A two-hormone closed-loop artificial pancreas using a computer algorithm may tighten blood sugar control in patients with type 1 diabetes while lowering risk for hypoglycemia (low blood sugar). This is according to the results of a recent study and editorial published online in Science Translational Medicine.
"We have developed a closed-loop control system that uses frequent measurements of blood glucose concentration along with subcutaneous delivery of both the fast-acting insulin analog lispro and glucagon (to imitate normal physiology) as directed by a computer algorithm. The algorithm responded only to blood glucose concentrations and incorporated a pharmacokinetic model for lispro," says Firas H. El-Khatib, PhD, fom Boston University Massachusettes and colleagues in their research.
Compared with six out of of 11 type 1 diabetes patients who had no episodes of hypoglycemia requiring treatment, five patients who did have hypoglycemia requiring treatment had slower lispro absorption kinetics during the 27-hour experiments.
In another experiment, the investigators set the time-to-peak plasma lispro concentration to 65 minutes resulting in the prevention of hypoglycemia in both groups to achieve an aggregate mean blood glucose concentration of 164 mg/dL.
"These results demonstrate the feasibility of safe blood glucose control by a bihormonal artificial endocrine pancreas," the study authors write. "Near-normal mean blood glucose concentrations without hypoglycemia were achieved without feed-forward information or pretreatment for very high carbohydrate meals in the subjects with faster insulin phramacokinetics. In subjects with slower insulin absorption, adjustments of the algorithm's phramacokinetic parameters prevented hypoglycemia at the cost of modestly higher average blood glucose concentrations."
-DiabetEASE Magazine
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