Q: Now that the artificial pancreas has been approved, I have so many questions… How does it work? Is it a good fit for my child? Will we still need to count carbs and do finger sticks?
A: A “closed-loop” or “artificial pancreas” system is a series of devices that work together to automatically deliver more or less insulin in response to rising or falling blood sugar. Closed-loop systems represent a milestone in type 1 diabetes care that families have been eagerly awaiting for several years. The first system was approved by the FDA in October 2016 and is expected to be available to patients in spring 2017.
The essential components of a closed-loop system include: 1) a continuous glucose monitor (CGM) which tracks the blood sugar level and trend (whether it’s heading up or down) in real time via a small sensor in the interstitial fluid under the skin, 2) an algorithm (or formula) that processes the information from the CGM to command an increase or decrease in insulin delivery, and 3) an insulin pump which delivers the insulin beneath the skin. The CGM communicates with the insulin pump wirelessly to automate insulin delivery.
Many parents want to know when their child can get one. In answer to this, be aware that the closed-loop system has been initially approved for people 14 years and older with type 1 diabetes. There are studies currently under way investigating the use of this system in children ages 7 to 13, so FDA approval for that age group may follow. The device cannot be used in patients receiving less than eight total units of insulin per day.
The closed-loop artificial pancreas system has the potential to be transformative in managing diabetes, and should make life with diabetes a lot simpler. However, it will not be a cure for diabetes, as patients will still rely on external devices to give insulin. Families will still need to count and enter carbohydrates to give insulin before snacks and meals. The CGM will still require blood sugar checks by finger stick at least twice daily for calibration. There may still be high blood sugars after meals, and the potential for low blood sugars, but they should occur far less frequently and not last as long due to automatic adjustments in insulin delivery.
Perhaps the best part of the closed-loop system may be its ability to help keep blood sugar in range overnight. Can you imagine being able to sleep through the night while significantly reducing your worries about your child going too high or low? Can you imagine starting the day with a blood sugar around 100 to 140 most mornings? This is what the closed-loop system may help bring about.
I’m incredibly excited that the long-awaited closed-loop artificial pancreas system will finally be available. I anticipate that in the next three years, several different closed-loop systems may be available with various CGM, algorithm, and insulin pump combinations. Most of all, I’m thrilled that the burden of managing blood sugar will be lightened, so that children can even more easily thrive with type 1 diabetes.
—Daniel DeSalvo, M.D., is a pediatric endocrinologist at Texas Children’s Hospital and assistant professor at Baylor College of Medicine.
How Other Parents Deal
“We have followed the progress of the artificial pancreas with eager anticipation, and it’s still almost a somebody-pinch-me (but please don’t, because this is too good) moment for us, to think that our 15-year-old daughter will have the ability to use this amazing technology. It’s not a cure, but it is an answer to prayers that our daughter’s life with diabetes — now almost a decade since diagnosis — could finally be a little easier.”
—Sarah G., Syracuse, New York
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.