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Can a bionic pancreas cure diabetes?
Wouldn’t it be great to a have way that you don’t have to test your sugar very often or give injections or even watch what you are eating? This could and will probably happen in the future with a system called ‘closed loop” pump.
Russell et al (http://www.nejm.org/doi/full/10.1056/NEJMoa1314474) evaluated the ability of a closed loop insulin pump system (which they called a Bionic Pancreas) to automatically regulate a person’s blood glucose without the patient needing to eat a measured diet, test their sugar or give themselves insulin.
The study compared 5 days of blood sugars of people on their routine diabetes management (called a control period) with5 days of sugars while on the Bionic Pancreas for 5 days each.
On the Bionic Pancreas, their blood sugar was automatically assessed by a continuous blood sugar machine (CGM) made by Dexcom . It is important to note that this measured sugar in fact “interstitial” fluid sugar and not ‘blood’ glucose. Interstitial sugar represents blood glucose from 15 minutes ago. The interstitial sugar measurements from the CGM was fed into a computer which mathematically determines an insulin dose and administers it. If the sugar is low, glucagon is automatically administered to increase the blood sugar.
In both adults and adolescents the mean blood sugar was lower during the time with the bionic pancreas than in their usual regimen. The average sugar during the Bionic pump was 138 as compared to 157 during the control time in the adolescents. A similar decline in the adult group was observed. This was quite an achievement considering the subjects did not have to obtain a finger stick to test their blood sugar for the bionic pancreas to administer the insulin or glucagon and were able to eat what they wanted pretty freely.
The Bionic Pancreas ‘appeared’ to improve the blood sugars during the night as compared to the control time. However the Bionic Pancreas may have had a unfair advantage since the blood sugar of adults were closely monitored through the night only during the Bionic Pancreas time which may have limited the amount of severe low blood sugars.
This study is even more exciting considering the limitations of the insulin administration and CGM. First, it takes 15 minutes after the administration of insulin to have insulin start lower the blood sugar. Secondly, as mentioned above, the CGM measures interstitial sugar which is a 15 minutes or so delay from the blood sugar reading. So it’s getting blood glucose information that is already 15 minutes old. All of this makes it make harder to safely control the sugars.
Further the accuracy of measuring blood sugar by CGM is not as accurate as by fingerstick. The more accurate, the more safe it is in avoiding low blood sugar. Thus, the FDA probably would not approve the general use of this closed loop system as it is. However, advances in CGM like technology will bring this kind of closed loop system to us more quickly and then allow the life a person with diabetes to more easily attain good blood sugar control with much less stress and work.
In addition, more long term studies are needed, studies in people who are not as in good control as the present study, and of course studies that will not bias the results.