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Patients with type 2 diabetes may soon receive artificial pancreas and a smartphone app assistance

Curator and Reporter: Dr. Premalata Pati, Ph.D., Postdoc

In a brief, randomized crossover investigation, adults with type 2 diabetes and end-stage renal disease who needed dialysis benefited from an artificial pancreas. Tests conducted by the University of Cambridge and Inselspital, University Hospital of Bern, Switzerland, reveal that now the device can help patients safely and effectively monitor their blood sugar levels and reduce the risk of low blood sugar levels.

Diabetes is the most prevalent cause of kidney failure, accounting for just under one-third (30%) of all cases. As the number of people living with type 2 diabetes rises, so does the number of people who require dialysis or a kidney transplant. Kidney failure raises the risk of hypoglycemia and hyperglycemia, or unusually low or high blood sugar levels, which can lead to problems ranging from dizziness to falls and even coma.

Diabetes management in adults with renal failure is difficult for both the patients and the healthcare practitioners. Many components of their therapy, including blood sugar level targets and medications, are poorly understood. Because most oral diabetes drugs are not indicated for these patients, insulin injections are the most often utilized diabetic therapy-yet establishing optimum insulin dose regimes is difficult.

A team from the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust earlier developed an artificial pancreas with the goal of replacing insulin injections for type 1 diabetic patients. The team, collaborating with experts at Bern University Hospital and the University of Bern in Switzerland, demonstrated that the device may be used to help patients with type 2 diabetes and renal failure in a study published on 4 August 2021 in Nature Medicine.

The study’s lead author, Dr Charlotte Boughton of the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge, stated:

Patients living with type 2 diabetes and kidney failure are a particularly vulnerable group and managing their condition-trying to prevent potentially dangerous highs or lows of blood sugar levels – can be a challenge. There’s a real unmet need for new approaches to help them manage their condition safely and effectively.

The Device

The artificial pancreas is a compact, portable medical device that uses digital technology to automate insulin delivery to perform the role of a healthy pancreas in managing blood glucose levels. The system is worn on the outside of the body and consists of three functional components:

  • a glucose sensor
  • a computer algorithm for calculating the insulin dose
  • an insulin pump

The artificial pancreas directed insulin delivery on a Dana Diabecare RS pump using a Dexcom G6 transmitter linked to the Cambridge adaptive model predictive control algorithm, automatically administering faster-acting insulin aspart (Fiasp). The CamDiab CamAPS HX closed-loop app on an unlocked Android phone was used to manage the closed loop system, with a goal glucose of 126 mg/dL. The program calculated an insulin infusion rate based on the data from the G6 sensor every 8 to 12 minutes, which was then wirelessly routed to the insulin pump, with data automatically uploaded to the Diasend/Glooko data management platform.

The Case Study

Between October 2019 and November 2020, the team recruited 26 dialysis patients. Thirteen patients were randomly assigned to get the artificial pancreas first, followed by 13 patients who received normal insulin therapy initially. The researchers compared how long patients spent as outpatients in the target blood sugar range (5.6 to 10.0mmol/L) throughout a 20-day period.

Patients who used the artificial pancreas spent 53 % in the target range on average, compared to 38% who utilized the control treatment. When compared to the control therapy, this translated to approximately 3.5 more hours per day spent in the target range.

The artificial pancreas resulted in reduced mean blood sugar levels (10.1 vs. 11.6 mmol/L). The artificial pancreas cut the amount of time patients spent with potentially dangerously low blood sugar levels, known as ‘hypos.’

The artificial pancreas’ efficacy improved significantly over the research period as the algorithm evolved, and the time spent in the target blood sugar range climbed from 36% on day one to over 60% by the twentieth day. This conclusion emphasizes the need of employing an adaptive algorithm that can adapt to an individual’s fluctuating insulin requirements over time.

