So I am curious - many people are interested in seeing what the artificial pancreas can do, but are you ready to trust it with your well-being?
I wrote a short post about it on the JDCA blog:
http://jdca2025.wordpress.com/2011/11/29/the-artifical-pancreas-are-you-ready-to-trust-it/
But I wanted to get people's opinions on here as well. How do you feel about the AP, and to what degree are you ready to trust it?
Well im ready for any kind of cure, so long as its confirmed to be efficient in its function. so far the only "cure" is a pancreas transplant, which isnt quite a good cure. All the other discussed cures have been under research for 10 years or so without apparent progress, basically giving us an illusion or false hope. I look forward more to its actual progress and availability, so at least it looks like we're actually getting somewhere. Kind of like depriving someone of water for a week, he/she wouldnt worry much about the quality of the water. But if there are obvious health risks in this artificial pancreas i wouldnt take it. but then again for it to be available worldwide it should already be pretty good anyway. the only problem is that its probably going to be extreeeemeeely expensive.
I don't believe that the current state of the cgms is good enough for an ap to work very well. I know some folks do well with it, but mine was grossly inaccurate and I couldn't trust it at all. I wouldn't trust it to give a good enough reading to a pump for the pump to dose me. I'd rather be the one giving the dosage. For the time being anyway.
Cora
I agree, I like the CGM ok but it's not accurate enough to depend on for data adjustments or safety purposes. And, if I had a really accurate CGM/ pokeless BG gizmo of some sort, I am not thinking I'd need an artificial pancreas anyway?
I was never interested in it from the day I heard of it. Even if it works its another angle to try and profit big money off suffering people. Plus the thought of walking around with tubes and crap hanging off me is totally unappealing. I'd take one for free and sell it on ebay or something. In fact I'd rather just have a non invasive glucose meter and stick with my shots. Nothing would be greater then the fruition of BCG to reverse this SOB but my next hope is with Viacyte.com. They are working with stemcells that will be put into a retrievable envelope where no anti-rejection drugs are needed. They are anticipating human trials sometime in 2013. I'll be first in line for that sucker.
Here is a little video clip
same, my CGM is way off. It always tells me i spike higher after i eat than i really do- I don't want insulin based upon that. Additionally i wouldn't trust an artificial pacreas that doesn't have glucagon in it. Having said that though, the A.P has been showing decent results in trials it seems so i'm sure it's worth trying. I'm sure the scientists and engineer recognize and acknowledge the margin of error that CGMS have.
I *sure* as hell wouldn't want an artificial pancreas *armed* with glucagon either. I had a bunch of days last summer where it would get "stuck" in the 40s. My BG was sort of running lower, perhaps because I was running more than I had previously, but it would just be 40 40 40 40 *BELOW 40* and I'd be like "dude, it's 70, I'll try calibrating*" and it was sort of useless. I'd pretty much plan sloth after longer runs but I would have been annoyed if a bunch of automated glucagon interfered with my post running junk-food binging. Or sushi binging. Or any of the other binging...heh heh heh...
I am not sure if I would or not, but from what I've read it would give me better control than I'm able to get right now which I would be fine with. I don't think I would expect perfect control with it, but fewer/less extreme highs and lows than I'm currently getting, with less work on my part, would be great.
I'd never trust an AP & it's not a "cure." Current CGMS aren't accurate & pumps aren't reliable. It's a phenomenal waste of money I'd rather see spent elsewhere.
If & when it comes to market, how many could even afford an AP? What small percentage of diabetics would benefit, if indeed there are benefits? There are many of us who can't afford insulin & strips.
The idea of the AP might be this: we are ready with the system so please dear pharma deliver sensors reliable enough to control the closed loop. The problem is that the incentive to deliver such a system is already high enough. A system capable of detecting lows in a statistically reliable way would be the seller on the market. However the reality looks much different and with the current state of sensors you can be pretty sure that the AP will have no chance to pass EU or FDA clearance. Of course I would not trust a system that is designed to inject me insulin and glucagon based on pure sensor data. Because of that the FDA has already decided that the first AP generation will have to ask for permission by the user before it will take any action.
I agree with Holger. The problem with a full closed look system is that key elements are highly unreliable and have failures at such a high rate that users can be exposed to dangerous conditions on a regular basis. This is a recipe for the FDA to not approve it. We all know how quickly our blood sugars can go south when a site fails. What happens with a system that is an order of magnitude more complex than an insulin pump. And people want to rush this into use on kids?
