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Does the Bionic Man dream of an Electric Pancreas?


Diabetes can be torture; between the pokes and pins, the special diet, and constant monitoring, diabetes can be a special brand of hell [which is right next to the people who talk in movies]. Insulin pumps can help ease that pain, but science has introduced a piece of technology that would make the bionic man proud.

Enter the bionic pancreas, sure it isn’t as sexy as, say Robocop or even the Bionic Man, but it is still a pretty neat little leap forward. In fact a new study out shows that people with type 1 diabetes who used a bionic pancreas, instead of manually monitoring glucose using finger stick tests and delivering insulin using a pump, were more likely to have blood glucose levels consistently within the normal range. They had fewer dangerous lows or highs.

The researchers — at Boston University and Massachusetts General Hospital — say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type 1 diabetes  can walk what feels like an endless tightrope. All because their pancreas doesn’t make the hormone insulin, their blood glucose levels can veer dangerously high or low. As if that wasn’t bad enough, several times a day they must use those annoying finger stick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump [which is only slightly better].

In two scenarios, the researchers tested the bihormonal bionic pancreas, which uses a removable tiny sensor located in a thin needle inserted under the skin which automatically monitors real time glucose levels in tissue fluid and then provides insulin and its counteracting “evil twin” hormone, glucagon, via two automatic pumps.

In one scenario, 20 adults wore this device combination and carried a cell phone-sized wireless monitor around Boston for five days, unrestricted in their activities. In the other, 32 youth wore the device combination for five days at a camp for children with type 1 diabetes. Both groups were also monitored for five days wearing their own conventional pumps that deliver insulin to give a baseline for comparison.

“The bionic pancreas system reduced the average blood glucose to levels that have been shown to dramatically reduce the risk of diabetic complications,” said co-first author Steven Russell, M.D., Ph.D., assistant professor of medicine at Massachusetts General Hospital. “This is tremendously difficult with currently available technology, and so most people with diabetes are unable to achieve these levels.”

The researchers found about 37 percent fewer interventions for low blood glucose [also called hypoglycemia] and a more than twofold reduction in the time in hypoglycemia in adults using the bionic pancreas than with the manual pump. What was more interesting, for adolescents using that badass bionic pancreas, results showed more than a twofold reduction in the need for interventions for hypoglycemia. As well, both groups had significant improvements in glucose levels with the bionic pancreas, particularly during the night.

“A cure is always the end goal,” said Ed Damiano, Ph.D., the paper’s senior author, an associate professor of biomedical engineering at Boston University. “As that goal remains elusive, a truly automated technology, which can consistently and relentlessly keep people healthy and safe from harm of hypoglycemia, would lift an enormous emotional and practical burden from the shoulders of people with type 1 diabetes, including my child and so many others.”

A good example of what the pancreas does, think of a thermostat, it helps control a home’s temperature. A normal pancreas senses blood glucose levels and adjusts the hormones that control it [insulin and glucagon]. People with type 1 diabetes, whose pancreas produces little or no insulin, have been using the equivalent of a manual thermostat, needing constant checking and adjustment.

But we live in a world where we don’t like manual anything, so a bionic pancreas – like the one used in these studies – would function more like an automated thermostat, automatically monitoring blood glucose and delivering insulin or glucagon when needed to keep glucose within the normal range. These bionic pancreas devices could even be monitored remotely by the patient’s medical provider or parent to make sure that it is functioning properly and doing it’s job.

So what’s next? Well larger trials of course, if all goes well, then hopefully these will be coming to the market and subsequently to the rescue for those who really need them.

Sure it isn’t terminator technology– cyberdyne won’t be knocking on your door anytime soon– and it may be a far cry from a cyborg, but you have to admit that it is a pretty badass piece of tech.

Already know if androids dream of electric sheep? Then you probably want the full study —here!

Steven J. Russell, M.D., Ph.D., Firas H. El-Khatib, Ph.D., Manasi Sinha, M.D., M.P.H., Kendra L. Magyar, M.S.N., N.P., Katherine McKeon, M.Eng., Laura G. Goergen, B.S.N., R.N., Courtney Balliro, B.S.N, R.N., Mallory A. Hillard, B.S., David M. Nathan, M.D. (2014). Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes New England Journal of Medicine : 10.1056/NEJMoa1314474

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