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Home use of artificial pancreas creates historic diabetes landmark

Five adults with Type 1 diabetes have played a landmark role in the history of diabetes research by becoming the first adults to use an artificial pancreas in their homes without medical supervision.

This step offers real hope for a future where people with Type 1 diabetes no longer have to monitor blood glucose levels, and where they have a better chance of living a long and healthy life.

Closed loop system

The artificial pancreas is a "closed loop" system that monitors blood glucose levels and uses this information to adjust the amount of insulin being administered by an insulin pump. This ensures that the person is always getting the right amount.

The idea for this system has been talked about for a long time, but researchers have had to proceed cautiously: having too much or too little insulin is potentially harmful, so malfunctions with the technology had to be avoided. But in 2011 researchers completed a trial where people with Type 1 diabetes used the artificial pancreas in a hospital setting, which cleared the way for a new trial of the prototype device at home.

Trial results expected by end of year

The research, led by Dr Roman Hovorka, began recruiting participants for the trial at the end of last year. Now five participants have spent four weeks using the artificial pancreas at night, which is a time when blood glucose levels can fall too low. In total, 24 people will take part in the trial and will use the artificial pancreas at night for four weeks, while using standard therapy for another four weeks. The results of the trial are expected to be ready by the end of the year.

Even if the results are promising, it will take some time before the artificial pancreas becomes available as a treatment for Type 1 diabetes, and initially it would probably be used just to stop people’s blood glucose levels from falling too low at night. However, it is thought that within a decade the technology could develop to a point where those who use it no longer have to monitor their blood glucose levels.

Convenience and tighter control

As well as being more convenient, the artificial pancreas could help people with diabetes to keep much tighter control of their blood glucose levels than is possible with current methods. Having consistently high blood glucose levels puts people at increased risk of health complications such as amputation, kidney failure and stroke, and is the main reason why, on average, people with Type 1 diabetes die about 20 years younger than the rest of the population. This means that, in the long term, the artificial pancreas has the potential to significantly reduce the number of premature deaths related to the condition.

Technology "offers real hope"

Dr Alasdair Rankin, Director of Research for Diabetes UK, said, "After years of scientists discussing the possibility of an artificial pancreas, we are now finally at the exciting point where people are using them in their homes. This means we have reached a landmark in the development of a technology that offers real hope for a future where Type 1 diabetes does not mean having to think constantly about the balance of blood glucose and insulin or having to face a much higher risk of dying early.

"Years rather than decades"

"We don’t want to give people false hope that an end to the management of Type 1 diabetes is just around the corner. It is still early days, and even if this trial shows that the artificial pancreas can be used safely and effectively in people’s homes, there will need to be bigger trials before it can be offered as a routine treatment. But I think we are talking years rather than decades before this becomes a reality.

"Also, it is likely that the device would initially be used only at night and so, while important for blood glucose control, the people using it would not notice an immediate difference in their daily lives. However, as the technology progresses, we expect it to make Type 1 diabetes an increasingly manageable condition until eventually we will reach the point where people might check their artificial pancreas when they get up in the morning and then do not have to think about their diabetes for the rest of the day.

Cutting edge of research

"The five participants who have spent four weeks using the artificial pancreas in their home are pioneers at the cutting edge of Type 1 diabetes research, as we expect thousands more people to follow in their footsteps in the years to come."

"Revolutionising blood glucose control"

Dr Roman Hovorka said, "The artificial pancreas has the potential to significantly improve the lives of people with Type 1 diabetes, by revolutionising blood glucose control at home and by lowering their risk of an overnight hypo. We’re excited to be making progress with this research and look forward to bringing this important device one step closer to the clinic."

"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 earlier this year.

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."

Scientific research in Diabetes Week

Dr Rankin added, "We are delighted to be announcing this development at the beginning of Diabetes Week, in particular, because the theme this year is how scientific research can make a real difference for people living with diabetes and those at risk. There is no better example of that working in practice than how the artificial pancreas promises to transform the lives of people with Type 1 diabetes within a generation."

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