Successful trial of an artificial pancreas for patients with type 2 diabetes

Successful trial of an artificial pancreas for patients with type 2 diabetes

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An artificial pancreas, formed by an algorithm-driven device, for people with type 2 diabetes doubled the time spent in a target glucose range and halved the time at high levels, compared to standard treatment.

Some 415 million people suffer from type 2 diabetes in the world, which represents an annual health expenditure of 760,000 million dollars (700,000 million euros), recall the authors of the study coordinated by the University of Cambridge and published this week. nature medicine.

Type 2 diabetes causes glucose (blood sugar) levels to be too high and is treated with a combination of Changes in lifestyle —improved diet and more exercise, for example— and medicationwith the aim of keeping glucose levels low.

The artificial pancreas is a device that combines a conventional glucose monitor and insulin pump with an app developed by the team, which runs on an algorithm that predicts how much insulin is needed to keep glucose levels in target range.

The study reports on the results of the first trial for eight weeks with a group of 26 people who did not need renal dialysis and who were divided into two groups. One half first tried the device and then continued with the usual treatment and the other the other way around.

can be used at home

charlotte boughton, from the Wellcome-MRC Institute of Metabolic Sciences in Cambridge, who co-led the study, said: “Many people with type 2 diabetes have difficulty controlling their blood sugar levels with current treatments, such as insulin injections. The artificial pancreas may provide a safe and effective approach to help them, and the technology is easy to use and it can be safely implemented at home.”

The team used several measures to assess the effectiveness of the artificial pancreas. The first was the proportion of time patients spent with glucose levels within a target range.

On average, patients using the artificial pancreas spent two-thirds (66%) of the time within that interval, twice as much as the other group (32%).

A second measure was the proportion of time they had elevated glucose levels. Those who continued in usual treatment spent two thirds (67%) of the time, a percentage that was reduced to 33% with the artificial pancreas.

No notable adverse effects

No patient experienced dangerously low blood sugar (hypoglycemia) during the study and only one had to be hospitalized while using the artificial pancreas due to an abscess at the pump cannula site.

Feedback from participants suggested that they were satisfied that the system automatically monitored glucose levels, and nine out of ten (89%) said they spent less time managing their diabetes overall.

Among the key benefits, they highlighted not having to inject and increased confidence in blood glucose control. The disadvantages were the increased anxiety about the risk of hypoglycemia and the practical inconveniences derived from the use of the devices.

The researchers had previously shown that an artificial pancreas driven by a similar algorithm was effective for patients with type 1 diabetes and in patients with type 2 who require dialysis.

Now, they plan to carry out a multicenter study much more extensively based on their findings and has submitted the device for regulatory approval with a view to marketing it in outpatients with type 2 diabetes.

Reference: Aideen B. Daly, Charlotte K. Boughton et al. ‘Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-centre randomized crossover trial’. Magazine nature medicine, 2023 | DOI: 10.1038/s41591-022-02144-z.

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