The bionic pancreas, a system that mimics the natural pancreatic regulation of serum glucose by automatically dosing insulin and glucagon, has been a dream for decades. New research to be presented at the Scientific Sessions could reveal whether that dream is one step closer to reality.
“Automated insulin delivery systems, a bionic pancreas, is the cutting-edge in diabetes, especially for treating type 1,” said Roy W. Beck, MD, PhD, Medical Director, Jaeb Center for Health Research Foundation. “This trial included persons from ages 6 to 83 using three different types of insulin. We are going to be presenting results in children, in adolescents, in adults, and patient-reported outcomes. In addition, the results comparing fast-acting insulin aspart versus insulin aspart or insulin lispro will be presented. Although this study was conducted for type 1 diabetes, we could see use of the bionic pancreas expanding in the future to people with type 2 diabetes who are using insulin as well.”
Dr. Beck will chair The Insulin-Only Bionic Pancreas Pivotal Trial—Randomized Clinical Trial Results, which will begin at 12:45 p.m. CT on Friday, June 3, in Great Hall A at the convention center. Presenters will report the latest trial data on the iLet® Bionic Pancreas, the first automated insulin delivery system to move beyond the hybrid closed loop stage.
Hybrid closed loop systems are a tremendous advance over the traditional finger sticks, dose calculation, and insulin injection, said Gregory P. Forlenza, MD, Associate Professor of Pediatrics and Director of Pediatric Diabetes Technology Research, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus. But hybrid systems still require significant input from patients or parents, he noted.
“What we hear from kids and families is that every meal becomes a math problem,” Dr. Forlenza said. “You don’t look at a plate of spaghetti and see a plate of spaghetti. You see a bolus 20 minutes pre-spaghetti, 60 grams of carbs, blood sugar 240. This design lets you initialize the system with the patient weight and that’s it. No carb ratio, no basal rate, no correction factors.”
The iLet system goes beyond currently approved hybrid systems but is not a good choice for every patient, Beck said.
“The only input is the user’s weight and that a meal is coming,” he explained. “The system learns over time, based on how much insulin is given and what happens, to fine-tune what is given. For the 10% to 15% of hybrid system users who are already under excellent control—their A1C 7% and under—this may not be a great system. But for the majority of people with type 1 diabetes, there is less effort with this system.”
Less effort could be a significant advantage for children and adolescents, noted Laurel H. Messer, PhD, RN, CDCES, Assistant Professor of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine.
“Teenagers are, developmentally, less attentive to their diabetes care,” Dr. Messer said. “Adolescents have the highest glucose levels of any age group across the lifespan of people with diabetes because they just can’t attend to their diabetes at the level they need to. It could be an enormous relief to not have to do the work of programming an insulin dose and counting carbohydrates every meal, and yet still have good glycemic control.”