The artificial pancreas developed at the Institute of Metabolic Science and Cambridge University Hospitals NHS Foundation Trust has so far been available only to people living with type 1 diabetes. In research published today in Nature Medicine, the Cambridge team – working with researchers at Bern University Hospital and the University of Bern, Switzerland – has shown that the device can be used to support patients living with both type 2 diabetes and kidney failure.
Diabetes is the most common cause of kidney failure, accounting for ~30% of cases. As the number of people living with type 2 diabetes increases, so too does the number of people requiring dialysis or a kidney transplant. Kidney failure increases the risk of hypoglycaemia and hyperglycaemia – abnormally low or high levels of blood sugar – which in turn can cause complications from dizziness to falls and even to coma.
Managing diabetes in patients with kidney failure is challenging for both patients and healthcare professionals and most oral diabetes medications are not recommended for these patients, so insulin injections are the most commonly used diabetes therapy – though optimal insulin dosing regimens are difficult to establish. In the new study, patients using the artificial pancreas spent more time in the target range for blood sugar and less with potentially dangerously low blood sugar levels.
Dr Charlotte Boughton, who led the study, said:
Patients living with type 2 diabetes and kidney failure are a particularly vulnerable group and managing their condition – trying to prevent potentially dangerous highs or lows of blood sugar levels – can be a challenge. There’s a real unmet need for new approaches to help them manage their condition safely and effectively.
The findings also highlight the importance of using an adaptive algorithm, which can adjust in response to an individual’s changing insulin requirements over time. Time spent in the target blood sugar range increased from 36% on day one of the study to over 60% by the twentieth day.
Senior author Professor Roman Hovorka said:
Not only did the artificial pancreas increase the amount of time patients spent within the target range for the blood sugar levels, but it also gave the users peace of mind. They were able to spend less time having to focus on managing their condition and worrying about the blood sugar levels, and more time getting on with their lives.
The team is currently trialing the artificial pancreas for outpatient use in people living with type 2 diabetes who do not need dialysis and exploring the system in complex medical situations such as perioperative care.
What is an artificial pancreas?
The artificial pancreas is a small, portable medical device designed to carry out the function of a healthy pancreas in controlling blood glucose levels, using digital technology to automate insulin delivery. The system is worn externally on the body, and is made up of three functional components: a glucose sensor, a computer algorithm to calculate the insulin dose, and an insulin pump.
While patients with type 1 diabetes need to tell their artificial pancreas that they are about to eat to allow adjustment of insulin, the new version for those with type 2 diabetes and kidney failure can be left to function entirely automatically and is known as a fully closed loop system.
The research was supported by the NIHR Cambridge Biomedical Research Centre, The Novo Nordisk UK Research Foundation, Swiss Society for Endocrinology and Diabetes, and Swiss Diabetes Foundation and Swiss Kidney Foundation.