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The promise of artificial pancreas
The pieces to assemble it already exist.On the one hand, infusors or insulin pumps, used by hundreds of diabetics;On the other, the continuous glucose monitoring systems, of which there are already several models in the market and that allow measuring blood sugar levels constantly.Now the goal is to connect both technologies or, in the words of scientists, 'close the handle', through a small computer that translates the readings of the glucose meter in orders for the insulin pump on the amount of this hormone that the organism needsAt every moment.
By: Hugo Cerdà/El País
07-Enero-2009 (01:57 p.m.)
Madrid, Spain.- The big problem that insulin-dependent diabetics have is the difficulty of providing the proper dose of the hormone at the right time, as the beta cells of the healthy pancreas do.Delayed the bet of stem cells as a solution, the best short -term option is to assemble through a small computer two technologies already available: a continuous glucose meter and an insulin infusion pump.This integrated system could soon be the first artificial pancreas.
Appeified the initial euphoria deposited in the power of stem cells to cure diabetes, the hopes and efforts of patients and researchers now go to the achievement of a parallel objective that seems more affordable in the short term: the construction of an artificial pancreas.
The pieces to assemble it already exist.On the one hand, infusors or insulin pumps, used by hundreds of diabetics;On the other, the continuous glucose monitoring systems, of which there are already several models in the market and that allow measuring blood sugar levels constantly.Now the goal is to connect both technologies or, in the words of scientists, 'close the handle', through a small computer that translates the readings of the glucose meter in orders for the insulin pump on the amount of this hormone that the organism needsAt every moment.
There are several artificial pancreas models in the experimental phase designed to simulate the physiological secretion of the pancreatic beta cell.The published data, although within the framework of research studies with a small number of patients and for short periods of time, provide evidence that glucose control can be achieved through systems that come to imitate the behavior of these pancreas cells.
The coordinator of the Working Group on New Technologies of the Spanish Diabetes Society, Maria Soledad Ruiz de Adana, is convinced of the possibilities of the artificial pancreas.'These integrated systems for continuous glucose monitoring and subcutaneous insulin infusion represent an advance in the current treatment of people with diabetes, and as they improve their technological development they could become the standard treatment for some people with type 1 diabetes,Explains Ruiz de Adana, of the Endocrinology and Nutrition Service of the Carlos Haya University Hospital, in Malaga.
more autonomous patients
If so, the diabetics would benefit from a relative relaxation of their commitment to the management of the disease, by transferring to a computer the strenuous task of constantly making decisions about how much insulin inject.An artificial pancreas would return to the patient part of the stolen autonomy and should improve the control of glucose concentration and, therefore, overcome the associated complications.
The Foundation for ResearchIn youth diabetes (JDRF) of the United States it is persuaded of the urgency of having this technology and, therefore, in 2006 the artificial Pancreas Project launched, which is proposed to accelerate its development.'There are too many diabetics that are not doing it well enough.The current care standard for people with diabetes and their results are not acceptable.We need to provide the person with diabetes to make safe and effective decisions, and we believe that this help will come from an artificial pancreas, 'said Larry Soler, vice president of the JDRF, during the celebration last July of a workshopof work that brought together researchers and representatives of the American drug agency (FDA) and the National Health Institutes (NIH) under the title towards an artificial pancreas.
The JDRF finances a consortium of seven research centers with different prototypes with 10 million dollars.One of them, who runs Roman Hovorka at the University of Cambridge (United Kingdom), begins to give hopeful results.During the last two years he has tried the ability of his artificial pancreas to control the nightlife concentrations of glucose in 12 children with type 1 diabetes. The system devised by Hovorka and his research group managed to maintain the concentration of blood sugar from children in children inThe ranges considered normal 61% of the time, compared to 23% of those who followed the usual treatment.
close the handle during the night
'With the closed handle system we are able to avoid the extremes, both of very high and very low glycemia,' "explains Hovorka.All this at one time, the night, in which the patient can do little to regulate their glucose concentration and in which, in addition, the processor that manages the algorithms has it easier by not going into play variables such as the intake offood or physical exercise practice.'We want to move towards an approach that can be marketed, and the simplest in this regard is to close the handle during sleep hours, "says Hovorka.
The determination of scientists comes to that degree of pragmatism.The innovations that are being developed, however limited, cannot wait for the achievement of a definitive device.The perfect should not be an enemy of the good.Therefore, if there is a system that can keep the concentration of glucose automatically, even if only during the night, it must reach patients as soon as possible.
Integrated glucose sensor and insulin infusor systems could be especially useful for younger children with type 1 diabetes, given their limitations to manage their own treatment.
But first, mathematical algorithms will have to be improved so that the small computer is able to interpret trends in glucose concentration and respond quickly and precisely to insulin needs.In addition, it will be necessary to advance in the development of more sensitive glucose sensors with a longer duration (the current ones must be changed between every three and eight days).Even so, experts doubt that in the short term the first systems allow the patient to completely disregard their illness.