I agree, resources should be put into the development and refinement, but there are serious risks involved.
I, for one, will be waiting. I've achieved fairly decent results with pumping and finger sticks. When I tried to use CGMs, even the much loved Dexcom, I got too many wacky/unreliable results. Now, I DO think that the low-glucose suspend feature is much needed, and that I would use. But I would NOT want my pump making insulin delivery decisions off a CGM at this time. The CGM would have to be far more reliable and I will be waiting to see the improvements in the CGMs before jumping onto any artificial pancreas. While I think the artificial pancreas is a great idea, the technology just isn't there yet for me to feel comfortable with it.
Some things I would like to see include more accurate glucometers, better CGMS, the low-glucose suspend system, and a wider availability of pumps to people who cannot otherwise afford them. I think research is great, but I have a hard time dumping money into something like the AP when there are SO MANY people on here who can barely afford insulin and test strips (i.e., the bare necessities for surivival when you're a type 1). We need to address that problem first.
I am not willing to trust an artificial pancreas with my knowledge of current technology. There would have to be more exact equipment (meter, CGM, etc.) and some reliable trials for me even to consider an artificial pancreas. I do not believe that an AP could control my T1 better than I can at this point in time.
I feel that this is more of a legal hurdle than one bound by the limits of technology.
The CGMs that we have today are possibly not what is the best available, but rather what needs to run it's course to gain back profits before they launch revision 2, and then 3.... As gross as that is when it's medical products, a company is in it for money, not charity and they often have several generations in development that are unknown.
If we can presume for the sake of argument that they have a superior product that reacts faster and screws up less, then yes, of course I'd trust it to automate. It's an uneasy step, but an inevitable one.
Would a pump manufacturer be prepared to launch that artificial pancreas knowing it could theoretically malfunction and empty 200 units into someone? Probably not without you signing away some serious rights.
I am assuming it would not be all that different in price from current pumps and CGM, and there are many out there who are able to afford (or have insurance cover) both of those.
I wouldn't trust any product that is "rushed through" to the market. Look how bad software turns out when companies try to release it before it's really ready! So I don't think something like this should be rushed at all. I think it should wait until CGMs are more reliable (I haven't used one so don't know how reliable/unreliable they are) and perhaps insulins are faster-acting than they are now.
I also personally would still test my blood sugar throughout the day. I don't think I would view the AP as a cure, just something that could make day-to-day life a bit easier. But then, I am also currently feeling like my diabetes makes no sense so maybe my attitude would change to a resounding "no" like everyone else when things are making more sense to me.
Hmm. People raise some good points. I think that in it's current state it really will be hard for many to trust it - we just don't know that much about it or how safe it is.
Secondly, I agree that if it still falls short from making a big impact on people's lives and allowing us to live a cure-like lifestyle (having tubes and wires attached to your body, like someone suggested, would not be that cool with me either) we can't allow that to discourage us from searching for a better cure.
Like I said even if it worked and was safe its still not a cure. Its just a machine that will better regulate our levels then we could do on our own. I doubt it would ever get approval unless it proved fool proof which will be many years of testing. So if its ever available it's likely going to be safe to use. Basically with diabetes you either fix it right or you don't do anything. We already have an far from perfect therapy with risk and we don't need another. I think the most realistic thing in the future will be what Viacyte is working on. We already know islet transplants can be effective. The problem is still an endless supply of cells to treat everyone and protection against our immune systems. Viacyte is working with stemcells and may be able to offer an endless supply. Otherwise the cells must come from pigs. There are a few company's working with different ways of protecting the cells and eventually I believe they will get it done. I just think the big problem will be the cost of treatment. If we could only be so lucky and have to shoot up with the BCG vaccination a few times a year to keep it at bay that would be the godsend.
I would definitely NOT be interested in a AP. If it is successful and accurately functions for at least 5 years, then I might consider it. I like to control my own insulin administration and not leave it to another "machine". That is why I don't have a pump.
^ Me too. I never had interest in the pump either. Not because of fear of it screwing up but I don't want crap hanging off my body..when I sleep, in the shower....etc. It seems like more of a hassle then its worth but to each his own. On top of that the cost of more supplies.I believe you can get the same control with shots but if you like to nosh food randomly your likely gonna be taking 6 to 8 shots a day. On a good sugar day I am usually at about 5 shots. Sometimes I take a shot for a meal and then 10 minutes later I decide I want more crap so I load it up again and eat my cake.