World-first artificial pancreas

Diabetes researcher Professor Timothy Jones is working to make the world’s first artificial pancreas a reality. He talks to Andrew Bracey.

“NOT that I’d want it at all, but if I were going to I’d rather have diabetes now [than 20 years ago],” Professor Timothy Jones says.

With available treatments and medical technology continuing to improve year on year, the sentiment may be applicable to many conditions. 

But the point made by Professor Jones – a clinical professor at the University of WA and head of the diabetes department at Princess Margaret Hospital in Perth – might resonate with those living with diabetes as he leads an Australian trial of pioneering technology that he hopes will eventually lead to the availability of an artificial pancreas.

The project is part of an international collaboration, but his team is the first in the world to be trialling a portable version of a glucose monitoring device.

Using already developed technology data from a sensor placed under the patient’s skin, it relays blood glucose readings back to a smartphone device – worn or carried by the patient – which is programmed with an algorithm, which then sends a command to an insulin pump telling it how much insulin to administer.

“For the last 10 years we have had CGM or Continuous Glucose Monitoring systems available – there are little electrodes that go under the skin and continuously measure the glucose levels in the tissues under the skin which reflects the blood glucose levels,” says Professor Jones.

“So when they became available there was a renewed interest in trying to develop an artificial delivery system so that the patient doesn’t have to think about what their blood glucose level is doing.

“There is a large burden of care trying to manage that – so it is about trying to reduce that burden.”

The system, currently being tested by Professor Jones and his team, has proven to be feasible in the hospital setting so the next goal, he says, is to have the devices available for people “while they’re walking around out of the hospital”. 

“Obviously if you have a computer algorithm delivering the insulin the safety concerns there are obvious if you use too much.

“The next set of studies will be using it for three days in a row and during the day allowing the patient to walk around with the system on, using what we call a ‘treat to range algorithm’.

“So if your blood glucose level starts to go too low it switches off the insulin and if it goes too high on a pre-set level then it will give you a little extra insulin so it keeps you in a range… during the day.

“[It then switches to] a fully closed loop where it actually gives you a set level overnight.”

During this phase of research, patients will be asked to do things including exercise or missing some insulin doses during the day in order to “stretch” the system and test its capacity.

“[We need to] see if it handles the things that happen in everyday life,” says Professor Jones.

“The next step will be a system that actually switches your insulin off when it predicts your [blood glucose level is] going low. So you’re not actually low but the computer is saying based on past experience and data, this person is going to have a hypoglycaemic episode in the next 40 minutes so I’m going to switch off the insulin to stop it.”

While the progress toward the ultimate goal of an intelligent, artificial pancreas continues to make the possibility of such a device increasingly real, after 20 years of research in the field Professor Jones remains hesitant to make time-based predictions as to when these goals may be reached.

“It is incremental – this is a world first in that it is the first system that actually is portable,” he says.

“It is another step to getting them in the outpatient or at home setting so it is exciting in that sense.

“The goal is that one day [the GP] can just say to the patient: ‘Okay, you have diabetes, but just wear this or put this on and though you have to look after it you will be able to get on with your life much more easily’.

“Diabetes is one of the commonest chronic diseases in children… so to try and help those children and their families is a big driving factor for me and it is an area that has moved and research is active – you can make a difference.”