Sunday, July 20, 2014

Closing the Loop

These has been lots of talk recently about the closed-loop (artificial and bionic pancreas) trials.  Many of my awesome friends have asked me about it, posted about it, etc.  It is a very exciting development that I have been following for a while.  I do have some concerns, things that will need to be addressed before it becomes available to all type 1s. 

First, the artificial and bionic pancreas both require 3 sites on the body.  2 pump sites, similar to the one shown in the first picture, and 1 CGM (Dexcom) sensor, like the second picture.

Having even one thing attached to the body can be a hassle, much less 3.  The pump sites will both be attached to plastic tubing.  Each one is attached to a separate pump. One pump delivers insulin, the other delivers glucagon. Pump sites can cause scar tissue.  Areas with scar tissue can no longer be used, at least not for a period of time to see if they heal. This is especially a concern for children, who have much less surface area for inserting all these devices. All 3 devices are connected to a smartphone that basically controls the insulin and glucagon delivery.

Another issue is that glucagon is not a stable solution.  At the present time, it must be replaced daily in the glucagon pump.  That would be a huge expense in regular use.  Researchers are working on stable forms of glucagon, so hopefully this issue will be solved soon.

At present, CGM (Dexcom) technology is not advanced enough to make dosing decisions.  We use Dexcom as a tool to view trends, but never inject insulin based on the number Dex gives.  A fingerstick test on a blood glucose meter is needed to confirm.  In closed-loop systems, the number from Dex is used for the system to make the decision.  A more accurate Dexcom is currently being worked on, from what I understand.  Until Dex is reliable enough for dosing insulin it really can't be used outside of clinical trials.

Insurance companies are also putting language into their policies to specifically exclude closed-loop systems.  Without insurance coverage, most people will not be able to afford the systems when they do become available.  Some companies do not cover pumps and CGMs, either. There are still many people that do not have the option to use the current technology, much less what is on the horizon.

One important thing to keep in mind...the closed-loop systems are in trials right now.  They have not been approved yet.  The people that are doing the trials are amazing.  They are volunteering their bodies to advance the technologies that will hopefully improve the lives of all those with type 1 diabetes.  Heros in my book, especially the children that have just recently been approved for these trials. Heros like Elise, who just started the bionic pancreas trial.  At 6, she is the youngest person to trial a closed-loop system.  

Don't misunderstand me. These clinical trials are hugely important. This will be life-changing for people with type 1 diabetes.  We're just not quite as far along as I think the media sometimes implies.  There are still some big obstacles to overcome before we get there. I am so thankful for the people that are working tirelessly to make this happen.  We'll have an even better tool to KDA. Until there's a cure.

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