JDRF has long supported development of the artificial pancreas, a closed loop system that would include a continuous glucose monitor (CGM) and an insulin pump, and set up the artificial pancreas consortium to help promote development of this technology around the world. This includes 21 clinics located around the world that are all involved with some aspect of research into the artificial pancreas.
The 7th International Conference on Advanced Technologies & Treatments for Diabetes in Vienna, Austria, attended by JDRF, focused on the exciting developments that have happened recently that will help make the artificial pancreas a reality in the near future.
In the UK, Roman Hovorka from the University of Cambridge is leading the JDRF-funded efforts in this field. As reported in a paper published in Diabetes Care last year, he and his colleagues showed that adolescents using a prototype artificial pancreas over a period of 36 hours in a research facility had significantly lower and less variable blood glucose levels than those using conventional pump therapy. More recently, Hovorka and team have had positive results in home-based studies.
The Cambridge prototype is far from the only one being developed. Many other researchers around the world are working on similar but subtly different models, often aimed at different subgroups of people with type 1, and a large number of these projects were discussed at the conference. For example, Moshe Phillip and colleagues have developed and are testing the ‘Glucositter’ artificial pancreas in Germany, Slovenia and Israel; and Edward Damiano and his US-based team have developed and are testing a ‘bionic pancreas’ in Boston.
Advances in artificial-pancreas related technology were a key theme of the meeting. Manufacturers Dexcom and Medtronic have responded to the successes of the competing global artificial pancreas research groups by improving the efficacy of their pumps and sensors.
Dexcom’s G4 Platinum CGM, shown to be more accurate than Medtronic’s Enlite CGM in a new study presented in Vienna, has already been upgraded by the development of the G4AP. Dexcom developed the new sensor technology, which is even more accurate than the G4 Platinum CGM, in conjunction with the University of Padova in Italy, specifically for use as part of an artificial pancreas system.
Similarly, Medtronic has already improved upon its MiniMed 530G, the first available pump system approved in both Europe and the US with a “low glucose suspend” feature that will automatically stop insulin delivery from the pump for two hours when an associated CGM reaches a preset low blood glucose level. While the 530G system is considered to be the first step of six on the path to a working artificial pancreas, the Medtronic MiniMed 640G is thought to be the second. The difference between the 530G and the 640G is that the latter will suspend insulin when hypoglycaemia is predicted, whereas the former will only do so if a preset hypoglycemic threshold is crossed. Medtronic hopes to launch the 640G in Europe sometime between mid 2014 and early 2015, and in two-to-three years in the US.
A key to the puzzle that remains to be solved is the speed which insulin can be absorbed into the body from an external pump, as with currently available options there is a delay of up to 20 minutes between insulin administration and uptake in the blood which makes smooth interaction between a CGM and an insulin pump tricky. A faster acting insulin than those currently available could solve this problem, but has yet to be developed.
Another method of speeding up insulin delivery is by going via the stomach. Eric Renard from Montpellier University, France is an expert on ‘intraperitoneal’ insulin pumps and spoke about them at the conference. The main problem with these pumps is that they have to be implanted in the stomach and are therefore quite invasive for most people with type 1. However, they can be very effective at improving blood glucose control in people whose diabetes is difficult to control. Renard is hoping to develop an artificial pancreas with an intraperitoneal pump, in order to improve treatment for people with highly variable response to insulin.
JDRF tweeted from the conference. To read more and see pictures of the event you can follow the story here.