Some of the most exciting research in diabetes management centers around the Artificial Pancreas Device System (APDS), an automatic blood glucose monitoring appliance, worn on the body, that will take the place of both a continuous glucose monitoring and insulin infusion pump used by everyone who lives with type 1 diabetes. The system consists of a linked set of devices that automatically monitors blood glucose levels and adjusts the delivery of insulin.

"The APDS takes the human guesswork out of diabetes management, especially the variable of carb counting," says Amber Taylor, MD, Director, The Diabetes Center at Mercy Medical Center in Baltimore.

Taylor, who was not part of the study, points out that if you are very insulin sensitive, the difference between entering 15 g and 17 g of carbs in your pump can make a huge difference. By taking the guesswork out of monitoring your own blood glucose levels, the system will help prevent complications of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar).

How an artifical pancreas works

A continuous glucose sensor, or monitor, and the insulin delivery pump are attached under your skin, usually on your abdomen, though it can also be worn on your thighs or arm. Based on information collected by the sensor, a computer algorithm controlled by a laptop or hand-held device calculates how much insulin you need and that amount is delivered through the pump.

Three different types of APDS's are in development, but the differ in how the insulin pump responds to information from the monitoring system.

  • A threshold suspend device system helps prevent low blood sugar by interfering with insulin delivery when glucose levels are low. 
  • A control-to-range system adjusts insulin delivery when blood sugar approaches either dangerously high or dangerously low levels.
  • A control-to-target system establishes target levels of blood glucose and aims to continuously maintain these levels.

When will the artifical pancreas by available?

If all goes as planned, the APDS will be an option in the not-too-distant future for most people living with type 1 diabetes. While nothing is holding up the development of various types of pancreas replacement systems, improvements are being made and their long-term safety and effectiveness are currently being reviewed. Researchers are trying to resolve important issues that may deter users, such as the size, bulk, and short lifespan of the sensor.

Variables that affect insulin monitoring and dosing, such as different types of meals, physical activity, menstrual cycles, and sleep patterns, are also being studied, so that researchers can learn how to improve and personalize the devices. The less conspicuous the APDS equipment, the fewer wires it contains, and the more accurately it monitors blood glucose levels and adjusts insulin delivery, the more valuable the system becomes to you as the user, and the less you will have to do any type of monitoring yourself throughout each day.

"Some patients will undoubtedly be the first in line to try this," says Taylor. "But as with any new technology, others will wait for the second or third generation of equipment, to make sure all the bugs are worked out."

Amber Taylor, MD, reviewed this article.

 

Sources:

Mayo Clinic: Artificial Pancreas: Yogish C. Kudva Web March 2013
http://mayoresearch.mayo.edu/mayo/research/basu-kudva-lab/

University of Minnesota: Building an Artificial Pancreas Web March 2013
http://blog.lib.umn.edu/mmf/news/diabetes/2012/building-an-artificial-pancreas.html

U.S. Food and Drug Administration: The Artificial Pancreas Device System (APDS) Web March 2013
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/
HomeHealthandConsumer/ConsumerProducts/ArtificialPancreas/default.htm