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Bionic Pancreas Outperforms Insulin Pump

Device tested to replace finger-stick tests, insulin injections in patients with type-1 diabetes

People with type-1 diabetes who used a bionic pancreas instead of manually monitoring glucose using finger-stick tests and delivering insulin using a pump were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs.

The new report, funded by the National Institutes of Health, was published in the June 15 edition of the New England Journal of Medicine.

Researchers at Boston University and Massachusetts General Hospital say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type-1 diabetes walk an endless tightrope. Because their pancreas doesn’t make the hormone insulin, their blood glucose levels can veer dangerously high or low. Several times a day they must use finger-stick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump.

The researchers tested a bihormonal bionic pancreas, which uses a tiny, removable sensor located in a thin needle inserted under the skin that automatically monitors real-time glucose levels in tissue fluid and provides insulin and its counteracting hormone, glucagon, via two automatic pumps. In one scenario, 20 adults wore the device combination and carried a cell phone-sized wireless monitor for 5 days, unrestricted in their activities. In another scenario, 32 youths wore the device combination for 5 days at a camp for children with type-1 diabetes. Both groups were also monitored for 5 days while wearing their own conventional pumps that delivered insulin.

The researchers found approximately 37% fewer interventions for hypoglycemia and a more than twofold reduction in the time in hypoglycemia in adults using the bionic pancreas compared with those using the manual pump. For adolescents using the bionic pancreas, results showed more than a twofold reduction in the need for interventions for hypoglycemia. In addition, both groups showed significant improvements in glucose levels with the bionic pancreas, particularly during the night.

“With promising results such as these, we plan to support larger multicenter trials of the artificial pancreas in the near future,” said Guillermo Arreaza-Rubín, MD, the project officer for artificial pancreas studies funded by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Within the next few years, we hope these technologies will go beyond experimental trials and be available to benefit more people with type-1 diabetes.”

Just as a thermostat helps control a home’s temperature, the normal pancreas senses blood glucose levels and adjusts the hormones that control it. People with type-1 diabetes, whose pancreas produces little or no insulin, have been using the equivalent of a manual thermostat, needing constant checking and adjustment. A bionic pancreas device — like the one used in the new studies — functions more like an automated thermostat, automatically monitoring blood glucose and delivering insulin or glucagon when needed to keep glucose within the normal range. Moreover, these devices could be monitored remotely by the patient’s medical provider or parent.

Source: NIH; June 15, 2014.

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