The Next Big Thing: Developing The Artificial Pancreas

All people with type 1 diabetes, and some with type 2, need to inject or pump insulin into their bodies to survive. Figuring out how much insulin is necessary requires frequent monitoring and can be difficult, even risky. According to Diabetes Forecast, the consumer magazine of the American Diabetes Association, one of the most hopeful trends in diabetes research is the quest to develop an artificial pancreas, a device that could make the lives of people with diabetes safer, healthier and easier - possibly within the next few years.
  Despite its name, the artificial pancreas would not replace the entire biological organ. Instead, its goal is to mimic the pancreatic beta cells, which are destroyed by a malfunctioning immune system in type 1 diabetes or have stopped producing adequate insulin supply in type 2 diabetes. The artificial pancreas would consist of three components; the first two, an insulin pump and a continuous glucose monitor (CGM), are already used by many people with diabetes. It's the third piece that acts like a glue between the two systems: an algorithm that will turn data from the CGM into instructions for the insulin pump. "Closing the loop" with an algorithm may allow for an automated system of insulin dosing, allowing the person wearing the device to spend less time on daily diabetes management.
  So if we already have insulin pumps and CGMs and we can do some math, why isn't the artificial pancreas already in place? The main reason is the math itself -- and its ability to contribute to safety. While some versions of the algorithm are being developed based on decades of diabetes research and even account for the imperfections of mechanical systems, like delays in CGM measurements or insulin delivery, the line between the ideal blood glucose range and a dangerously low level is very narrow. In fact, Aaron Kowalski, PhD, who oversees the Artificial Pancreas Project at the Juvenile Diabetes Research Foundation, tells Diabetes Forecast that the ideal target for glucose levels is "right next to hypoglycemia, so there's very little buffer."
  As the artificial pancreas concept evolves, it has taken research into new directions, including shut-off mechanisms for insulin pumps when glucose levels drop too low, pumps that deliver a second hormone in addition to insulin that would raise blood glucose, faster-acting insulins that could make the automated artificial pancreas work more effectively, and, of course, several different algorithms with different capabilities based on an individual's routine. Getting an artificial pancreas approved for market in the United States is going to take a lot of research -- but scientists are closer than they've ever been before.
  The artificial pancreas would not be a cure for diabetes. But it has tremendous potential to improve and save lives. And, perhaps, the best part? "An artificial pancreas is there all the time," says Boris Kovatchev, PhD, who developed one of the algorithms for a U.S. study. "It can make decisions while a person sleeps." In a not too distant future, people with diabetes may finally be able to rest easy.
  The September issue of Diabetes Forecast also reports on how health care reform will affect people with diabetes and their families, including what to expect, and when. By the time the new law has fully taken effect, diabetes should no longer keep people from getting and keeping adequate health insurance coverage.
  This issue also offers:
- Eyes on the Prize: Prevention is crucial in combating retinopathy
- Diabetes and Dementia: Does type 2 care also bolster brain function?
- Pump Up the Volume: How to eat more but lose weight

Source: American Diabetes Association

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