Diabetes and the Artificial Pancreas: Closed-Loop Systems

An article I read recently declared that the artificial pancreas, or a closed-loop artificial pancreas system for diabetes management, is likely to hit the market by 2018. This is potentially life-altering news for anyone with Type 1 diabetes — this is the next step in diabetes care that we have been waiting for. But what is a closed-loop artificial pancreas system, and what are the details researchers need to iron out for such a system to truly be a viable day-to-day option for diabetes management?

A closed-loop artificial pancreas system is a device, or series of devices, that can work in concert with one another to automatically give the correct amount of insulin in response to food intake and rising blood glucose. There is also research into dual-hormone systems — these would provide insulin in response to rising blood sugars, and provide glucagon in response to falling blood sugars. However, the current formulations of glucagon are not as stable as would be ideal, and the reservoir would have to be replaced every 24 hours. The most likely candidate for release in the near future is a closed-loop artificial pancreas system that only supplies insulin. Such a system would be much less likely to CAUSE hypoglycemia, but on the occasions when hypoglycemia does occur, it would simply alert the user of low blood sugar and still require us to eat some of our good old glucose tablets.


So now that we know what a closed-loop artificial pancreas system is, we need to know the components researchers will address in the next couple of years to make the bold prediction of 2018 a reality. Let’s take a look.

1. Glucose monitoring
Obviously, accurate and continuous glucose monitoring (CGM) is absolutely vital in implementing a closed-loop artificial pancreas system. CGM systems have been around for years, but they measure glucose via interstitial fluid under the skin rather than directly measuring glucose in the blood itself. This works, but there is a lag between blood glucose and interstitial fluid reading of about 10 minutes. This is a certainly a roadblock for closed-loop artificial pancreas systems, which need information to be as accurate as possible.

However, CGM research has been surging in recent years, as well. In fact, I wrote a blog entry about this very subject a few weeks ago, and a number of the innovations highlighted in that article could prove invaluable for closed-loop systems. First-generation closed-loop artificial pancreas systems may not benefit from some of the advances, but certainly second- and third-generation devices will be able to take full advantage of the advancing discoveries of CGM technology.

2. Algorithms
The heart of any closed-loop artificial pancreas system is the algorithm that takes in all of that blood glucose data and converts it into insulin dosages. Successfully calculating all of this data is a massively complex thing. Here’s a good way to think about it. The Apollo moon missions could have been accomplished years ago using the computing power of a cell phone — one of the greatest technological achievements of the twentieth century is easily achievable on modest current-day technology. Yet getting the algorithm for successful closed-loop artificial pancreas systems has only been managed in very recent years.

This makes sense, of course. We’re talking about automating one of the most complex systems within the human body — the absorption of energy into the blood and the delivery of that energy into our cells, all while managing the delicate balance our blood sugar requires.

3. Bringing it all together
This last step is one that years ago would have seemed like a huge challenge. But in the age of Bluetooth and microchips the size of a flea, the communications between the components of a closed-loop artificial pancreas system becomes pretty straightforward. The glucose monitor will send its information to the heart of the system, the control device, which contains the algorithm that manages the whole thing. The control device will then send commands, probably wirelessly, to the insulin pump, which will give out the needed doses on a continuous basis.

If all of this works together the way researchers hope it will, our lives as Diabetians may be drastically different five years from today. As someone who has lived with Type 1 diabetes for 22 years now, I can say that this is the first time I’ve read research news that I would actually bet ON, rather than against. Research news is always to promising on its surface, but so many strategies fall by the wayside — encountering problems in trials, unexpected side effects, unknown roadblocks, and other setbacks that eventually stall the search. But each of the individual components of the closed-loop artificial pancreas system (mainly the CGM and the insulin pump) have not only been researched, they’ve been available on the consumer market for many years. And that makes this leap forward feel much more probable than most that I have read about. So I say, with a little bit of healthy skepticism of course, here’s to the future! It looks just a little brighter today!

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