Bangalore: Almost nine decades after insulin was discovered, the hormone remains the mainstay of type 1 diabetes treatment, even as the treatment resembles a tightrope walk—keeping blood sugar levels from dropping too low or surging too high.
Now scientists have developed an artificial pancreas that uses a computer programme to balance sugar levels in the body and could help patients maintain near-normal sugar levels.
Reporting in Wednesday’s issue of Science Translational Medicine, scientists from Harvard Medical School, Boston University, and Massachusetts General Hospital in the US, who have tested the device in humans with type 1 diabetes, say it will eventually run on a computer chip as part of a wearable artificial pancreas system, somewhat like the insulin pump that’s currently used.
Type 1 diabetes involves two hormones—insulin, which lowers blood sugar, and glucagon, which raises it—both of which are needed for proper sugar control.
“This is a very exciting development. The difference in this artificial endocrine pancreas is that it is simulating normal physiology of the body—it is modifying two key hormones, insulin and glucagon,” said Anoop Misra, director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi.
Graphic: Ahmed Raza Khan / Mint
This works like “techno-biological” software for controlling diabetes, said A.G. Unnikrishnan, professor of endocrinology at Amrita Institute of Medical Sciences in Kerala. Unnikrishnan and his colleague Bipin Nair, professor and dean at Amrita School of Biotechnology, say such an experiment combining insulin and glucagon infusion to achieve normal glucose levels in diabetics without hypoglycemia, or dangerously low levels of blood sugar, has not been achieved before.
In earlier attempts, artificial pancreas have only focused on supplying insulin, which hasn’t succeeded in preventing hypoglycemia. The present “pancreas” comprises a continuous blood sugar monitor, two pumps that inject the hormones under the skin and a laptop that runs the algorithm which facilitates communication between the two pumps.
Study authors Steven J. Russel and Edward R. Damiano, who are currently testing a more portable system where the computer program runs on a chip, believe this kind of a “closed loop” artificial pancreas will become the standard care for type 1 diabetes. “It will likely first be adopted by current users of insulin pumps and continuous monitors, but this will likely be followed by a more widespread adoption among the type 1 population,” they wrote in an email.
The device could also potentially treat those persons whose pancreas have been destroyed due to pancreatitis or surgically removed. Misra is currently experimenting with stem cells for treating diabetes but experts say such cellular therapies are a long way off.
Additionally, several recent studies have shown that even type 2 diabetes, which has reached epidemic levels in India afflicting at least 50 million people, should be considered for insulin therapy. The authors say they will soon begin studying the use of artificial pancreas in type 2 diabetes.
In such instances, say experts, devices like these could provide insight into disease processes. While it is now commonly believed that the Indian population is prone to diabetes, even manifesting an earlier onset of the disease compared with Western populations, little is known why this could be so.
“Systems (such as these) that can sense biological metrics and delivery (of) multiple hormones may be a powerful tool in studying the pathophysiology of disease, and in particular, in groups with specific genetic predisposition,” said Elazer R. Edelman, a professor at Harvard Medical School and at Massachusetts Institute of Technology, who is not associated with the study.
Still, many worry that new healthcare technologies come with a hefty price tag and widespread adoption may prove elusive; insulin pumps in India being one such case. The study’s authors say this need not necessarily be the case.
“We think it will be very cost-effective because it will reduce complications, the care of which is the most expensive thing about diabetes,” said Russell and Damiano, adding that one way out could be for national health services to invest in providing an artificial pancreas to all people with type 1 diabetes.
Before such targets can be considered, many challenges confront the device. Fortis’ Misra said the artificial pancreas needs to be always on, akin to a body part, and for this the glucose sensor, which should be in permanent touch with bloodstream, should be robust and not prone to deterioration over time. Nair, who is commercializing a locally developed insulin pump, said: “The reliability and the user-friendly interface for such devices, in terms of patient acceptability, is a critical component”.