It can be difficult to control your blood glucose levels when you have type 1 diabetes, because it can lead to dangerously low glucose levels, which is known as hypoglycaemia. This even occurs when you’re getting a continuous predetermined subcutaneous supply of insulin from your insulin pump treatment. According to Ahmad Haidar, Institut de Recherches Cliniques de Montréal and McGill University, and his co-authors, who published their study in CMAJ (Canadian Medical Association Journal), ‘Hypoglycaemia is feared by most patients and remains the most common adverse effect of insulin therapy’.
However, by using infusion pumps based on continuous glucose sensor readings, as guided by an intelligent dosing algorithm, the dual-hormone artificial pancreas can deliver insulin and glucagon with a reduced risk of hypoglycaemia. The intelligent algorithm was the part that was developed by the researchers in Montreal, who found that with this system, patients’ glucose levels were in the target zone 71% of the time, rather than the 57% of the conventional pump treatment. Further, the number of night-time glucose measurements in the low glucose level range was reduced 20 times over, thanks to the artificial pancreas.
The authors wrote ‘[The dual-hormone artificial pancreas] improved glucose control and reduced the risk of hypoglycaemia in our 15 participants, as compared with continuous subcutaneous insulin infusion.’ They added, ‘Rates of hypoglycaemia were reduced, with no increased risk of hyperglycemias.’
The authors concluded by saying that ‘Closed-loop delivery systems have the potential to substantially improve the management of diabetes and the safety of patients. These systems will probably be introduced gradually to clinical practice, with early generations focusing on overnight glucose control and using insulin alone.’
Dr David Nathan and Dr Steven Russell of Massachusetts General Hospital, Harvard Medical School, wrote in a related commentary, ‘Although [this] study is neither the first nor the longest investigation using a dual-hormone artificial pancreas, it is the first to compare such an apparatus to conventional intensive therapy in a randomized design. Treatment with the artificial pancreas increased the amount of time patients spent in the target range of blood glucose levels and decreased hypoglycaemia. Thus, Haidar and colleagues show that low doses of glucagon administered under the control of a computer algorithm can act as a counter-regulatory hormone, preventing glucose levels from falling too low.’