Artificial pancreas proven to be a game changer for patients with type 2 diabetes

Cambridge scientists have successfully tested an artificial pancreas on patients living with type 2 diabetes. (CREDIT: University of Cambridge)

Cambridge scientists have successfully tested an artificial pancreas on patients living with type 2 diabetes. The device, based on an algorithm developed at the University of Cambridge, doubled the amount of time patients were in their target glucose range compared to standard care and halved the time patients experienced high glucose levels.

It is estimated that around 415 million people worldwide are living with type 2 diabetes, costing approximately $760 billion a year in global health care costs. Over 4.9 million people in the UK alone have diabetes, of whom 90% have type 2 diabetes, according to Diabetes UK, and it’s estimated to cost the NHS £10bn a year.

Type 2 diabetes causes glucose (blood sugar) levels to become too high. Normally, blood sugar levels are controlled by the release of insulin, but in type 2 diabetes, insulin production is impaired. Over time, this can cause serious problems, including damage to the eyes, kidneys, and nerves, as well as heart disease.

The disease is usually treated with a combination of lifestyle changes – such as improving nutrition and increasing exercise – and medication to keep glucose levels low.

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Researchers at the Wellcome-MRC Institute for Metabolic Sciences at the University of Cambridge have developed an artificial pancreas that helps maintain healthy glucose levels. The device combines an off-the-shelf glucose monitor and insulin pump with a team-developed app known as CamAPS HX. This app is driven by an algorithm that predicts how much insulin is needed to keep your glucose levels in the target range.

Researchers have previously shown that an artificial pancreas that works on a similar algorithm is effective for patients living with type 1 diabetes, from adults to very young children. They have also successfully tested the device in patients with type 2 diabetes who require kidney dialysis.

Today, in the journal Nature Medicine, the team reports the first trial of the device in a wider population living with type 2 diabetes (not requiring kidney dialysis). Unlike the artificial pancreas used in type 1 diabetes, this new version is a completely closed loop system, while patients with type 1 diabetes need to tell their artificial pancreas that they are going to eat, such as in this version to adjust insulin. they can leave the device running fully automatically.

Cambridge Abstract of the Artificial Pancreas. (Credit: Cambridge University)

The researchers recruited 26 patients from the Wolfson Diabetes and Endocrine Clinic at Addenbrooke’s Hospital, part of the Cambridge University Hospitals NHS Foundation, and a local team of general surgeons. Patients were randomly assigned to one of two groups: the first group experienced an artificial pancreas for eight weeks and then switched to standard therapy with multiple daily insulin injections; the second group first received this control therapy and then switched to an artificial pancreas eight weeks later.

The team used several metrics to evaluate how well the artificial pancreas was performing. The first is the proportion of time that patients kept their glucose levels within the target range of 3.9 to 10.0 mmol/L. On average, patients with an artificial pancreas spent two-thirds (66%) of their time within the target range, twice as much as the control group (32%).


The flow of study participants. (Credit: Natural Medicine)

The second measure was the proportion of time spent with glucose levels above 10.0 mmol/L. Over time, high glucose levels increase the risk of potentially serious complications. Patients on control therapy spent two-thirds (67%) of their time with high glucose levels – with an artificial pancreas, this figure was halved to 33%.

The average glucose level decreased from 12.6 mmol/l when taking control therapy to 9.2 mmol/l when using an artificial pancreas.

The app also lowered levels of a molecule known as glycated hemoglobin, or HbA1c. Glycated hemoglobin is formed when hemoglobin, the protein in red blood cells that carries oxygen throughout the body, combines with glucose in the blood, becoming “glycated”. By measuring HbA1c, clinicians can get an overall picture of what a person’s average blood sugar has been over weeks or months. For people with diabetes, the higher the HbA1c level, the higher the risk of diabetes-related complications. After control therapy, the average level of HbA1c was 8.7%, and after the use of an artificial pancreas – 7.3%.

Glucose control in the closed and control periods. Mean sensor glucose measurements during insulin feedback delivery and control insulin therapy (usual patient therapy). (Credit: Natural Medicine)

None of the patients experienced dangerously low blood sugar (hypoglycemia) during the study. One patient was hospitalized while using an artificial pancreas due to an abscess at the site of the pump cannula.

Dr Charlotte Boughton of the Wellcome-MRC Institute of Metabolic Sciences at the University of Cambridge, who led the study, said: “Many people with type 2 diabetes are trying to control their blood sugar with currently available treatments, such as insulin. injections. An artificial pancreas can provide a safe and effective way to help them, and the technology is easy to use and can be safely implemented at home.”

Glucose control in the closed and control periods. Mean amount of algorithm-driven insulin during the feedback intervention. Shaded area, IQR. (Credit: Natural Medicine)

Dr. Aidin Daly, also of the Wellcome-MRC Institute of Metabolic Sciences, said: “One of the obstacles to the widespread use of insulin therapy has been concern about the risk of severe hypo — dangerously low blood sugar. But we found that none of the patients in our study had this, and patients spent very little time with their blood sugar levels below their target.”

Participant feedback indicated that participants were satisfied that the system was automatically monitoring their glucose levels, and nine out of ten (89%) reported spending less time managing their diabetes overall. Users cited the elimination of the need for injections or finger tests, as well as increased confidence in blood glucose control, as key benefits. Drawbacks included increased concern about the risk of hypoglycemia, which the researchers said may reflect increased glucose awareness and monitoring, as well as practical inconveniences associated with wearing the devices.

The team now plans to conduct a much larger multicenter study to build on their findings and has submitted the device for regulatory approval with the goal of making it commercially available to outpatients with type 2 diabetes.

The study was supported by the Cambridge Biomedical Research Center of the National Institute for Health and Care Research (NIHR).

For more science news, visit our New Innovations section at The bright side of the news.

Note: Materials provided above by the University of Cambridge. Content can be edited for style and length.

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