Managing blood sugar levels can be a difficult task for those living with type 2 diabetes, particularly with current treatment options such as insulin injections. A new artificial pancreas system offers a safe, effective solution to this challenge, with its simple usage and ability to be used safely in a home setting.

Scientists from Cambridge have successfully tested an artificial pancreas for patients with type 2 diabetes. The gadget, which was driven by an algorithm created at the University of Cambridge, increased the amount of time patients were in the target range for glucose and cut the time spent experiencing high glucose levels in half.

Type 2 diabetes is predicted to affect 415 million people globally, with a corresponding $760 billion yearly global health expenditure. Diabetes UK estimates that there are more than 4.9 million diabetics in the UK alone, 90% of whom have type 2 diabetes, and this disease costs the NHS £10 billion annually.

Type 2 diabetes results in abnormally high amounts of glucose (blood sugar). Normally, blood sugar levels are regulated by the release of insulin, but type 2 diabetes disrupts insulin synthesis. This may eventually lead to major issues including heart disease, kidney, nerve, and eye damage.

The disease is usually taken care of by making changes to the way people live, like eating better and getting more exercise, and by giving them medicine. The goal is to keep glucose levels low.

Researchers at the University of Cambridge’s Wellcome-MRC Institute of Metabolic Science have made an artificial pancreas that can help keep glucose levels at a healthy level. The device is made up of an off-the-shelf glucose monitor and insulin pump, as well as an app called CamAPS HX that was made by the team. An algorithm runs this app and figures out how much insulin is needed to keep glucose levels in the target range.

The researchers have previously shown that individuals with type 1 diabetes, ranging from adults to very young children, may benefit from an artificial pancreas controlled by a similar algorithm. They have also tested the gadget successfully on type 2 diabetics who need kidney dialysis.

The team reports the results of the device’s first trial in a larger sample of people with type 2 diabetes (not requiring kidney dialysis) today in Nature Medicine. This new version of the artificial pancreas for type 1 diabetes is a completely closed loop system, as opposed to the artificial pancreas used for type 1 diabetes, which requires the user to alert the device when they are going to eat so that it may alter their insulin, for example.

The researchers got 26 patients from the Wolfson Diabetes and Endocrine Clinic at Addenbrooke’s Hospital, which is part of Cambridge University Hospitals NHS Foundation Trust, and from a group of local GP surgeries. Patients were randomly assigned to one of two groups: the first group would use the artificial pancreas for eight weeks before switching to the standard therapy of multiple daily insulin injections; the second group would use the standard therapy for eight weeks before switching to the artificial pancreas.

The team used a number of different ways to figure out how well the artificial pancreas worked. The first was the amount of time that a patient’s glucose level was between 3.9 and 10.0mmol/L, which is the ideal range. On average, patients who used the artificial pancreas spent two-thirds (66%) of their time in the target range. This was twice as much as when they were on the control (32%).

A second metric was the percentage of time when glucose levels were over 10,0 mmol/L. High glucose levels increase the possibility of potentially dangerous consequences over time. Patients receiving the control treatment had elevated glucose levels 67% of the time; this decreased to 33% when an artificial pancreas was used.

The artificial pancreas reduced the average glucose level from 12.6 mmol/L under control treatment to 9.2 mmol/L.

Glycated hemoglobin, or HbA1c, levels were also lowered by the app. Glycated haemoglobin is produced when haemoglobin, a protein inside red blood cells that transports oxygen throughout the body, binds to glucose in the blood, therefore becoming “glycated.” By testing HbA1c, physicians may determine what a patient’s typical blood sugar levels have been over the course of weeks or months. The risk of complications from diabetes increases for patients with diabetes when HbA1c levels rise. Average HbA1c levels were 8.7% during control treatment, but they were 7.3% after utilizing the artificial pancreas.

Throughout the course of the research, not a single subject suffered hypoglycemia. One patient was taken to the hospital owing to an abscess at the pump cannula site while utilizing the artificial pancreas.

“Many people with type 2 diabetes struggle to manage their blood sugar levels using the currently available treatments, such as insulin injections,” says co-lead author Dr. Charlotte Boughton, adding, “the artificial pancreas can provide a safe and effective approach to help them, and the technology is simple to use and can be implemented safely at home.”

One of the obstacles to the broad use of insulin treatment has been worry about the potential of severe “hypos,” or dangerously low blood sugar levels, according to Dr. Aideen Daly. 

“But we found that no patients on our trial experienced these and patients spent very little time with blood sugar levels lower than the target levels.”

From what the participants said, it seemed like they were happy to have the system control their glucose levels automatically, and nine out of ten (89%) said they spent less time managing their diabetes overall. Users said that the biggest benefits were not having to use needles or prick their fingers to check their blood sugar and feeling more confident about managing their blood sugar. Downsides included increased worry about the risk of hypoglycemia, which the researchers think may be a result of more awareness and monitoring of glucose levels, and the fact that wearing the devices was annoying in everyday life.

Now, the team wants to build on their findings by doing a much larger multicenter study. They have also sent the device to the government for approval so that it can be sold to type 2 diabetes outpatients.

Source: 10.1038/s41591-022-02144-z

Image Credit: Getty


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