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The Dawn of Closed-Loop Artificial Pancreases for Diabetes Management

Written by William Boyce '25

Edited by Lorenzo Mahoney '24

Introduction

Type 2 diabetes is a chronic, metabolic disorder that affects the way the body processes glucose (sugar), leading to high levels of glucose in the blood [2]. According to the World Health Organization (WHO), around 422 million people worldwide suffer from diabetes, with type 2 diabetes being the most common form of the condition [3]. In the United States alone, around 34.2 million people have diabetes, accounting for 11.3% of the population [4]. The societal cost of diabetes is staggering, with the condition costing around $760 billion annually [5]. The current standard of care for type 2 diabetes involves lifestyle modifications around diet, fitness, or medications, like administering insulin via injections or an insulin pump [6]. However, many diabetics struggle to manage their insulin therapy, largely due to the treatment’s time-consuming and complicated nature. To alleviate current treatments' flaws, Cambridge researchers have attempted to take the body's own insulin processor, the pancreas, and make an artificial version powered by artificial intelligence (AI) of the organ to help diabetics [5].


Understanding Type 2 Diabetes

Type 2 diabetes is characterized by the body’s inability to effectively use insulin or produce enough insulin to maintain healthy blood sugar levels [2]. Insulin is a hormone produced in the pancreas that regulates the cellular uptake of glucose for energy. When the body doesn’t produce enough insulin or the insulin it produces isn’t utilized effectively, glucose builds up in the blood, leading to hyperglycemia [2]. This, in turn, can cause a variety of health problems, such as nerve damage, kidney damage, cardiovascular disease, and blindness.


Current Treatment Mechanisms

While most cases of type 2 diabetes can be managed with lifestyle changes, some patients require carefully administered doses of insulin, either through injections or an insulin pump [6]. However, managing insulin therapy can be time-consuming and complicated for many patients, leading to difficulties in maintaining target glucose levels.


New Treatment Mechanisms

The artificial pancreas developed by scientists from the University of Cambridge aims to address the challenges of traditional insulin therapy. The system is a closed-loop management system that incorporates an off-the-shelf glucose monitor, an insulin pump, and AI software developed by the team [5]. Utilizing existing insulin injection mechanisms, the new system sits on the patient’s skin, while a small needle continuously samples the patient’s blood glucose levels and sends the data to the artificial intelligence software [5]. The software uses this information to adjust the insulin dosage delivered by the insulin pump automatically [5]. This closed-loop management system reduces the need for frequent blood glucose monitoring and insulin dose adjustments by the patient [5].


To test their creation’s functionality, The University of Cambridge’s artificial pancreas underwent a series of clinical trials. The study included 26 patients with type 2 diabetes who had not achieved their target glucose levels with traditional insulin therapy [5]. During the trial, the patients used the artificial pancreas for a period of 12 weeks [5]. The researchers found that the system significantly improved patients’ glucose control compared to standard treatment [5]. The patients spent an average of 73% of the time in their target glucose range, compared to 59% of the time with standard treatment [5]. The system also significantly reduced occurrences of high and low glucose levels [5]. Limiting these periods of high and low glucose ranges helps patients avoid various unpleasant symptoms, such as dizziness, confusion, headache, fatigue [2].


Ethical Considerations

Despite the clinical success of the artificial pancreas, ethical concerns regarding the technology's privacy/security, potential biases against certain populations, and accountability remain unanswered. There is a risk that the technology may not be accessible to all patients, partially due to novel biotechnology’s high costs, leading to health disparities among populations. Additionally, the system's reliance on artificial intelligence raises questions regarding the technology's ability to make ethical decisions and the potential for bias in decision-making processes. For instance, could AI misuse race as a corrective or risk-adjusting variable in clinical algorithms?


Finally, concerns about the accountability of the system in the event of adverse health outcomes must be addressed before widespread adoption. If the AI makes an erroneous decision that negatively impacts a patient’s health, who is to blame? The biotechnology company, bad luck, AI itself, or something else?


Conclusion

The development of the artificial pancreas for the treatment of type 2 diabetes is a significant achievement in medical technology. The technology promises to revolutionize the way patients manage their diabetes, leading to better health outcomes. However, ethical concerns must be addressed before widespread adoption, and further research is needed to evaluate the technology's long-term efficacy and safety. The potential of the artificial pancreas as a new treatment option for type 2 diabetes is exciting and holds enormous promise for the future of healthcare. On our current course, we might soon see a future where diabetics can live without thinking twice about their condition.

 

References

1. Yu J, Zhang Y, Yan J, Kahkoska AR, Gu Z. Advances in bioresponsive closed-loop drug delivery systems. International Journal of Pharmaceutics. 2018 Jun 15;544(2):350–7.

2. Hypoglycemia - Symptoms and causes [Internet]. Mayo Clinic. [cited 2023 Apr 10]. Available from: https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685

3. World Health Organization - Diabetes [Internet]. World Health Organization. [cited 2023 Apr 10]. Available from: https://www.who.int/health-topics/diabetes

4. National Diabetes Statistics Report | Diabetes | CDC [Internet]. 2022 [cited 2023 Apr 10]. Available from: https://www.cdc.gov/diabetes/data/statistics-report/index.html

5. Daly AB, Boughton CK, Nwokolo M, Hartnell S, Wilinska ME, Cezar A, et al. Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-center, randomized crossover trial. Nat Med. 2023 Jan;29(1):203–8.

6. Endocrine Society - Diabetes Treatments [Internet]. 2022 [cited 2023 Apr 10]. Available from: https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-treatments

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