Artificial pancreas developed in Cambridge could help diabetes patients with kidney failure

An artificial pancreas developed in Cambridge can help type 2 diabetes patients with kidney failure to manage their condition, tests have shown.

Tests led by the University of Cambridge and Inselspital, University Hospital of Bern in Switzerland, show it can reduce the risk of low blood sugar levels.

The small, portable device is worn on the body and features a glucose sensor that sends information to a smartphone, which uses an algorithm to control how much insulin is provided to the patient via a pump

Dr Charlotte Boughton from the Wellcome-MRC Institute of Metabolic Science at the University of Cambridge, who led the study, said: “Patients living with type 2 diabetes and kidney failure are a particularly vulnerable group and managing their condition – trying to prevent potentially dangerous highs or lows of blood sugar levels – can be a challenge. There’s a real unmet need for new approaches to help them manage their condition safely and effectively.”

Thirty per cent of cases of kidney failure are caused by diabetes. The number of people requiring dialysis or a kidney transplant is growing as the number living with type 2 diabetes rises.

Kidney failure leads to a heightened risk of hypoglycaemia and hyperglycaemia – abnormally low or high levels of blood sugar respectively. Complications can include dizziness or falls and even coma.

But there are challenges to managing the condition, including with targets for blood sugar levels and treatments.

Insulin injections are the most commonly used method of therapy but getting the optimum dosing right is difficult.

An artificial pancreas was previously developed by the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust to replace insulin injections for those with type 1 diabetes. It required patients to tell their artificial pancreas that they are about to eat so it adjusted insulin levels.

The new version for those with type 2, however, is a closed loop system, meaning it is entirely automated.

A glucose sensor measures blood sugar levels and sends information to the user’s smartphone so it can continuously adjust how much insulin is delivered by the pump.

In tests on 26 patients, patients using the artificial pancreas spent 53 per cent of their time in the target blood sugar range over 20 days, while those in the control group, receiving standard insulin treatment, spent 38 per cent of their time in this range.

This means those using the device spent about three and a half hours a day extra in the target range. Their mean blood sugar levels were lower and they spent less time with potentially dangerously low blood sugar levels, or ‘hypos’.

Thanks to the adaptive algorithm learning over time, the efficacy of the artificial pancreas improved during the study period, with time spent in the target range increasing from 36 per cent on day one to more than 60 per cent by the twentieth day.

All participants who responded to a survey said they would recommend it to others, with 92 per cent reporting that they spent less time managing their diabetes and 87 per cent confirming they were less worried about their blood sugar levels when using it, improving peace of mind. There was also less need for finger-prick blood sugar check.

Downsides mentioned were discomfort wearing the insulin pump and the need to carry the smartphone around.

Senior author Professor Roman Hovorka, from the Wellcome-MRC Institute of Metabolic Science, said: “Not only did the artificial pancreas increase the amount of time patients spent within the target range for the blood sugar levels, it also gave the users peace of mind. They were able to spend less time having to focus on managing their condition and worrying about their blood sugar levels, and more time getting on with their lives.”

The team is now trialling the artificial pancreas for outpatient use in people living with type 2 diabetes who do not need dialysis and they are exploring the system in complex medical situations such as perioperative care.

Dr Boughton added: “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.”

Dr Lia Bally, who co-led the study in Bern, said: “The artificial pancreas has the potential to become a key feature of integrated personalised care for people with complex medical needs.”

The research, published in Nature Medicine, was supported by the NIHR Cambridge Biomedical Research Centre, The Novo Nordisk UK Research Foundation, Swiss Society for Endocrinology and Diabetes, and Swiss Diabetes Foundation and Swiss Kidney Foundation.

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