MedicalResearch.com Interview with:
Dr Hood Thabit and
Co-author: Dr Roman Hovorka
University of Cambridge Metabolic Research Laboratories
Wellcome Trust-MRC Institute of Metabolic Science
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Type 1 diabetes is an insulin-deficient condition, therefore people with type 1 diabetes need to be on life-long insulin therapy to maintain normal blood glucose levels. Currently insulin is delivered either by injections (with an insulin pen) or by infusion (with an insulin pump). In addition, they have to monitor their blood glucose regularly by performing fingerprick measurements several times a day, to avoid over- or under-dosing with insulin. Hypoglycaemia, or low blood glucose, can occur as a result of giving too much insulin; if severe or prolonged can lead to the patient being unconscious and in some cases sudden death. Hyperglycaemia, or high blood glucose, can occur as a result of giving too little insulin, and chronic hyperglycaemia can lead to diabetes related complications such as blindness, kidney failure and heart disease. Maintaining blood glucose within a normal range poses a daily challenge and struggle for many people with type 1 diabetes, who have to juggle with the variability and unpredictability of their glucose levels and insulin requirements due to meals, physical activity and stress.
People with type 1 diabetes have on average 3 episodes of severe hypoglycaemia per year which requires third party assistance and sometimes hospitalisation. In the UK, the average HbA1c for people with type 1 diabetes is around 8.5% (69mmol/mol), which puts them at risk of diabetes complications and developing significant disability affecting their lives. There is therefore an unmet need of a novel therapeutic approach to be able to automatically modulate and change the amount of insulin delivered, based on real-time glucose levels. The artificial pancreas, or closed-loop insulin delivery, is an emerging technology which couples real-time sensor glucose levels with insulin delivery under the direction of a control algorithm, and automatically steps-up insulin delivery when glucose levels are going up, and reduces or suspends insulin delivery when glucose levels are going down. The longest home study to date was recently performed by researchers at the University of Cambridge and showed that compared to best available therapy, the artificial pancreas significantly improved long-term glucose control (HbA1c) and reduces the risk of hypoglycaemia.
MedicalResearch.com: What should readers take away from your report?
Response: The past decade has seen rapid advances in the field of closed-loop insulin delivery. It has transitioned from research facility based studies, where patients were closely supervised and monitored, to 3-months home study where patients used the system in their day-to-day lives without any restriction or supervision. Results have been very promising, showing improved HbA1c whilst reducing the risk hypoglycaemia, which has not been achievable with conventional insulin therapy previously. The artificial pancreas may therefore serve as a viable alternative to beta-cell replacement until a cure can be found for type 1 diabetes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Several pivotal studies are currently underway by device manufacturers and academic groups. An artificial pancreas system is likely going to be commercialised and available for use in clinical practise by 2018.
The first commercially available artificial pancreas will be a single-hormone (insulin only) delivery system. It may take several more years for dual-hormone (insulin and glucagon) delivery system to be available for clinical use, as it will be dependent on the development of stable glucagon formulation and dual-pump chamber device, with the long-term safety of glucagon needing further evaluation for regulatory approval.
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Hood Thabit, Roman Hovorka. Coming of age: the artificial pancreas for type 1 diabetes. Diabetologia, June 2016 DOI: 10.1007/s00125-016-4022-4
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