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A bihormonal closed-loop artificial pancreas for type 1 diabetes
Firas H El-Khatib1, Steven J Russell1, David M Nathan1
1Department of Biomedical Engineering, Boston University and the Diabetes Unit and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Science Translational Medicine
|April 16, 2010
Summary
A new bihormonal artificial pancreas safely controls blood glucose (BG) for type 1 diabetes patients. This closed-loop system uses insulin and glucagon, demonstrating feasibility for improved diabetes management.
Area of Science:
- Biomedical Engineering
- Endocrinology
- Diabetes Technology
Background:
- Type 1 diabetes management aims for automated blood glucose (BG) control.
- Current therapies often struggle to mimic normal physiological BG regulation.
Purpose of the Study:
- To develop and evaluate a closed-loop artificial pancreas system for type 1 diabetes.
- To assess the safety and efficacy of bihormonal (insulin and glucagon) delivery.
Main Methods:
- A closed-loop system with frequent BG monitoring and subcutaneous insulin lispro and glucagon delivery.
- An algorithm incorporating a lispro pharmacokinetic model, adjusted for individual absorption rates.
- 27-hour trials in 11 type 1 diabetes subjects, including meals.
Main Results:
- The system achieved a mean BG of 140 mg/dl, below the ADA target (<154 mg/dl), with no hypoglycemia in 6 subjects.
- 5 subjects experienced hypoglycemia, linked to slower lispro absorption kinetics.
- Adjusting the algorithm's lispro pharmacokinetic parameters prevented hypoglycemia and achieved a mean BG of 164 mg/dl.
Conclusions:
- A bihormonal artificial pancreas system demonstrates feasible and safe BG control in type 1 diabetes.
- Individualized pharmacokinetic modeling is crucial for preventing hypoglycemia in closed-loop systems.
- This technology offers a promising advancement for diabetes therapy.
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