Artificial Pancreas Found Safe And Effective For Very Young Children With Type 1 Diabetes

This artificial pancreas will transform lives of children with type 1 diabetes and their families. Parents can relax and spend less time worrying about their child's blood sugar levels, particularly at night time.

Type 1 diabetes was once known as juvenile diabetes as most of the people who got it were young children. While a child could get type 1 diabetes as an infant or as a toddler or a teen, it usually appears after age 5. It happens when their pancreas -- an organ in the upper-right side of the belly -- makes little or no insulin. The condition is an autoimmune disorder wherein the immune system attacks and destroys cells that make insulin. Current devices that deliver insulin via a pump have proved successful to an extent in older children, but not in very young children.

The good news is University of Cambridge scientists have developed an artificial pancreas that is more effective at managing blood sugar levels in very young children with type 1 diabetes than current technology -- sensor-augmented pump therapy.

Management of type 1 diabetes in very young children

Children with type 1 diabetes are particularly at risk of dangerously low blood sugar levels (hypoglycaemia) and high blood sugar levels (hyperglycaemia), which have been linked to lower IQ scores and slower brain growth.

Management of glucose levels in very young children has been quite challenging due to various factors including the high variability in levels of insulin required and their unpredictable eating and activity patterns.

Current technology -- sensor-augmented pump therapy -- has proved successful to certain extent in older children, but not in very young children. Also, it requires parents to check their child's glucose levels using a monitor and then manually adjust the amount of insulin administered by the pump.

The artificial pancreas, on the other hand, uses an algorithm to determine the amount of insulin administered by a device worn by the child. Hence, parents are not required to continually monitor their child's blood sugar levels.

Image Courtesy: University of Cambridge

How the artificial pancreas works

The artificial pancreas consists of an app called CamAPS FX, a glucose monitor and insulin pump. When combined, it automatically adjusts the amount of insulin it delivers based on predicted or real-time glucose levels. It is a 'hybrid closed loop system', which means that parents or the child's carer will have to administer insulin at mealtimes, but at all other times the algorithm works by itself. So far, there are no commercially available versions of fully closed loop systems.

The CamAPS FX app is developed by Professor Roman Hovorka from the Wellcome-MRC Institute of Metabolic Science at the University of Cambridge.

He explained: "CamAPS FX makes predictions about what it thinks is likely to happen next based on past experience. It learns how much insulin the child needs per day and how it changes at different times of the day. It then uses this to adjust insulin levels to help achieve ideal blood sugar levels. Other than at mealtimes, it is fully automated, so parents do not need to continually monitor their child's blood sugar levels."

Trial proves safety and efficacy of artificial pancreas

To evaluate the safety and efficacy of the artificial pancreas, Professor Hovorka and an international team of researchers conducted a trail including 74 children with type 1 diabetes, aged one to seven years, from across seven centres in the UK and Europe. First, the children used the CamAPS FX hybrid closed-loop system for 16 weeks, and then the sensor-augmented pump therapy for 16 weeks.

When using CamAPS FX, the children spent around three-quarters of their day (71.6 per cent) in the target range for their glucose levels and spent less than a quarter (22.9 per cent) of their time with raised blood sugar levels hyperglycemia. The differences compared to the control period was almost nine percent. However, no difference was found between the two groups in the time spent in hypoglycemia.

CamAPS FX led to improvements in several measures, including hyperglycaemia and average blood sugar levels, without increasing the risk of hypos, said Dr Julia Ware, the study's first author, also from the Wellcome-MRC Institute of Metabolic Science.

With artificial pancreas, parents were able to relax and spend less time worrying about their child's blood sugar levels, particularly at night time. Hence, parents have described it as 'life-changing', Dr Ware added.

Currently, CamAPS FX can be availed through NHS trusts across the UK, including Cambridge University Hospitals NHS Foundation Trust. The team is hoping that it will soon be available even more widely.