Artificial pancreas system trialled in patients with type 2 diabetes

Significant advances have been made in the field of technology to deliver insulin and to continuously monitor glucose levels in patients with type 1 diabetes. Much of these developments have led to the close-loop system (simply known as the artificial pancreas) which simultaneously monitor glucose levels and deliver the optimal amount of insulin in order to achieve a stable glucose levels. A recent study published in the journal Nature Medicine conducted by researchers from the Wellcome-MRC Institute of Metabolic Science at the University of Cambridge looked at the use and efficacy of this system in people with type 2 diabetes. The device used in their study combines an off-the-shelf glucose monitor and insulin pump with an app developed by the team, known as CamAPS HX. This app is run by an algorithm that predicts how much insulin is required to maintain glucose levels in the target range. Previous studies have shown that an artificial pancreas run by a similar algorithm is effective for patients living with type 1 diabetes as well as in patients with type 2 diabetes who require kidney dialysis. Unlike the artificial pancreas used in their previous studies, this new version is a fully closed loop system – i.e. patients do not need to bolus their insulin to adjust for their food.

In this study, 26 patients insulin treated patients with Type 2 diabetes recruited from the primary and secondary care were randomly allocated to a trial of the artificial pancreas for eight weeks and then switch to the standard therapy of multiple daily insulin injections; or to take this standard therapy first and then switch to the artificial pancreas after eight weeks.

They found that patients using the artificial pancreas spent two-thirds (66%) of their time within the target range (between 3.9 and 10.0 mmol/L) compared with 32% in the standard therapy. Furthermore, patients receiving standard therapy experienced 67% of their time with high glucose levels (>10 mmol/L), which was reduced to 33% when using the artificial pancreas. Average glucose levels fell - from 12.6 mmol/L when taking the control therapy to 9.2 mmol/L while using the artificial pancreas. HbA1c level after using the artificial pancreas was 7.3% compared with 8.7% in the standard therapy. Reassuringly, despite tight glucose control, no patients experienced hypoglycaemia during the study. One patient was admitted to hospital while using the artificial pancreas, due to an abscess at the site of the pump cannula. Feedback from participants suggested that participants were happy to have their glucose levels controlled automatically by the system, and nine out of ten (89%) reported spending less time managing their diabetes overall.

While the majority of patients with type 2 diabetes should be and will still be managed by drug therapies, for some patients with type 2 diabetes who requires multiple insulin injection, the use of artificial pancreas technology will improve their glucose levels, reduce risks of long-term complications and improve quality of life. This study forms a basis for a much larger multicentre study to build on their findings. The team have also submitted the device for regulatory approval with a view to making it commercially available for outpatients with type 2 diabetes.

The research was supported by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre.