The Islet, Bionic Pancreas

I attended the Friends For Life type 1 conference in Orlando in 2015. Dr. Ed Damiano was a very dynamic speaker that year. He has done something wonderful for his T1 son, and for all of us. Beta Bionics is the origin of the Bionic Pancreas, called the Islet. Here are the purposes of this creation. The Islet is presently an experimental device, but I can see a very good future for it.

"To provide and protect our turnkey solutions for safe and effective autonomous glycemic control;

To bring our technology to as many people living with diabetes or other conditions of glycemic dysregulation as possible in an expeditious and responsible manner;

To continue to innovate and to offer the latest advances as expeditiously and responsibly as possible; and

To act in the best possible interest of the community of people living with diabetes or other conditions of glycemic dysregulation in connection with fulfilling our corporate functions."

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I’ve been hearing about “artificial pancreases” for decades. Wake me when there is an actual one.

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This does look very good.
It is not vaporware. It is real and has already been in multiple clinical trials.
Anything takes time but this seems very solid.

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I think the term “artificial pancreas” is a misnomer. None of the projects in use or even under development can approximate the full function of a human pancreas which secretes multiple hormones and digestive enzymes. A better descriptive term is “automated insulin dosing systems.” The Islet Bionic Pancreas is an exception in that developers hope to deliver glucagon as well as insulin to help patients control their glucose metabolism.

I wouldn’t write off these not-fully-automated systems so quickly. I’ve been using the do-it-yourself automated insulin dosing system, Loop, for over a year now. It has added to my quality of life in that it takes less effort and delivers better results. The value of confidently sleeping through the night without fear of hypos is large for me.

What I’m trying to say is that the incremental baby steps that developers are making with these efforts will benefit all of us in the years ahead. I understand the frustration of seeing all the ink used to tout a commercial system that seems stuck on the one-to-two-years-out time horizon. These systems will arrive. And when they do, they will not be perfect but they’ll be a significant step in the right direction. Future iterations will get better.

I hear you, though. These developments seem to be taking forever. I am grateful for the DIY movement with the OpenAPS, Loop, and AndroidAPS offerings. These systems are here today and at least 500 people around the world are enjoying the benefits they produce. I have no plans to terminate my Loop therapy. It’s the best technological improvement I can adopt today.

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The only thing that matters to me is what is available that I can get an Rx for, that is covered by insurance, and that is better than my current regimen. The rest is just for reading, if one is interested in the (possible) future. I’m interested in the NOW. :slight_smile:

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Understood.
As well as the “buy now”, I also like to read about the “almost” now. For me, this means things that are developed but need to be integrated, tested, trialed, tweaked and approved and marketed.

Things that still need R&D - those I have trouble getting excited over as I see them as over the horizon.

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If you don’t choose to join the impatient “we are not waiting” movement, then your best friend is patience.

A solid viable automated system will arrive but I think it will take longer than you expect or at least it will seem to take longer.

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I expect to be long dead before a TRUE, affordable (read: insurance covers ALL the cost) “artificial pancreas” or other “cure” for T1 is on the market. I’m not being dramatic–I’m totally serious.

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should “patience” include the patience of listening to multiple decades of promises that a cure or artificial pancreas is just a few years into the future?

I don’t consider any of these systems a cure. They are simply improved treatments. Nothing to sneeze at, but still not a cure.

I remember reading descriptions of CGM technology back in the '90s. I felt the same frustration as I wondered why it was taking so long. I got my first Dexcom CGM in 2009. Even though it was not as accurate as today’s CGMs, it was a big deal to me. It improved my health and safety immeasurably.

Terry, I bet you remember the ill-fated Glucowatch. It caused skin irritation. I can’t remember what all else was wrong with it.

My issue is with the breathless articles that manage somehow, and incorrectly, to place the word “cure” into their poorly researched articles.

Don’t believe me? google “diabetes cure”.

