In 2015, we took another step forward in the pursuit of developing an artificial pancreas. We joined forces with DreaMed Diabetes, a leading developer of diabetes treatment and management solutions, to incorporate DreaMed’s MD-Logic Artificial Pancreas algorithm into Medtronic’s future closed loop systems. Professor Moshe Phillip, M.D., Chairman and Chief Scientific Officer of DreaMed Diabetes, and Director of the Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel shares the idea behind MD-Logic Artificial Pancreas algorithm, and how it has the potential to impact the daily management of people with diabetes.
Q. Why do we need a closed loop system?
A closed loop system automatically regulates glucose levels to provide people with type 1 diabetes better glucose control, dramatically reducing the daily burden of diabetes management. As doctors, we continuously strive to keep our patients in their target blood glucose and A1C range to avoid complications. Despite decades of continued advancements in therapy, too many people with diabetes are unable to control their blood glucose at target. A closed loop system can help both minimize the risk of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose). In turn, this reduces the risk of short and long term complications of diabetes while reducing the daily burden associated with management of the disease.
Q. What do you think the future holds for the artificial pancreas?
Our goal is to change the way patients manage their diabetes and reduce some of the burden. From being involved in diabetes management 24 hours a day, 7 days a week, 365 days a year, to living with diabetes without thinking about it is the ultimate goal of the artificial pancreas.
Q. What can we expect from an artificial pancreas?
- Prevent not only the percentage of hypoglycemic episodes, but also the duration and severity
- Less alarms
- Reduced glucose variability
- More protection overnight
- Increase time in control
- Better fasting glucose
- Better A1C with less effort from the patient
Q. What was the goal in developing MD-Logic Artificial Pancreas algorithm? Why did you call it MD-Logic?
Many physicians successfully take care of their patients by providing them individualized health recommendations the patient then implements into their diabetes management. So we asked ourselves, how could we take the insights from the physician and put it into an algorithm? At the same time, physicians have to calculate a variety of inputs in order to provide this advice, in computer terms what you would call “Fuzzy Logic.” We decided to combine the insights from the physician (MD) into a fuzzy logic algorithm, which we named MD-Logic. The goal behind the algorithm is to automatically regulate glucose levels for people with diabetes without the daily inputs from the patient that today’s technology requires, relieving patients from the daily burden of diabetes management.
Q. How does the algorithm work?
The algorithm links a continuous glucose monitor (CGM) with an insulin pump through computerized control algorithms. Using the patient’s CGM data, the insulin pump is directed to deliver the correct dose of insulin in order to maintain balanced blood glucose (BG). In effect, the software continuously monitors glucose levels, and defines precisely when and how to adjust insulin levels. It’s a personalized, learning system, as each patient is different and their BG changes throughout the day.
Q. With this algorithm, will people with diabetes still have to bolus before meals?
To properly bolus for food you’re about to eat, you need to know how many carbs you’re eating, and the system can’t predict that. So, there either needs to be a faster acting insulin or a better way to assess the amount of carbs you’re about to eat.
Q. Why isn’t the algorithm integrated in a dual pump (both insulin and glucagon)?
Currently, there are no long term studies on the side effects of extended use of glucagon, or studies showing a real clinical benefit of using a dual pump versus an insulin alone system. In addition, laboratory studies have indicated the continued use of glucagon can cause tachyphylaxis (a decreased response to a drug after its administration). Using a dual pump may require using higher amounts of insulin to balance out glucose levels when glucagon is administered. Lastly, glucagon can be unstable and too much of it can cause nausea and vomiting.
Q. Why did DreaMed partner with Medtronic Diabetes?
We partnered with Medtronic to go faster. DreaMed and Medtronic share a common goal of improving the lives of those living with diabetes, and a common history of leading innovations toward the closed loop. We bring the expertise of some of the first camp and in-home closed loop studies. Medtronic brings countless years of expertise in closed loop and commercializing systems. Working together, we can incorporate our algorithm into Medtronic’s next generation closed loop system, with the goal of improving the health and quality of life of people living with diabetes.
Tags: artificial pancreas
, closed loop system