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Research spotlight – the artificial pancreas

Diabetes UK is proud to be funding groundbreaking research aimed at developing and testing an artificial pancreas for adults with Type 1 diabetes.

The artificial pancreas is a system that measures blood glucose levels on a minute-to-minute basis using a continuous glucose monitor (CGM), and transmits this information to an insulin pump that calculates and releases the required amount of insulin into the body.

This system, which is worn like an insulin pump, has been termed the 'artificial pancreas' because it monitors and adjusts insulin levels just as the pancreas does in people without diabetes.

How the artificial pancreas works

Artificial pancreas diagram

  1. Glucose sensor under skin
  2. Wireless transmission
  3. Monitor picks up data

Outcomes

  • Better glucose control, which reduces the risk of complications
  • Glucose levels monitored continuously
  • Risk of overnight hypos reduced
  • Improved quality of life and peace of mind

A better life

The device has the potential to transform lives, particularly for people who find it difficult to maintain good blood glucose control.

By levelling out the peaks and troughs in blood glucose levels, the artificial pancreas will help to avoid:

  • raised glucose levels, which over time contribute to the development of complications
  • low glucose levels, or ‘hypos’, which can be distressing and in extreme cases can lead to a coma or death.

Diabetes UK research

Diabetes UK-funded researchers are currently working to tailor the artificial pancreas system for adults with Type 1 diabetes, and for women with Type 1 diabetes during pregnancy.

Developing the artificial pancreas for people with Type 1 diabetes

Dr Roman Hovorka at the University of Cambridge has generated a first-generation artificial pancreas prototype and evaluated its ability to improve blood glucose control at home and reduce the risk of overnight hypos in adults with Type 1 diabetes.

In April 2011, Dr Hovorka published encouraging results from two studies evaluating the performance of the artificial pancreas compared with conventional treatment in 10 men and 14 women with Type 1 diabetes.

The studies showed a 22 per cent improvement in the time that participants kept their blood glucose levels in a safe range, halving the time they spent with low blood glucose levels and reducing the risk of both short- and long-term complications.

In 2014, Dr Hovorka’s team published results from a study of 24 adults with Type 1 diabetes who used the artificial pancreas overnight in their homes for four weeks without medical supervision. People using the system spent 13.5 per cent more time with their glucose levels in the ideal range, compared to people using the current gold-standard insulin therapy.

They also had lower average overnight blood glucose levels without increasing the time they spent with their blood glucose level falling too low.

"Revolutionising blood glucose control"

Dr Roman Hovorka says, “The advantage of a ‘closed-loop’ system like this one is the ability to fine-tune insulin delivery to account for variations in overnight insulin needs. Now that we’ve tested the system at multiple centres, we can see that its benefits apply to a wide range of individuals.

“A large-scale clinical trial of the artificial pancreas will be the next step in helping to translate these exciting findings into an end product that will help to transform the management of Type 1 diabetes by achieving consistent glucose levels and reducing the risk of blood glucose levels falling dangerously low during the night. Such a product may be viable with existing technology.”

"It felt like I was on holiday"

Mark Wareham, 42, from Cambridge, has had Type 1 diabetes for 27 years. He normally uses an insulin pump to control his condition, and took part in the trial early in 2013.

Mark said, “I am so glad I took part in this trial as I don’t think I would have believed what a positive outcome the artificial pancreas may have on people with Type 1 diabetes otherwise. I felt fantastic and my energy levels were through the roof.

Sense of stability

“I was hoping to see some physical benefits of using the artificial pancreas device, but I wasn’t at all prepared for the additional psychological and emotional benefits of the trial. It felt like I was on holiday for the whole month’s duration. Waking up almost every day of the month’s trial with blood glucose levels within their target range was something new for me, and gave me a sense of stability I don’t get just by using the insulin pump.

“Although it may be a while until the artificial pancreas is available for everyone with Type 1 diabetes, ongoing research like this is taking us closer to breakthrough moments in treating this condition."

Trials for pregnant women with Type 1 diabetes

Dr Helen Murphy has led on a project to adapt the artificial pancreas to control blood glucose levels during pregnancy. This research could drastically reduce the risk of complications for pregnant women with Type 1 diabetes.

In January 2011, Dr Murphy published results from a small study of 10 pregnant women, with an average age of 31 and with Type 1 diabetes.

The artificial pancreas system was able to automatically calculate the right amount of insulin at the right time, maintain near-normal blood glucose levels and, in turn, prevent nocturnal hypoglycaemia in both early and late pregnancy.

In December 2011, her team also demonstrated the safety and effectiveness of the system in pregnant women over a 24-hour period, including during and after moderate exercise. Women using the system achieved glucose levels within the recommended target range for over 19 hours per day (comparable to the very best control achieved using insulin pump therapy) and the system helped to protect against extreme low blood glucose levels.

In 2016, her team showed that the artificial pancreas is safe and effective for pregnant women to use in a home setting. 16 women used the device for a month, and then 14 of them chose to continue using the artificial pancreas for the rest of their pregnancy and during birth.

Managing blood glucose levels during pregnancy

This device could help women to better manage their blood glucose levels during pregnancy, something that is particularly difficult to do during this time.

If blood glucose levels aren’t managed properly, Type 1 diabetes can be linked to a number of complications during pregnancy, ranging from having a baby slightly early to unfortunate cases of stillbirth.

There are around 400,000 people with Type 1 diabetes, with a great number of those being women that may wish to have children. The artificial pancreas could make it much easier for these women to manage their blood glucose levels during pregnancy, helping to keep the risk of complications to a minimum.

Lots of women with Type 1 diabetes have healthy babies. If blood glucose levels are managed properly, there’s no reason why you can’t have a complication-free pregnancy. That said, it’s important to get as much support as you can during this time. Speak to your healthcare professional, so that they can help you plan and manage your blood glucose levels before and during pregnancy.

The artificial pancreas isn’t available yet

It’s still being tested in clinical trials. Dr Murphy's team are currently testing the system using a smartphone – instead of a larger tablet – in an ongoing trial with 16 pregnant women. They then hope to carry out a larger trial, involving more women, so that they can be sure of its effectiveness. So we’re a few years away from this being available in the clinic.

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