No need to needle, automatically regulate blood sugar, diabetics must see!

Reviewed by: Xubin Yang (Third Affiliated Hospital of Sun Yat-sen University)

Artificial pancreas may revolutionize the treatment of diabetes, and it may only take a few years.

For millions of diabetics around the world, life is rife with hand, injections, and spikes and drops in blood sugar levels.

For people who want to automatically regulate blood sugar levels, an artificial pancreas can change all that.

1. The artificial pancreas consists of 3 parts

"Artificial pancreas will revolutionize the way diabetes is treated," said Dr Eric Renard, professor of endocrinology, diabetes and metabolism at the Montpellier School of Medicine in Montpellier, France. "It can prevent diabetes complications, including blindness, kidney failure, amputations, heart disease and even death."

Raynard, who led the first clinical trial of the device, said: "Because people will no longer need to constantly needle to monitor their physical condition, the quality of life will be greatly improved. ”

He explained that artificial pancreas is designed to help people with type 1 diabetes maintain blood glucose levels within the normal range, which is essential to prevent diabetes complications.

Dr. Jeffrey I. Joseph, director of the Center for Artificial Pancreas at Thomas Jefferson University in Philadelphia, says that artificial organs have three parts that must work perfectly in sync: Sensors that continuously monitor blood or tissue sugar levels, insulin infusion pumps, and computer algorithms that control every minute insulin delivery based on blood glucose measurements.

The sensor passes the information to the insulin infusion pump, which then distributes the right amount of insulin.

"We are moving toward this goal step by step," Joseph says, with researchers around the world testing individually or jointly on various components of the system.

Image source: Stand Cool Helo

Second, the insulin pump is convenient for patients to live

The best developed device is the insulin pump, which can be worn on a belt or fully implanted in the body. External pumps are already used by thousands of diabetics worldwide, while implantable pumps are approved in Europe and undergoing clinical trials in the United States, both of which can be used in artificial pancreas.

Renard said the development of implantable pumps is a big step forward, and studies have shown that multiple injections of insulin daily are beneficial in controlling blood sugar levels and improving quality of life.

Medtronic MiniMed, Calif., made an ice hockey-sized device implanted subcutaneously into the abdomen that delivers insulin to the body "like a real pancreas," he said.

Lori Hahn, a 41-year-old Californian who has had diabetes for more than a decade, says the implantable pump has changed her life.

"Before I used implantable pumps, my life was like a roller coaster, blood sugar and emotions," said Hahn, who is working on a U.S. clinical trial.

"I felt out of control and had to spend a lot of time controlling my blood sugar levels. With implantable pumps, I can forget that I'm diabetic," said Hahn, a full-time wife and mother of three lively children.

This pump uses insulin made from a special formulation and is filled up every 2 to 3 months.

Insulin is delivered in small doses throughout the day, similar to the pancreas. It is also programmed to deliver more insulin at mealtime.

Before eating or snacking, press a button on a pager-sized personal pump communicator so that the pump dispenses a dose of insulin.

Third, the intelligent system manages the amount of insulin required

Other studies have focused on improving the transfer of information between glucose sensors and external insulin pumps.

According to Joseph, the U.S. Food and Drug Administration (FDA) approved one of the first smart systems that allowed two systems to pass information over a wireless connection, a major milestone.

Such a system, he says, requires a lot of measurement in insulin dosing.

Traditionally, patients have had to puncture their fingers and drip blood on a test strip to get a blood glucose reading to estimate how many grams of carbohydrates they plan to eat, and to calculate how much insulin they need.

There is a large margin of error in the system, and incorrect calculations can lead to dangerously high or low blood sugar levels.

Image source: Stand Cool Helo

With the newly approved Paradigm system, which combines a Medtronic MiniMed insulin pump and a glucose monitor from Becton Dickinson, the patient still measures their blood glucose level by puncturing their fingers, but the pager-sized glucose monitor transmits the information directly to the insulin pump.

The insulin pump then calculates the amount of insulin needed for the current blood glucose. Calculating the required dose by pumping it can prevent errors that sometimes come with manually entering this data, he said.

