The buzz around the artificial pancreas sometimes neglects the realities around this medical device.
When people hear the term “artificial pancreas,” they often get quite excited. When I ask what they envision, some say it will be a Holy Grail for diabetic patients. Others think it is an advanced device that will be implanted in the human body, actually replacing the human organ. Still others say, “Well, it’s simply a continuous glucose meter that works together with an infusion pump.”
So what is all the buzz about? The concept of an artificial pancreas has been around for some time. I have attended diabetes world conferences for several years where doctors and technology companies gather to show how they are using continuous glucose meters and insulin pumps and claim that the artificial pancreas, or closed loop solution, will be to diabetes treatment what the iPhone was to the mobile market.
As both a doctor and a technologist, here is what I see as the realities:
Technology for the artificial pancreas has made significant advances; however, software will be the key to further improvements. The goal is simple: keep a normal glucose level in the patient at all times of the day. This means we need to control dietary intake, as well as the way different patients react to insulin, the type of insulin(s) used, exercise, etc. -- all of which requires a high-level of software development and new algorithms. Also, I believe there is a place for miniaturization, and a need for more robust security.
There have been major advances in technology, especially on the sensor side where the level of accuracy for reading and measuring glucose to oxidation has greatly improved. Developing this accuracy is quite difficult because the measurement is not done in the intravascular space, but rather in the interstitial cell space, that could be similar to the real glucose level in the circulation system but never the same. Also, the sensor's way of measuring glucose is based in a chemical reaction to oxidation. In the end, the company that provides the best algorithms will rule this market.
The artificial pancreas only treats 10 percent of the diabetic market. These are patients with type 1 diabetes who do not produce insulin and must receive it externally through daily injections and this is where the artificial pancreas is beneficial.
What is marketed as a “pancreas” is nothing like what medical terms suggest. The pancreas is not just about insulin, but also acts like endocrine and exocrine glands. Its broader function is lost in its marketing toward one subset of a disease population. I sometimes wonder if some of the hype is not simply a strategy used by corporations to justify the long-term investment placed on its development, even if the ROI is not justified.
In conclusion, for type 1 diabetic patients the artificial pancreas might be the Holy Grail, but let’s keep its success in context. Though it could be an important solution for 10 percent of the diabetic population, we can’t stop researching. We still need to find better pharmacological treatments, establish new technology innovations, outline healthy dietary and exercise habits, and encourage better treatment adhesion to help the other 90 percent.