Yes, I remember the Glucowatch. It used a transdermal patch to display blood glucose. It never panned out. Science and technology development has always been built on failures.

Was it the skin irritation alone that doomed it? For the life of me, that’s all I remember.

Using the word “cure” incorrectly in the popular press is journalistic malpractice. The larger public doesn’t seem to care and the inaccurate clickbait headlines continue to produce value for the publishers.

When I was first diagnosed with diabetes, the Professor of Endocrinology from Harvard Medical School who was teaching new patients at the Joslin Clinic in Boston told us that strict blood sugar control would be very difficult to achieve, but we should do our best since “within five years” an artificial pancreas would be available which would control glucose levels automatically, so we should try to prevent any damage developing until then. The problem was, that was in 1966, and I have been hearing the usual ‘five to ten years’ cant ever since. If you gave medical science a diagram and a working model of a door knob, it would take ten to twenty thousand years for them to develop a way to open doors, since they are so glacially slow in their ability to make progress. Physics operates via decisive experiments which can change the field overnight, but in medicine no one believes anything until a few decades go by, and even after it has been abundantly proven to work, many people still oppose it. Here, even if everything goes perfectly, we are looking at 16 years to approval under the tyranny of the FDA (the foot-dragging administration).

Even if approved, the published results show this device will be far from perfect, since it does not provide full normalization of blood sugar levels and even still permits hypoglycemic episodes to occur. Also, we know that the complications are in part caused by genes inherited along with the genes that predispose people to develop the initial autoimmune attack on the pancreas which produces diabetes, and also by the continuing autoimmunity as it affects other parts of the body after the initial destruction of the pancreatic beta cells, so even perfect blood sugar control would not entirely prevent the complications from developing.

For the published results, see: Steven Russell, Edward Damiano, et al., “Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes,” New England Journal of Medicine, 371: 313-325 (2014):
Results
Among the adults, the mean plasma glucose level over the 5-day bionic-pancreas period was 138 mg per deciliter (7.7 mmol per liter), and the mean percentage of time with a low glucose level (<70 mg per deciliter [3.9 mmol per liter]) was 4.8%. After 1 day of automatic adaptation by the bionic pancreas, the mean (±SD) glucose level on continuous monitoring was lower than the mean level during the control period (133±13 vs. 159±30 mg per deciliter [7.4±0.7 vs. 8.8±1.7 mmol per liter], P<0.001) and the percentage of time with a low glucose reading was lower (4.1% vs. 7.3%, P=0.01). Among the adolescents, the mean plasma glucose level was also lower during the bionic-pancreas period than during the control period (138±18 vs. 157±27 mg per deciliter [7.7±1.0 vs. 8.7±1.5 mmol per liter], P=0.004), but the percentage of time with a low plasma glucose reading was similar during the two periods (6.1% and 7.6%, respectively; P=0.23). The mean frequency of interventions for hypoglycemia among the adolescents was lower during the bionic-pancreas period than during the control period (one per 1.6 days vs. one per 0.8 days, P<0.001).
Conclusions
As compared with an insulin pump, a wearable, automated, bihormonal, bionic pancreas improved mean glycemic levels, with less frequent hypoglycemic episodes, among both adults and adolescents with type 1 diabetes mellitus. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01762059 and NCT01833988.)

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In the genes versus glycemia debate with regard to developing secondary complications, I believe that good control will reduce the risk of complications. There is no absolute guarantee, like many things in life.

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See, the problem for me is, until we get both super fast acting insulin and super reliable and long lasting infusion technology, the “artificial pancreas” devices will never be close to the level of control of an actual pancreas. For people like me who’s body takes a lot longer for insulin to start acting, and who suffers from very unreliable infusion that often changes day to day and sometimes suddenly stops working, these devices will still include a large amount of manual intervention.

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Yep. Also the lag-time with CGM’s reading interstitial fluid instead of blood.

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