Joseph said: "It is up to the patient to decide whether the recommended dose is correct and press the button to deliver the recommended dose. "It's not an artificial pancreas because it's not fully automated." But this is a big step forward in convenience and has the potential to improve glycemic control clinically. ”

Fourth, the glucose sensor measures blood glucose levels

About two dozen companies and academic labs are working on glucose sensors, Joseph said.

Some are blood glucose sensors, some are tissue fluid glucose sensors, some are placed under the skin by the patient, and some are implanted in the body for a long time.

While glucose sensors have improved significantly over the past few years, he said, they remain a limiting factor in the manufacture of artificial pancreas.

Dr. Steve Lane, Acting Program Leader for the Medical Technology Program at the U.S. Department of Energy's Lawrence Livermore National Laboratory, agrees.

"It's almost certain that the production goals of the artificial pancreas will be met," Wren said. "Wren's department worked with MiniMed to develop a prototype of an artificial pancreas." But there are still some hurdles to overcome, the main one being glucose sensing. To date, no one has developed a very safe method of sensing glucose. ”

Animas is developing a implant-based optical glucose sensor that uses infrared optics to accurately measure blood glucose levels in blood in animal and preliminary human studies.

"The miniature sensor head is placed around the blood vessels, and the light source is focused through the blood onto the detector," Joseph said. "The absorption of light at a specific infrared wavelength determines the concentration of sugar in the blood."

Further developed are MiniMed's short- and long-term implantable glucose sensors, which are designed to continuously measure sugar levels in tissue fluid or blood.

Image source: Stand Cool Helo

5. Artificial pancreas that has undergone clinical trials for the first time

In France, Renard led the first clinical trial of an artificial pancreas, a fully automated system that combined MiniMed's long-term glucose sensor with its implantable insulin pump.

In small surgical procedures, implantable sensors are inserted into a vein in the neck that leads to the heart.

Sensors are connected to implantable insulin pumps via subcutaneous wires: As blood glucose levels fluctuate, sensors send signals to the pump to indicate the dose of insulin the pump is going to deliver.

"Patients don't have to do anything," Renard said. "All of this is automated. Even when eating high carbohydrates, the sensor sends the appropriate signal for the pump to deliver more insulin. ”

Data from the top 5 patients who used the device for at least 6 months showed that the sensor accurately measured glucose levels in 95 percent of cases compared to values obtained through hand, Renard said.

"Our goal is to achieve 90 percent accuracy, so it's very accurate," he says.

What's more, patients using sensor-connected insulin pumps maintained blood glucose levels in the normal range more than 50% of the time, while those who used implantable pumps to adjust insulin delivery through hand prick measurements only maintained blood glucose levels in the normal range about 25% of the time.

In addition, Renard said, the risk of blood sugar plummeting to dangerously low levels called hypoglycemia — which can occur whenever insulin is delivered in excess — drops below 5 percent.

One of the next steps, he said, is to make the sensor more durable, only needing to be replaced every two or three years.

Although implantable insulin pumps take an average of 8 years to replace, the sensors fail after an average of 9 months, he said.

However, Renard believes that this obstacle is easy to overcome. "We just have to use a different material to make it stronger," he says. ”

But Joseph says this can pose a huge challenge: "Years of research have shown that sensors tend to fail within months rather than years due to the harsh environment of the body. ”

Renard said the mathematical procedures for calculating insulin delivery at different times of the day also need to be perfected. "Now, insulin pumps can allow diabetics to maintain normal blood sugar levels for half a day, just like a non-diabetic. But it also meant he couldn't control his blood sugar levels for the other half a day, which was a bit too high. ”

But he added that the problem was easy to solve. "The main problem is to have precise sensors, which we have today. We should have sensors that work longer and run better, and then they can be clinically put into use. ”

Joseph agreed. "They have demonstrated the feasibility of signaling between the glucose sensor and the insulin pump, which automatically delivers insulin, which is the artificial pancreas," he said. Is that perfect? Of course not. But we are constantly approaching perfection. ”

*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.

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