VOICE OVER: For people living with Type-1 Diabete, tight glucose
levels are really important because they dramatically reduce
the risk of complications affecting the eyes, the nerves
and the kidneys. The artificial pancreas offers great promise
for patients with diabetes but researchers are still in the
process of gathering evidence through trials. Researchers like
Helen Murphy at the University of East Anglia.
HELEN MURPHY: So the importance of tight glucose levels is well
established, but actually the realities of how to achieve it
are really quite challenging. So for those of us who have a
normal functioning pancreas, our bodies are making insulin and
adjusting that insulin, really every five to ten minutes.
Whereas for people with diabetes, they're having to
inject insulin, they might do that three or five times a day.
But it's really difficult to mimic what the normal
functioning pancreas does. So really, people living with type-1
diabetes almost need to be expert nutritionists, they
need to understand exactly how much carbohydrate's in their
food. And then they need to be mathematical geniuses to match
the insulin dose very precisely to the amount of carbohydrates
that they eat.
So the real difference between the conventional insulin
delivery that's delivered by injections or by an insulin
pump, compared to the artificial pancreas is that the artificial
pancreas is able to deliver small amounts of insulin, little
and often. So it's mimicking a normal functioning pancreas in
that way, if you like because it's adjusting insulin every ten
to twelve minutes, including during the overnight when people are
asleep. So the artificial pancreas has got three
components - a continuous glucose monitor, an insulin pump, and a
mathematical algorithm that links the insulin pump delivery
to the real-time glucose levels. Over the last decade, the
advance in continuous glucose monitoring has meant that we've
been able to start some high quality research studies into
the artificial pancreas across a whole range of different patient
groups. So the early studies for the artificial pancreas have
been conducted in children as young as one and right up to
adults in the age of eighty. Now the group that I work with, in
particular pregnant women, so we've been really delighted to
be able to work together with bioengineers and bring the
latest artificial pancreas developments to this important
patient population.
VOICE OVER: Helen has been running a trial of a newly developed closed loop
artificial pancreas system at her local hospital with pregnant
women with diabetes. The trial's ongoing but she spoke to one of
the trial participants - specialist midwife, Nina Willer
to hear how it had affected her glucose control during her
pregnancy.
NINA WILLER: Well, in my previous pregnancy, I was using a combination of
finger pricking and freestyle libre. So for this having the
alarm function just on the Dexcom alone is quite life-
changing, because I don't have to worry so much about having
significant hypos. But also, when my blood sugars rise, even
if I had no awareness of it, if I was sleeping through it, then
I wake up always on a perfect blood sugar level, no matter
what happens. The algorithm just kicks in and takes care of it.
And also, I feel more in tune with what's going on with my
body, and more educated.
HELEN: And I think that's been one of the real things, we've noticed
the feedback that actually just the importance of waking up with
a blood sugar that's already on target, rather than having to
spend half of your morning catching up,
NINA: Starting the day right makes such a difference. And I feel
like I spent a lot of my awake hours and asleep hours worrying
about my diabetes when I wasn't pregnant, but then again, when
you're pregnant, you've got to worry about the baby as well.
It's quite a high-stress situation. Whereas this, I'm
still thinking about it and I'm still informed, but I'm somewhat
on autopilot. And it just reduces my stress levels so much.
HELEN: And really that's our hope for all pregnant women, that
they can be a little bit more on autopilot with their diabetes.
And yeah, enjoying a healthy pregnancy and delivering safe
healthy babies. Where we're up to now is risk where I think
getting the real word evidence that the closed-loop artificial pancreas
can achieve tighter glucose levels than any of the
individual components by themselves. So we're up to
the larger scale, what we call the phase three or the clinical
effectiveness trials. The next phase, of course, is going to
involve health economics and regulators and getting these
devices approved for real-world use in people with diabetes.
So what I think we're going to see over the next five to ten
years, will be a wider variety of different sorts of closed
loop artificial pancreas systems. Hopefully we will see
pumps, whole range of pumps that are insulin pumps that are
compatible with the artificial pancreas. We'll start to see
smaller, even more accurate continuous glucose monitoring
systems. Already we see the control algorithms are worn on
used on their smartphone, people can access their glucose data on
a smart watch. So the devices are becoming less intrusive,
more user friendly, easier to incorporate into normal daily
living. But of course, the question everyone wants to ask
is, well, are these a cure? And the honest answer is that
probably they don't necessarily represent a cure
They represent, you know, this fantastic technological progress
towards a cure. We think of it like the bridge to a cure. So in
the meantime, the artificial pancreas is certainly the best
technological solution we have that's likely to help the
largest number of people achieve the target glucose levels that
they need to reduce the risk of complications.