A Bionic Pancreas!

451096797Anyone out there remember the TV show 'The Bionic Man'? The central premise involves a guy who is severely injured and subsequently largely rebuilt using bionic parts.  What exactly is bionic?  Wikipedia defines the term this way: Bionics (also known as bionical creativity engineering) is the application of biological methods and systems found in nature to the study and design of engineering systems and modern technology.  Rick and I discuss a bionic pancreas on PodMed this week, based on a study presented at the American Diabetes Association meeting and published in NEJM. This study's senior author is a biomedical engineer who designed an artificial pancreas to resemble a human one, using both insulin and glucagon, the two hormones primarily responsible for regulating blood sugar, to manage same.  The early results look promising indeed, if not quite yet ready for prime time (pun intended).

The paper reports the results of two five-day trials, one in adults and one in adolescents, with type 1 diabetes, who were fitted with a bionic pancreas that automatically monitored blood glucose and utilized either insulin or glucagon to achieve a desirable level with an iPhone app interface.  Previous work by the same group established that in an inpatient setting, the device was capable of managing blood glucose effectively for 48 hours.

So what about the outpatient setting, where variability in all sorts of parameters that directly and indirectly affect blood glucose are operational? Assessing the device in this setting was the intention of the current study. All subjects had previous experience with insulin pumps and glucose monitoring. The adults were resident in a hotel geographically close to the hospital, and their activities were limited to an area within three square miles of the hospital for the duration of the study.  They were also accompanied by a staff member. During the study period they could eat whatever they liked, exercise at will, and were allowed to consume 3 alcoholic drinks per day for men and 2 for women.  The adolescents were resident in a camp for people with diabetes.  For the duration of the study they ate the same meals and participated in the same activities as other campers.  Both groups had abundant data collected on blood glucose, episodes of hypoglycemia and other adverse events, and they all acted as their own controls with a five-day usual care period during which all parameters were recorded as well.

Here's what they found: the bionic pancreas was able to decrease the number of episodes of hypoglycemia in the adult population but not in the adolescents.  The authors speculate this may be due to prompt intervention in the camp setting to avoid such an outcome. Both groups saw a lower mean blood glucose level with use of the bionic pancreas compared to usual care. There were a few issues with the iPhone interface but these spontaneously resolved and infusions resumed as appropriate. The authors caution that the device may overestimate blood glucose if acetaminophen is used, and that currently available glucagon must be reconstituted daily, but Rick and I agree that this is a great proof of concept study that clearly should be ramped up. And it's cool!

Other studies this week include thrombolysis for pulmonary embolism in JAMA, exercise for depression in JAMA Internal Medicine, and mammography outcomes in the BMJ.  Until next week, y'all live well.


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