Patients living with Type 2 diabetes that also require kidney dialysis may soon benefit from an artificial pancreas which would help them manage their blood sugar levels to prevent blood sugar from reaching dangerously high or low levels.
The number of people living with type 2 diabetes is increasing and diabetes is already the leading cause of kidney failure, accounting for around 30% of cases each year. Patients with kidney failure have a much higher chance of hypoglycaemia and hyperglycaemia and managing diabetes and blood sugar levels can be problematic in patients with kidney failure.
Insulin injections are the only recommended treatment for these patients and achieving the optimal dosing regimen can be difficult to establish. One potential treatment that could replace insulin injections is an artificial pancreas. These devices have been developed for patients with type 1 diabetes, but a new research shows patients with type 2 diabetes and kidney failure could also benefit from the devices.
One such device was developed by researchers at the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust. They have been working with scientists at Bern University Hospital and University of Bern, Switzerland and showed that their artificial pancreas can be used to treat patients with type 2 diabetes and kidney failure.
The device consists of three elements: a glucose monitor, smartphone algorithm to calculate the correct insulin dose, and an insulin pump. The device is small and is worn externally on the body. The glucose monitor is used to measure blood sugar levels, which sends readings to the software on the smartphone, which in turn sends signals to the insulin pump which adjusts the dose of insulin delivered to the patient.
The devices used to treat type 1 diabetes need to be told when patients are about to eat in order for insulin levels to be adjusted; however, the artificial pancreas system developed for treating patients with type 2 diabetes is a fully closed loop system that requires no input from the patient. It simply monitors glucose levels and makes the adjustments automatically.
The researchers conducted a study on 26 patients with type 2 diabetes and kidney failure that required dialysis, with the patients recruited between October 2019 and November 2020. The findings of the study have just been published.
13 of the patients received the artificial pancreas first while the other 13 patients received standard insulin injections first. The patients were monitored and compared to determine how long each remained in the targeted blood sugar range. When patients used the artificial pancreas, they spent an average of 53% of their time in the target range, compared to 38% on standard insulin injections, which equated to an additional 3.5 hours a day in the target range. The artificial pancreas reduced the time patients spent with potentially dangerously high or low blood sugar levels.
Overtime, the efficacy of the artificial pancreas improved from 36% in the target range on day 1 to 60% on day 20 due to the adaptive algorithm. The artificial pancreas also proved popular with patients who had to spend less time managing their diabetes. 87% of patients were less worried about their blood sugar levels when using the artificial pancreas and 92% said they would recommend it to others.
“Now that we’ve shown the artificial pancreas works in one of the more difficult-to-treat groups of patients, we believe it could prove useful in the wider population of people living with type 2 diabetes,” said Dr Charlotte Boughton of the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge, who led the study.
The researchers are now trialling the artificial pancreas on outpatients with type 2 diabetes who do not require dialysis.
You can read more about the study in the paper – Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomized crossover trial – which was recently published in Nature Medicine. DOI: 10.1038/s41591-021-01453-z