January 27, 2023

New algorithms are changing the landscape of diabetes care, but a “functional cure” remains elusive.

Welcome to impact factor, your weekly dose of  commentary on a new medical study. i’m dr. f.   it was 100 years ago when leonard thompson,   age 13, received a reprieve from a death sentence.  young master thompson had type 1 diabetes – a   disease that was uniformly fatal within months  of diagnosis. but he received a new

Treatment,   insulin, from a canine pancreas. he would live 13  more years before dying at age 26 of pneumonia.  the history of type 1 diabetes since that time  has been a battle on two fronts. first, the   search for a cause of and cure for the disease.  second, the effort to make the administration   the past two decades have

Seen a technological   continuous glucose monitors decreasing the   need for painful finger sticks, and insulin pumps  allowing for more precise titration of doses.  those two technologies – continuous glucose   monitoring and insulin pumps – to create so-called  “closed loop” systems – basically an artificial  

Pancreas – that would obviate the need for any  intervention on the part of the patient save   we aren’t there yet – but we are closer than ever.  are a marvel of technology, but they  to dial in settings for their insulin  and inform the system that they are about  to eat those meals to allow the algorithm   the perceived

Complexity of these systems   may be responsible for why there are substantial  disparities in the prescription of closed-loop   systems. kids of lower socioeconomic status are  dramatically less likely to receive these advanced   technologies. providers may feel patients with  lower health literacy or social supports are

Not   that means that easier might be better.  in this article from the new england  broadly, it’s another closed-loop system. the  bionic pancreas integrates with a continuous   needed. but the algorithm appears to be a bit   smarter than what we have in existing devices. for  example, the patient does not need to provide

Any   – just their body weight. they don’t need to   count carbohydrates at meals – just to inform the  device when they are eating, and whether the meal   is the usual amount they eat, more, or less. the  algorithm learns and adapts as it is used. easy.  care, though it was required that control   participants were

As young as 6 years old up to   income. the mean a1c was around 7.8% at baseline. by the end of the study, the a1c was significantly   improved in the bionic pancreas group, with a  mean of 7.3% vs 7.7% in the usual care group.  this effect was most pronounced in those with  higher a1cs at baseline, as you can see here.  the target

Glucose range of 70 – 180 mg/dl. all in all – the technology that makes it   but new technology is never without its hiccups.  you can see that those randomized to the bionic   pancreas had a markedly higher rate of adverse  events 244 events in 126 people compared to   this is actually a little misleading though – the  

Vast majority of these events were hyperglycemic  episodes due to infusion set failures – which were   only reportable in the bionic pancreas group. in  other words, the patients in the control group   who had an infusion set failure (assuming they  were using an insulin pump at all) would have   just called their regular doctor

To get things  sorted and not reported it to the study team.  nevertheless, these adverse events – not serious,  but common – highlight the fact that good software   is not the only key to solving the closed-loop  problem. we need good hardware too – hardware   children with type 1 diabetes deserve to live.  type 1 diabetes

– A true artificial pancreas,   is closer than ever, but it’s still just a dream.  with iterative advancements like this though,   for medscape, i’m perry wilson

Transcribed from video
A “Bionic Pancreas” for Type 1 Diabetes? By F. Perry Wilson MD