One more step toward bionic living: replacing a pancreas with technology

William Rusnak explores the impact of technology on patients with diabetes with the emergence of the artificial pancreas and how this will change the treatment regimen for patients with diabetes.

Today, technology is so integrated into our lives that sleep seems to be our only break from it. It helps us stay organized, entertained, socially connected, and sometimes even alive (see cardiac pacemakers). Recently, scientists have been looking to use technology to solve yet another problem: diabetes control. They are looking to replace the human pancreas, which is the organ of the body involved in the regulation of glucose (sugar) levels in the blood (blood-glucose). Specifically, in diabetes, depending on the stage and type of the disease, the pancreas is generally nonfunctional and fails to release a necessary regulatory hormone, insulin.

In a normal pancreas, insulin is released when blood-glucose levels in the body are high (e.g. shortly after someone devours a jelly donut). Insulin then works its magic, which is to "push" sugar into muscle cells to be used or, if the muscle cells are not currently active, into adipose (fat) cells to be stored. This effectively lowers a person's blood-glucose levels.

For diabetics, especially those who cannot produce insulin, controlling blood-glucose is essential. This is done by monitoring blood-glucose levels throughout the day and delivering sub-cutaneous injections of insulin to keep blood-glucose somewhere between 80-100mg/dl. Additionally, physicians use glycated hemoglobin (HbA1c) levels to measure the long-term control of blood-glucose. Research shows that keeping this level below 7% in diabetics reduces the risk of developing microvascular disease and cardiovascular complications by as much as 76%, hence the need for tight control.1

"Using insulin pumps is nothing new."

Using insulin pumps is nothing new. In fact, pumps that deliver subcutaneous doses of insulin have been in use for many years. However, combining the pump with a continuous blood-glucose monitor that is equipped with software to self-regulate is a much newer idea.

Early models of the artificial pancreas only tested patient's blood glucose levels and administered insulin. Unfortunately, physicians have found that this method only solves part of the problem.1 Hormones tend to work in a very delicate balance with other hormones. In this case, the missing component of the mixture is glucagon, a hormone that is essentially the opposite of insulin. In 2010, Firas El-Khatib, Ph.D. and colleagues performed a study involving 11 diabetic patients that demonstrated the possibility of safely achieving target blood-glucose levels by using an artificial pancreas. The researchers attributed their success to including glucagon in the mix. 1

The addition of the hormone glucagon to the artificial pancreas reduces the roller coaster-type effect of typical insulin injections. Remember that insulin lowers blood-glucose and the traditional injections can often exceed the desired effect and actually cause low blood-glucose levels. In contrast, an artificial pancreas performs continuous glucose monitoring and delivers adequate doses of each hormone to the body when indicated. 2,3

Most recently, a study involving researchers from Massachusetts General Hospital, Harvard Medical School, and Boston University showed great promise for the idea. After over 550 hours of testing using human subjects with Type 1 diabetes, the artificial pancreas was found to have considerable potential for safely maintaining blood glucose levels, especially at night when hypoglycemic (low blood-glucose) episodes are more likely to occur. 2

"...an artificial pancreas performs continuous glucose monitoring and delivers adequate doses of each hormone to the body when indicated"

Ultimately, an artificial pancreas may seem like another step toward becoming a bionic human being, but that certainly beats the alternatives, right?

Consider what diabetics go through on a daily basis right now. Many are pricking the tips of their fingers numerous times throughout the day to check glucose levels and then following that with an injection of insulin. Anything that makes this process more convenient will likely to welcomed by patients. Not to mention, the treatment will be much more precise, relieving patients of the worry of giving themselves a wrong dose. Predictably, cost may be a barrier in the early phase of implementation, but ultimately this technology is promising.

References

1. El-Khatib, F. H., Russell, S., Nathan, D. M., Sutherlin, R. G., & Damiano, E. R. (2010). A bihormonal closed-loop artificial pancreas for Type 1 diabetes. Science Translational Medicine, 2(27). DOI: 10.1126/scitranslmed.3000619

2. Russell, S. J., El-Khatib, F. H., Nathan, D. M., Magyar, K. L., Jiang, J., & Damiano, E.R. (2012). Blood glucose control in Type 1 diabetes with a bihormonal bionic endocrine pancreas. Diabetes Care, 35. 2148-2155. DOI: 10.2337/dc12-0071

3. Russell, S. (2013). Using mathematics to treat diabetes . . . five minutes at a time. Retrieved from http://www.artificialpancreas.org/Home_Page.html

About the author:

William Rusnak is a fourth year student at Drexel University College of Medicine, financial investor, writer, and entrepreneur. He writes for NueMD about topics such as healthcare technology, biotechnology, and nutrition. He is currently applying to residencies with plans to practice in Primary Care and Sports Medicine. Outside of his professional life, he is a family man, performing musician, and paleo-diet enthusiast.

Closing thought: What potential does the artificial pancreas hold for patients with diabetes?