June 17, 2014
News Review From Harvard Medical School -- Study: 'Bionic Pancreas' Aids Type 1 Diabetics
A "bionic pancreas" can help people with type 1 diabetes control their disease with fewer incidents of low blood sugar, 2 new studies find. The "pancreas" is a device that includes two pumps. One delivers small doses of insulin to keep blood sugar from going too high. The other delivers glucagon, another hormone, to prevent hypoglycemia (very low blood sugar). A smartphone wirelessly receives reports from a continuous glucose (blood sugar) monitor. An app on the phone controls the pumps and adjusts them based on blood sugar levels. One study tested the pumps on 20 adults. The other study tested them on 32 teenagers at a diabetes summer camp. People wore the devices for 5 days. On another 5 days, people wore normal insulin pumps. For both adults and teens, average daily blood sugar was lower with the new device than with the pump. The amount of time with very low blood sugar dropped from 7% with the pump to 4% on the new device for adults and slightly for teens. The New England Journal of Medicine published the study online. HealthDay News wrote about it June 16.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Wearable devices are very cool. You can track body functions such as heart rate, fitness levels, sleep time and whether you are drinking enough fluids to avoid dehydration.
They have become very useful for athletes. And surely future wearables will help keep us healthy and make it easier to manage medical diseases.
That reality for people with type 1 diabetes is near. Edward Damiano, Ph.D., and his colleagues have taken the first steps to invent a wearable device and prove that it can greatly improve the management of type 1 diabetes.
People with type 1 diabetes stop making insulin. Most often this happens because the body's immune system misfires. Antibodies attack insulin-producing cells in the pancreas.
Treatment of type 1 diabetes always requires insulin. The goal is to keep blood sugar as close to normal as possible. At the same time, you need to prevent low blood sugar (hypoglycemia).
Most people with type 1 diabetes give themselves shots multiple times per day to control blood sugar. This is a major challenge. Tightly controlling blood sugar almost always means more frequent episodes of low blood sugar.
An insulin pump that provides a continuous infusion of insulin under the skin does a better job. But it can't respond to changes in diet, exercise and stress.
Dr. Damiano had a special reason to focus his professional life on inventing a device to make blood sugar control easier and safer. His son developed type 1 diabetes before his first birthday. He and his wife, a pediatrician, were well aware of the importance of blood sugar control to avoid more health problems later in life. They had to get up several times every night to check their son's blood sugar level with a skin prick.
The "bionic" pancreas is still a bit clunky. It required a blood sugar monitor and two tiny tubes placed under the skin. The tubes were attached to an infusion pump. One tube delivered insulin. The other tube delivered a hormone called glucagon that rapidly raises the blood sugar level.
The device under the skin was connected wirelessly to a smart phone. It was programmed to automatically deliver insulin or glucagon when blood sugar levels got too high or too low. The smart phone also was used to tell the device when the person was eating. Acting like a normal pancreas, the device pumped out extra insulin at mealtimes.
The beauty of this study was that the researchers tested the device in "real life." People in the study engaged in their usual activities, with few restrictions. People using the device were compared with another group using normal insulin pumps. Comparing average blood sugars and the number of hypoglycemic events, the device performed better on both counts.
What Changes Can I Make Now?
This type of bionic pancreas won't be available for several years. It needs a lot more refinement and testing.
Type 1 diabetes can't be prevented and can't be cured. Meanwhile, control of blood sugar levels will continue to require frequent blood sugar checks. People with type 1 diabetes also must make an extra effort to maintain a consistent diet and exercise schedule. They also must adjust their insulin use when needed.
On the other hand, type 2 diabetes can be prevented. And type 2 diabetes is 10 times more common today than type 1 diabetes.
A bionic pancreas to pump in more insulin is not an option for people with type 2 diabetes. Early in the disease process, they make plenty of insulin. In fact, they need to make extra insulin to move sugar out of the blood and into cells. This is known as insulin resistance.
The way to help prevent type 2 diabetes is to ask your pancreas to make as little insulin as possible to keep blood sugar in the normal range.
Of course, you can't command your pancreas to do that. But you can help make it happen.
- Maintain a healthy body weight.
- Keep your waistline trim. There is no consensus on an ideal waistline. I suggest less than 30 inches for women and less than 35 inches for men.
- Stay as physically active as you can throughout the day.
- Dedicate at least 30 minutes a day, most days of the week, to moderate-intensity exercise. If you need to lose weight, you should strive for 60 minutes daily.
- Eat and drink fewer products that contain simple sugars and high-fructose corn syrup.
If you have pre-diabetes or a family history of type 2 diabetes, I urge you to take these actions right away. They can help you to lower your blood sugar while asking your pancreas to make less insulin.
What Can I Expect Looking to the Future?
The bionic pancreas of the future will be all contained in a single device that won’t require a wireless connection.