Artificial pancreas revolutionizes treatment of type 1 diabetes
Kathimerini speaks to Cambridge University’s Professor Roman Hovorka, who is leading the development of the device
A cutting-edge technological device has been developed by a scientific team in the UK, called the “artificial pancreas,” to optimize the treatment of people with type 1 diabetes. The artificial pancreas incorporates modern algorithms and interacts with each user individually, automating the process of measuring and taking insulin.
Roman Hovorka, professor of metabolic technology in the Department of Paediatrics at Cambridge University, who is leading the development of the artificial pancreas, is aiming to find solutions to the existing needs of the population and to simplify the lives of people with type 1 diabetes. Speaking to Kathimerini, the renowned professor explains the features of the artificial pancreas, which consists of a closed-type device of automated control and tuning of blood glucose, as well as its individual components which are controlled and regulated using modern algorithms without the intervention of the individual.
Professor Hovorka, when you started your research, what were the needs of the population?
The needs of the population were similar to what they are today. Diabetes is a disease that does not go away. There are no holidays and no breaks for type 1 diabetes. And this applies to people with diabetes and also to their families. Just think that for parents of children with type 1 diabetes, awareness is day-night. It is really tiring. And in addition, there are also worries for the parents about what will happen to their children if the glucose is not correct, short-term or long-term. So, the needs have not changed, but have improved and relate to the quality of life.
The development of the artificial pancreas is a source of hope for many patients. How does it function?
In a normal healthy body, the pancreas is very sophisticated and without us thinking about it or knowing about it, the beta cells in the pancreas produce the right amount of insulin to keep the glucose pretty stable. Glucose is a really tightly regulated substance in the blood and glucose is needed as the main source of fuel for the brain. When glucose is too low the brain does not have the fuel and it stops working resulting in people getting confused. They can even die. On the other hand, if glucose is high for a long time, it gives complications. People develop a major problem with the heart, the eyes, the kidneys, and the extremities, so they can have amputations as well. And so, the objective of the artificial pancreas is to mimic what the healthy pancreas does – that is, to get the insulin we need to replace the glucose lost due to diabetes. The issue is that there is a hugely varying insulin need. After the meal, glucose goes up, so the body secretes lots of insulin, people exercise again, and there is less insulin needed. Every minute the body produces different amounts of insulin.
Therefore, the objective of the artificial pancreas is to detect the glucose level. This is obtained through a glucose sensor that sits on the skin and every minute the sensor gets the glucose values into the computer program, which is the brain of the system, and basically says how much insulin we should give depending on the circumstances. Finally, the algorithm calculates the insulin needs and then tells the insulin pump how much insulin to give as well. And it is basically what is called a closed loop or feedback control.
‘The people will have reduced burdens and improved quality of life and better sleep. The same applies to the parents of people with type 1 diabetes’
Did you encounter any difficulties with the algorithm?
So, everybody is different. We need to be able to adapt to individuals and to their changing needs. There is no standard day for people with type 1 diabetes. And there are, for example, situations like in adolescence where through the hormone system, the body becomes more resistant over time to insulin. So, this needs to escalate to support the growth and those needs. So, this tuning of the algorithm and making it safe as well has been challenging. The other thing is managing the delays in the system and the delay in the insulin actions. It takes about 50 minutes on average for the insulin to reach its peak. But sometime it could be 100 minutes or 30 minutes. Also, there are differences in where you put a new infusion set and it depends on the local place where you put the insulin. So, there is variability between people and also within people as well. Therefore, one needs to be really careful about it.
How will the artificial pancreas contribute to improving the living conditions of patients with diabetes?
Normally, if people have type 1 diabetes, they need to be constantly aware of what they need to eat, and what is happening to glucose, and they need to be always alert during the day and night. The artificial pancreas will automate the process while we remove the alertness. The people will have reduced burdens and improved quality of life and better sleep. The same applies to the parents of people with type 1 diabetes.
How user-friendly is the artificial pancreas?
One of the aspects of the artificial pancreas is to make it as user-friendly as possible, which is to minimize the burden of the devices. So, our approach is that you can give yourself a bolus from an app by running the algorithm on a phone, which means that you do not necessarily want to take the pump and show everybody you have type 1 diabetes. You can do it discreetly from the phone. Therefore, it increases privacy as well. And we try to reduce some of the alerts of the system. Again, alerts are good when glucose is high or low, but it is also bad because people are maybe frequently alerted about certain conditions. Another major limitation that needs improvement is that the closed-loop system is limited by the need for people to wear the sensor, to wear the pump, which makes it more difficult to use.
Do you see any future improvements to the artificial pancreas?
Each of the components can be improved. You can have a smaller sensor, you can have better, longer-lasting infusion sets in, kind of patch pumps which are smaller as well. Also, another improvement that we will try in the next generations of the system is to automate the dosing around meals, and that is why new insulins which act faster are being developed.
