The Bionic Pancreas – is it Within our Grasp?


FEATURE STORY

By Annette Gisele Chua, M.D.


Managing diabetes is a challenge. Fear of low blood sugar, finger pricks multiple times a day and difficulty estimating insulin doses are real concerns. Despite pharmacologic discoveries and technological advancements, many people at some point feel burdened by their diabetes. What is the artificial or bionic pancreas? Can this do the job?

The idea of developing an artificial pancreas has been in the buzz since the late 1950s. But it wasn’t until the last 2 decades that the pieces of the puzzle have rapidly come together.

Two key innovations are the insulin pump and the continuous glucose monitor. The insulin pump is a device, the size no bigger than a deck if cards. It delivers continuous infusion of insulin via a small plastic tubing inserted through the patient’s skin. This eliminates the need for multiple insulin injections and allows delivery of different amounts of insulin at different times of the day.

Then there is the continuous glucose monitor (CGM), a device that allows monitoring of blood sugar via a small sensor attached to the patient. It gives useful information on the blood sugar trend 24/7, with less need for finger pricking.

Despite these new technologies, managing blood sugar is still far from perfect or easy. A considerable amount of patient input and decision making is still needed.

The artificial pancreas

So what is the artificial pancreas or bionic pancreas? It is a fully automated system that makes use of the continuous glucose monitor, an insulin pump, and an app or program device like a smartphone. The information from the glucose monitor is transmitted to the application every few minutes. Using complex algorithms, the application in turn regulates the amount of insulin administered through the pump, depending on the trend and the level of the patient’s blood sugar.

Taking it a step further, Professor Damiano with Dr. Russel and their team from Boston, cane up with the iLet bionic pancreas. A system that can deliver not only insulin but also glucagon. Insulin, as many people with diabetes are familiar with, is a substance that helps the body use up glucose or sugar in the blood, thereby bringing its levels down. Another less popular hormone is “glucagon”, a substance also secreted by the pancreas. It counteracts the action of insulin by sending signals to increase glucose production, releasing it into the bloodstream. A balance of these 2 hormones fine tunes and maintains the blood sugar in a normal range.

Pros and Cons

Patients who have type 1 or even type 2 diabetes who are insulin-dependen may potentially benefit from the artificial pancreas. It would probably best benefit patients who have brittle diabetes; those who experience frequent hypoglycemia; young children or even adults who may not have the high level of vigilance and judgment needed to keep their blood sugars under control.

The promise of benefits with the artificial pancreas sounds exciting. Is it all still in theory or research setting? The artificial pancreas has been studied on children and adults, initially in more controlled setting such as diabetes camps or hotels under close monitoring by medical and research personnel.

Recently, studies have moved into more of the “real world” setting; where patients go home and go about their usual activities for days, and are monitored only remotely.

These studies have shown improvement in blood sugar control with less incidence of having the sugars drop too low. In psychosocial studies, patients reported benefits such having a “time-off”, having less worries in managing their blood sugar, less fear of low blood sugar, and better quality of life.

The fully automated artificial pancreas is not yet available commercially, but cost may be an issue for many. Wireless connectivity, cyberthreat and data privacy are some of the concerns as well. Technical issues can lead to serious consequences in a matter of a few hours, so troubleshooting and safety protocols are still essential.

The artificial or bionic pancreas may not be as good as the human pancreas, but it sure will help lift the burden in management of diabetes.

THE AUTHOR

Dr. Annette Chua is a an Endocrinology consultant at Providence Hospital and the Chinese General Hospital and Medical Center. She underwent her residency training in Internal Medicine at the University of Connecticut and finished her fellowship in Endocrinology, Diabetes and Metabolism at the Medical University of South Carolina.

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