‘Artificial Pancreas’ May Treat Type 1 Diabetes

Study Shows Computer-Assisted Device Improves Blood Sugar Control

April 14, 2011 -- New research raises hopes that a so-called “artificial pancreas” can help patients with type 1 diabetes better control their disease.

Adults with type 1 diabetes in a newly published study showed improvements in overnight blood sugar control when an experimental computer-assisted device was used, with fewer episodes of levels dropping to dangerously low levels.

For decades, researchers have searched unsuccessfully for a way to automatically coordinate insulin delivery with real-time changes in glucose to maintain optimal blood sugar levels with minimal effort.

Technological advances have led to commercial devices that continuously monitor blood sugar, as well as insulin pumps.

Researchers are now attempting to tie the two together using sophisticated computer software.

In studies in children with type 1 diabetes, the experimental devices proved to be better than conventional insulin pump delivery for maintaining optimal blood sugar control during the night.

The new study, published today in BMJ Online First, is among the first to show the same thing in adults.

Nighttime episodes of low blood sugar, or hypoglycemia, are common in patients with type 1diabetes, and can cause seizures and even sudden death.

“In children and young adults with type 1 diabetes, nighttime hypoglycemia represents the greatest risk for death,” American Diabetes Association past president Larry C. Deeb, MD, tells WebMD.

It is also among the biggest dangers for adult patients.

The new research compared an experimental computer algorithm, which coordinated glucose monitoring and delivery to traditional insulin pump delivery in 24 adults with type 1 diabetes who had used an insulin pump for at least three months before enrollment.

In one scenario, 12 patients who ate a moderate-sized meal early in the evening were assigned to either the experimental artificial pancreas or conventional insulin pump therapy during overnight hours for two nights, separated by a period of one to three weeks.

The design was similar to a second scenario, except that the 12 remaining patients ate a heavier meal later in the evening and the meal included wine.

“The point of this was to test the devices in different real-world situations,” says study researcher Roman Hovorka of the University of Cambridge Metabolic Research Laboratories.

In both scenarios, use of the computer-assisted model resulted in better overnight glucose control compared to traditional insulin pump delivery. The time spent with blood sugar levels in the target range increased by up to about 28% with the closed-loop insulin delivery.

Deeb says the research in children and adults provide strong evidence that a fully automated, practical system for coordinating blood sugar monitoring and insulin delivery is possible and will improve nighttime blood sugar control.

But in the studies reported so far, nurses manually transmitted data from the glucose monitors to the computer and transmitted insulin injection recommendations from the computer to the insulin pump to ensure that patients got appropriate doses of insulin.

Hovorka says the technology exists to make the process fully automatic, but the researchers have not received approval to test the technology.

Technological challenges to a fully automated artificial pancreas also remain, and the path to approval is far from certain, Spyros G. Mezitis, MD, of Lenox Hill Hospital in New York City, tells WebMD.

‘The FDA is likely to be very cautious about approving these devices,” he says. “The investigators will have to prove that they are safe.”

Deeb says he would like to see a first-generation artificial pancreas approved for nighttime use within the next year.

“FDA is being abundantly cautious and that is understandable,” he says. “But my feeling is that if it is not yet time to approve them, it certainly will be soon.”

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How a 'Diabetes Diet' Protects Your Health

Healthy food can help prevent diabetes complications.

If you have diabetes, a healthy diet does more than keep your blood sugar under better control. A good diabetes diet can also help prevent or delay the onset of complications such as nerve pain or heart disease.

Although some people talk about a "diabetes diet," there's really no such thing, experts say. The same healthy diet recommended for those without diabetes will help you if you have diabetes, too. You may need to then tailor the meal plan to your specific needs, such as lowering your cholesterol. But the general concepts of healthy eating are the same for you as for someone without diabetes.

Type 2 Diabetes and the Insulin Pump

If you have type 2 diabetes and take insulin, you may want to ask your doctor about the insulin pump. Insulin pumps are small, computerized devices (about the size of a small cell phone) that you wear on your belt or put in your pocket that allow for a continuous flow of a rapid-acting insulin to be released into your body. The pumps have a small flexible tube (called a catheter) with a fine needle on the end, which is inserted under the skin of your abdomen and taped in place. The insulin pump...

Read the Type 2 Diabetes and the Insulin Pump article > >

Here, what you need to know about eating to feel better now -- and for years to come.

"The diet that used to be termed a diabetes diet is now considered just a healthy diet for all Americans based on the healthy guidelines from the Department of Agriculture," says Ruth S. Pupo, RD, a registered dietitian and certified diabetes educator at the East Los Angeles Center for Diabetes at White Memorial Medical Center.

One slight difference when she counsels those with diabetes: "We might encourage them to be more cautious with concentrated sugars like juices, candy, cake," she says.

Diet plans for people with type 2 diabetes are also more individualized than in the past. Such diet plans follow good nutrition, but also take into account the individual's specific dietary needs, says Angela Ginn-Meadow, RD, a registered dietitian and certified diabetes educator at the Joslin Diabetes Center, in Baltimore.

One person with diabetes may need to lower cholesterol. Another may need to lower high blood pressure.

"One diet [plan] is not going to work for everyone," she says.

Yet, all are based on the same general concepts proven effective for improving blood sugars and controlling diabetes. Eat a diet that is:

Lower in caloriesHigher in complex carbohydrates found in vegetables, fruits, beans, and whole grain cerealsLower in saturated fats like butter, cheese, and fatty meatHigher in mono and polyunsaturated fat like olive oil or canola oil   

Although experts disagree somewhat on the "ideal" meal plan details, they agree that spreading your carbohydrates over the day, or counting them carefully, are good ways to maintain blood glucose control.  

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