When asked if they would recommend the artificial pancreas to others, everyone who responded indicated they would. Nine out of ten (92%) said they spent less time controlling their diabetes with the artificial pancreas than they did during the control period, and a comparable amount (87%) said they were less concerned about their blood sugar levels when using it.

Other advantages of the artificial pancreas mentioned by study participants included fewer finger-prick blood sugar tests, less time spent managing their diabetes, resulting in more personal time and independence, and increased peace of mind and reassurance. One disadvantage was the pain of wearing the insulin pump and carrying the smartphone.

Professor Roman Hovorka, a senior author from the Wellcome Trust-MRC Institute of Metabolic Science, mentioned:

Not only did the artificial pancreas increase the amount of time patients spent within the target range for the blood sugar levels, but it also gave the users peace of mind. They were able to spend less time having to focus on managing their condition and worrying about the blood sugar levels, and more time getting on with their lives.

The team is currently testing the artificial pancreas in outpatient settings in persons with type 2 diabetes who do not require dialysis, as well as in difficult medical scenarios such as perioperative care.

The artificial pancreas has the potential to become a fundamental part of integrated personalized care for people with complicated medical needs,” said Dr Lia Bally, who co-led the study in Bern.

The authors stated that the study’s shortcomings included a small sample size due to “Brexit-related study funding concerns and the COVID-19 epidemic.”

Boughton concluded:

We would like other clinicians to be aware that automated insulin delivery systems may be a safe and effective treatment option for people with type 2 diabetes and kidney failure in the future.

Main Source:

Boughton, C. K., Tripyla, A., Hartnell, S., Daly, A., Herzig, D., Wilinska, M. E., & Hovorka, R. (2021). Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomized crossover trial. Nature Medicine, 1-6.

Other Related Articles published in this Open Access Online Scientific Journal include the following:

Developing Machine Learning Models for Prediction of Onset of Type-2 Diabetes

Reporter: Amandeep Kaur, B.Sc., M.Sc.

https://pharmaceuticalintelligence.com/2021/05/29/developing-machine-learning-models-for-prediction-of-onset-of-type-2-diabetes/

Artificial pancreas effectively controls type 1 diabetes in children age 6 and up

Reporter: Irina Robu, PhD

https://pharmaceuticalintelligence.com/2020/10/08/artificial-pancreas-effectively-controls-type-1-diabetes-in-children-age-6-and-up/

Google, Verily’s Uses AI to Screen for Diabetic Retinopathy

Reporter : Irina Robu, PhD

https://pharmaceuticalintelligence.com/2019/04/08/49900/

World’s first artificial pancreas

Reporter: Irina Robu, PhD

https://pharmaceuticalintelligence.com/2019/05/16/worlds-first-artificial-pancreas/

Artificial Pancreas – Medtronic Receives FDA Approval for World’s First Hybrid Closed Loop System for People with Type 1 Diabetes

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/09/30/artificial-pancreas-medtronic-receives-fda-approval-for-worlds-first-hybrid-closed-loop-system-for-people-with-type-1-diabetes/

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Artificial pancreas effectively controls type 1 diabetes in children age 6 and up

Reporter: Irina Robu, PhD

A new trial funded by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institute of Health created a clinical trial at four pediatric diabetes centers in the US of a new artificial pancreas system, which monitors and regulates blood glucose levels automatically. The artificial pancreas technology, the Control-IQ system has an insulin pump programmed with advanced control algorithms based on a mathematical model using the person’s glucose monitoring information to automatically adjust the insulin dose, and it was originally developed at University of Virginia (UVA), Charlottesville with funding support from NIDDK.

The artificial pancreas closed-loop control is all in one diabetes management system which monitors and tracks blood glucose levels using a continuous glucose monitor and at the same time delivers the insulin when needed via an insulin pump. The system is not only useful in children age 6 and up, but it also replaces reliance on testing by fingerstick or delivering insulin via injection multiple times a day.

