New artificial pancreas for diabetics

There’s some good news for the millions of people affected by type 2 diabetes, the condition that leads to high blood sugar levels that can damage eyesight, blood vessels, nerves and our kidneys: researchers at Cambridge University have shown that an “artificial pancreas” - that keeps tabs on blood glucose and automatically administers the sugar-lowering hormone insulin - can keep the blood glucose levels of type 2 diabetics in the “sweet spot” associated with best health outcomes. Charlotte Boughton from the University of Cambridge has been working on this project…

Charlotte - An artificial pancreas, or a closed loop system, is made up of three separate devices or pieces of hardware. People using the system wear a continuous glucose sensor, which is about the size of a 50p piece and they wear it on the arm or on the stomach. And that sends information about somebody's real-time glucose levels to an computer algorithm, which, in our system that's been developed at the University of Cambridge, is an app on a smartphone. And that then calculates the amount of insulin that's required to keep the glucose in the target range and communicates that automatically to an insulin pump, which is a small device that people wear usually attached to the stomach or legs or arm.

Chris - And who did you test this on this time? Because this technology has been used in people with type one diabetes who normally inject insulin to control their diabetes. This has been tested on them before, so what's the difference here?

Charlotte - Yeah, absolutely. So it's been a big news week for people with type one diabetes and NICE have released their guidance for who should be given access to artificial pancreas technology for people with type one. But as you say, our study was one of the first studies using similar technology to that that's been used before for people with type two diabetes who need insulin, which is about a third of people with type two diabetes. So we included people with type two diabetes who use insulin therapy who come to either clinic at Addenbrooke's Hospital or from a local GP practice in and around Cambridge. And the main difference between the system that we used in this study is that for people with type one diabetes, every time they have a meal or a snack, they actually need to tell the system what they're eating and how much insulin to give. They're often called hybrid systems, whereas this system is fully automated so the person wearing the devices doesn't need to do anything to tell the system they're having a meal or anything. So the whole system is completely automated, which makes it much easier for people to use.

Chris - What did you compare with what?

Charlotte - So we compared the closed loop system with their current insulin therapy that they use day to day and we measured how long they spent with their glucose levels in the recommended target range over eight weeks. So they wore the devices at home, carried on with their work, their daily lives, and we compared the glucose control between the two periods and we found that, when they were wearing the closed loop devices, they spent twice as much time with their glucose in the target range as when they were using their current insulin therapy. So much better glucose control with the closed loop system.

Chris - And in that respect, of course the patients are being their own control, aren't they? Because you are asking them to do this and then don't do this or don't do it, then do it. And so you are comparing apples with apples here to see how their lifestyle fits in with this machine.

Charlotte - Exactly. And it means everybody has a chance to access technology so we have more people using it. So we have a better idea that it works for more people with different challenges and also the safety as well.

Chris - Do you think this is gonna become widespread in terms of this will be the go-to way to manage type two diabetes in future?

Charlotte - Yes. I think if our aim is to reduce the risk of long-term complications of diabetes, then this is a reasonable step towards doing that. So we hope that it'll improve access to this technology for people with type two diabetes.