For those living with diabetes managing their disease is an important step to maintaining or improving their health depending on what type of diabetes you have blood sugar monitoring insulin and oral medications may play a role in your treatment type 1 diabetes once known as juvenile diabetes or insulin dependent diabetes is a chronic condition in which the pancreas produces little or no insulin while there’s no cure for type 1 diabetes new technology is improving treatment for type 1 diabetics.
So the treatment is different certainly for type 1 diabetes versus type 2 explain for us so in type 1 diabetes individuals who have the disorder do not have the ability to make any insulin of their own so they are completely dependent on insulin being provided from outside the way that is done is usually with 4 to 5 injections of insulin a day or by using an insulin pump to actually deliver the insulin when an insulin pump is used the the insulin can be delivered all the time and also at the time of eating a meal.
With type 2 diabetes these patients then have insulin yes they are able to make at least some insulin now the ability to make insulin decreases with time so with individuals with type 2 diabetes generally being diagnosed and prescribed diabetic drugs it’s very possible that ultimately they’ll end up with making very little insulin.
Nowadays we’ve had a continuous glucose monitoring technology which enables glucose to be checked every 5 minutes or so on an automated basis because of this ability to do continuous glucose monitoring that signal can be used to change insulin delivery through an insulin pump and that is the artificial pancreas system so at this time since March of this year2020 an artificial pancreas made by Medtronic called 670 G has been approved and is available for clinical use and it represents the culmination of about 40 years of research and so we are testing it with patients now.
So at the moment it is clinically approved so certain patients could go ahead and have it through their endocrinology office by doing appropriate paperwork but there is also a research study involving this and They are at the center for this research study so they could enroll individuals using an insulin pump or using a pump and a continuous glucose monitor but without the control algorithm or those on injections so this is a Medtronic sponsored study.
And there are several other sites around the country in the world there is also competing technology. So there are a lot of research opportunities now for patients and the exciting thing about these opportunities are that by taking part in these studies patients could have real treatment benefit and talked about this artificial pancreas what is that is it is it a device that’s planted into the skin.
what exactly is it that’s a great question so an artificial pancreas is a bit of a simplification because as we now appreciate the pancreas has got two parts to it one part is the part that allows us to digest food and the second part is the part that allows us to process and store the digested food you know so the food is digested and that results in an increase in the blood stream of glucose and fatty acids and certain amino acids which make up protein so with a meal there is a part of the pancreas that releases insulin and other related peptides so the insulin is the main mediator of this fuel storage mechanism so in the artificial pancreas as we use it for time for diabetes there are two components there is a component that is the continuous glucose monitor that checks the glucose all the time every five minutes and then there is the insulin pump that delivers the insulin and then there is a control algorithm which takes the continuous glucose monitoring signal including the current state of the glucose the rate of change of glucose and the prediction of what’s going to happen to the glucose in the next 30 minutes or so and use all of this information in real time to change insulin delivery so that is the artificial pancreas system that we are using through Medtronic.
If you read the popular press they will also use another terminology for it and it’s called hybrid closed loop so closed loop is just a terminology indicating that there are components of the system and the components are interacting with each other so the loop is closed as opposed to an open loop where the components are given back to the patient to take a decision.
The term hybrid is used because the insulin that is being delivered all the time is being modulated with this control algorithm but at mealtime the patient needs to get involved and needs to put certain information into the insulin pump in order to help control so doctor could when you look in your crystal ball in the future do you think that this is the be-all and end-all or do you think this is the beginning of a long 40 year journey.
Well I don’t think it is the beginning and end all I think it is the end of a beginning and I think the beginning of a lot more sophisticated you know things to come for example our experience with these technologies is quite short duration at this time we have a lot of experience with the insulin pump views for example but we used insulin pump for several decades.
Remember insulin is usually released by the pancreas into the circulation in the abdomen so when we do the insulin pump here usually the insulin pump infuses insulin below the skin on the belly wall or certain insulin pumps can be used at other sites like buttock and upper arm and again they would infuse the insulin below the skin there so that is an unnatural site for insulin to be in and with insulin there are other diluent and so there could be some changes that happen in the skin over time so how long will this last as a question now continuous glucose monitors are disposable the probe has to be changed every seven to fourteen days and it has to be secured in place with tape and tape allergy is part of the challenge for modern day you know people it’s an allergy allergies are part of our life and so tape allergy is a is a significant part of the life of patients who have to use tape for everyday management so one way forward has been for the continuous glucose monitoring technology to get less intrusive and for the patient involvement and patient burden to be less.
So one solution for that is to have an implantable continuous glucose monitor so there is one such technology being reviewed by the FDA right now so the product is called ever since and the company is sensi onyx and what it will enable to do is actually implant the continuous glucose monitors just below the skin of the arm and then that is approved in Europe for three months six months studies are going on and the idea is this will go on for longer.
The future is not that far away. The future is happening and I think if there are patients reading you can be an active part of it and you can help create it so that’s a vision here talk to your physician yes we’ve been talking about new diabetes technologies for treating type 1 diabetes.