The study contains 101 children between ages of 6 and 13 and the children are assigned either to the control or experimental group. The control group uses a standard injection method and separate insulin pump and the experimental uses the artificial pancreas system. Data was conducted every week for four months, while the participants continue on daily lives.

The results of the study showed that using an artificial pancreas system has a 7% improvement in keeping blood glucose in range during the daytime, and a 26% improvement in nighttime control compared to the control group. However, night time control group is important in people with type 1 diabetes, since unchecked hypoglycemia can lead to seizure, coma or even death. The artificial pancreas system shows about 11 % improvement to the standard method and it shows that the improvement in blood glucose control is impressive and safer for kids. No severe case of hypoglycemia or diabetic ketoacidosis occurred during the study, only some minor issues with the equipment.

After the clinical trial and based on the data received, Tandem Diabetes Care has received clearance from the U.S. FDA for use of the Control-IQ system in children as young as age 6 years.

SOURCE
https://www.nih.gov/news-events/news-releases/artificial-pancreas-effectively-controls-type-1-diabetes-children-age-6

 

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World’s first artificial pancreas

Reporter: Irina Robu, PhD

Diabetes is a life-long condition where your body does not produce enough insulin (Type 1) or your body cannot use the insulin it has effectively. Since there is no cure for diabetes, the artificial pancreas system comes as a relief for patients that are suffering with this disease.

The artificial pancreas, MiniMed 670G hybrid closed loop system designed by Medtronic is the first FDA-approved device that measures glucose levels and delivers the appropriate dose of basal insulin. The system comprises Medtronic’s MiniMed 670G insulin pump that is strapped to the body, an infusion patch that delivers insulin via catheter from the pump and a sensor which measures glucose levels under the skin and can be worn for 7 days at a time. While the device regulates basal, or background, insulin, patients must still manually request bolus insulin at mealtimes.

The device is intended for people age 14 or older with Type 1 diabetes and is intended to regulate insulin levels with “little to no input” from the patient. The artificial pancreas measures blood sugar levels using a constant glucose monitor (CGM) and communicates the information to an insulin pump which calculates and releases the required amount of insulin into the body, just as the pancreas does in people without diabetes.

The 2016 FDA approval was done in just three months which is a record for any medical device. The agency evaluated data from a clinical trial in which 123 patients with Type 1 diabetes used the system’s hybrid closed-loop feature as repeatedly during a three-month period. The trial presented the device to be safe for use in those 14 and older, showing no serious adverse events. The system is on sale since spring 2017.

While further clinical research is needed to ensure that the strength of the device in different settings is consistent, several researchers support the view that “artificial pancreas systems are a safe and effective treatment approach for people with type 1 diabetes. Medtronic counts this device as a step toward a fully automated, closed-loop system.

SOURCE

https://www.fiercebiotech.com/medical-devices/fda-approves-medtronic-s-artificial-pancreas-world-s-first

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Adipocyte Derived Stroma Cells: Their Usage in Regenerative Medicine and Reprogramming into Pancreatic Beta-Like Cells

Curator: Evelina Cohn, Ph.D.

The following presentation can be dowloaded in PowerPoint form by clicking on the link below:

adipocytes (1)

 

In Summary:

There are different results related to betatrophin and its characteristic to induce insulin and/or expand the pancreas beta cells. All the experiments so far were performed in mice. Some of the authors like Elisabeth Kugelberg from Harvard University agrees that betatrophin can induce insulin and expansion of secreting beta cells in mice (E. Kugelberg , 2014). Levitsky et al., 2014, come to the conclusion that betatrophin stimulate growth of beta cells in mice, while Gusarova et al., 2014, said that Betatrophin doesn’t control cell expansion in mice ( Gusarova et al., 2014) All three results are based on experiments on mice.

