. The patient still has to count carbohydrates when eating to make decisions about meal-time insulin and notify the system during exercise.”
Tout points out that more elements must be addressed to create a true “closed-loop” system that completely mimics the role of the pancreas:
- Less intrusive sites for insulin delivery and sensing of blood glucose levels, which currently cause irritation and need to be frequently rotated. A goal would be to extend site duration, allowing them to stay in place for a longer period of time.
- A co-formulation of glucagon and insulin, since glucagon is another hormone that the body requires in order to regulate blood glucose levels.
- Faster-acting insulin because there is still a 15-minute delay between insulin delivery and effectiveness.
- A further miniaturized size would be even more inconspicuous than current device elements, and therefore, a more appealing option for patients.
- With more data collected over time, more advanced algorithms can be created.
“What is exciting is that all of these elements are being investigated and developed right now,” Tout says. “Future systems will take the burden fully away and address all of the variables, such as meals, snacks, exercise and hormonal fluctuations. The ultimate goal of the Artificial Pancreas Consortium is the development of multiple, reliable, completely automated systems that replicate the operations of a normal pancreas.”
Innovations and advancements
The significant progress happening in the artificial pancreas field means that the Medtronic system is not the only breakthrough or cause for optimism. According to Tout, numerous other artificial pancreas systems are currently in development and advancements are being made.
For example, JDRF-funded researcher, Dr. Rabasa-Lhoret, is testing two configurations of the external artificial pancreas at the Montreal Clinical Research Institute, an independent non-profit research institution affiliated with the Université de Montréal. One configuration infuses insulin while the other infuses both insulin and glucagon (a hormone that can help raise blood sugar and reduce the risk of hypoglycemia).
It’s an exciting time in the field of T1D research. Until a cure is found, the potential of the artificial pancreas offers incredible promise for people living with T1D because it could significantly reduce the 24/7 burden of managing the disease.
To accelerate the pace of research, JDRF needs funding. Please consider contributing either in the form of a donation, participating in our JDRF Revolution Ride to Defeat Diabetes, attending one of our galas, or volunteering. With your help, we can turn type one into type none.