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