To make sure what are the characteristics of betatrophin in human pancreatic beta cells I suggest to try to determine the concentration and effect on those concentrations on immortal beta cells from human, CM cell line (insulinoma-obtained from ascitic fluid of cancer patients ) ( they are not producing any insulin under the glucose stimulation, therefore they may be a good for our model if they respond to betatrophin) TRM-1 (foetal Human SV40 T antigen)-Express small amount of insulin, not responsive to glucose stimulation) and finally Blox5 ( foetal Human SV40 T –antigen) which Exhibit glucose responsive. and Low insulin content. Blox5 may be the second good cell line to experiment, because they are responsive to glucose and they may be responsive to betatrophin as well.

If we found that those cell lines are inducing insulin then we may try primary beta cells. There is an article of 2013 (Ilie and Ilie, 2013) in which there is a possibility of regeneration of beta cells in vivo by neogenesis from adult pancreas. We can use their model to see if betatrophin indeed induce insulin in those cells. ( see the article attached)

On the other hand there are possibilities of growing beta cells directly onto pancreatic duct as it shows below:

pharmacoogicalapproaches to islet regeneration

 

 

 

 

 

 

 

 

 

 

From: https://infodiabet.wordpress.com/2010/08/31/new-sources-of-pancreatic-beta-cells/

Therefore, I suggest of producing pancreatic duct by using 3D printing and grow the cells by neogenesis

directly on the pancreatic duct.

References:

Gusarova V, Alexa CA, Na E, Stevis PE, Xin Y, Bonner-Weir S,

Cohen JC, Hobbs HH, Murphy AJ, Yancopoulos GD, Gromada J (2014), ANGPTL8/Betatrophin Does Not Control Pancreatic Beta Cell Expansion. Cell 159: 691-696.

Kugelberg E. (2013) Diabetes: Betatrophin—inducing β-cell expansion to treat diabetes mellitus? Nature Reviews Endocrinology 9: 379

Levitsky LL, Ardestani G, Rhoads DB (2014). Role of growth factors in control of pancreatic beta cell mass: focus on betatrophin. Curr Opin Pediatr. August 26 (4):475-9

 

 

 

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Clinical Trials Could Lead to FDA Approval for Artificial Pancreas

 Reported by: Irina Robu, PhD

Approximately 1.25 million American have type 1 diabetes accroding to the U.S. Centers for Disease Control and Prevention. A device that automatically monitors and regulates blood-sugar levels in people with type 1 diabetes developed by University of Virginia School of Medicine undergo two clinical trials starting early 2016.

The goal of the artificial pancreas is to eliminate the need for people with type 1 diabetes to stick their fingers multiple times daily to check their blood-sugar levels and to inject insulin manually.The artificial pancreas is designed to oversee and adjust insulin delivery as needed. At the center of the artificial pancreas platform is a reconfigured smartphone running advanced algorithms that is linked wirelessly to a blood-sugar monitor and an insulin pump, as well as a remote-monitoring site. People with the artificial pancreas can also access assistance via telemedicine.

Beneficial results from these long-term clinical trials examining how the artificial pancreas works in real-life settings could lead the U.S. Food and Drug Administration and other international regulatory groups to approve the device for use by people with type 1 diabetes, whose bodies do not produce enough insulin. The trials will conducted at nine locations in the U.S. and Europe sustained by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

The first study – the International Diabetes Closed-Loop trial – will test technology developed at UVA by a research team led by Boris Kovatchev, director of the UVA Center for Diabetes Technology. That technology has been refined for clinical use by TypeZero Technologies, a startup company in Charlottesville that has licensed the UVA system. The second trial will examine a new control algorithm developed by the team of Dr. Francis Doyle III at the Harvard John A. Paulson School of Engineering and Applied Sciences to test whether it further improves control of blood-sugar levels.

Along with UVA, the artificial pancreas will be tested at eight additional sites: Harvard University, Mount Sinai School of Medicine, Mayo Clinic, University of Colorado, Stanford University, University of Montpellier in France, University of Padova in Italy and Academic Medical Center at the University of Amsterdam in The Netherlands.

SOURCE

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