With Dr Kylie McLachlan
Your pancreas probably doesn’t run on radio frequency. But the one next to you just might. Scientists are one step closer to creating an “artificial pancreas”, and it’s now available to diabetes patients in Australia.
It’s called a hybrid closed-loop insulin pump, and it has the potential to revolutionise daily life for people with diabetes around the world. We spoke to Dr Kylie McLachlan, consulting endocrinologist with St Vincent’s Private Hospital Melbourne, to find out about this promising new development in the treatment of type 1 diabetes.
In recent years, continuous glucose monitors have removed the burden of finger-pricking and constant manual blood sugar checking by measuring glucose levels every 5 minutes through a tiny needle under the skin. Patients then program insulin deliveries through a separate device—an insulin pump that also works via a small needle under the skin.
The aim of all this monitoring and pumping is simple: avoid hypoglycaemia. ‘Hypo’, as it’s known by the diabetes community, happens when there is too much insulin and not enough glucose (sugar) in the blood. “Patients start to feel weak, get cold sweats, and they can even black out,” Dr McLachlan explains. With the manual insulin pumps in use today, patients are only within their target blood glucose range between 40-50% of the time—a long way away from the 70% ideal. With the average type 1 diabetes patient experiencing symptomatic hypoglycaemia twice a week, it’s a problem the medical world is intent on solving.
Closing the loop: a new kind of pump
In a step closer to creating an ‘artificial pancreas’, scientists have recently developed algorithms to connect glucose monitors with insulin pumps, allowing monitors to signal insulin doses to pump in real time based on blood glucose levels, essentially mimicking the function of the human pancreas.
It’s called a hybrid ‘closed-loop’ pump because it partially bridges the human gap between insulin monitoring and delivery. A Glucose sensor placed under the skin transmits glucose data to the connected transmitter (collectively, these parts make up the ‘Continuous glucose monitoring system’), which forwards the data via radio frequency, to the insulin pump every 5 minutes. The pump delivers (or withholds) insulin automatically, through the infusion site under the patient’s skin.
But Dr McLachlan cautions that the new system is not entirely set-and-forget. Rather, it takes care of what is called basal insulin delivery. “Patients still have to deliver a manual bolus (extra shot) at mealtimes.”
A new reality for diabetes patients
The system is newly available for people with diabetes, with Australia’s first patients fitted with the devices in the early months of 2019.
“Hypoglycaemia is life-threatening. It puts patients at risk of physical injury and accidents—especially car accidents,” Dr McLachlan warns. 7,380 people died of type 1 diabetes in 2015. In 2015-16, there were approximately 14,500 hospitalisations due to type 1 diabetes. “If the new system was widely adopted, we could see a decrease in hospitalisations from hypoglycaemia.”
“It’s not just about avoiding hypos, but reducing the anxiety that surrounds them. Diabetes patients live constantly in fear of hypo episodes, so that in itself would be life-changing.”
Not quite happily ever after
But the new system comes at a cost. “It costs about $50-60 a week to run, so there’s a large portion of the population who won’t be able to afford it,” Dr McLachlan explains. Though the Australian government has introduced limited subsidies, we’re a long way from making the system available for most, if not all.
Still, this is the closest we’ve been, and we can hope that government support for diabetes patients will continue to grow.
One step closer to a cure
Though the holy grail of diabetes research is an immunological cure, the second-best thing is the development of an independently functioning ’artificial pancreas’. “If we can create a device people can put on and forget about, that would be amazing,” says Dr McLachlan.
Alongside developments like islet cell transplants, the future is looking promising for those diabetes diagnoses.
Treating diabetes at St Vincent’s Private Hospital Melbourne
The Endocrinology and Diabetes department at St Vincent’s Private Hospital Melbourne is unparalleled. “There’s not many private hospitals or clinics in Melbourne that have the experience of the St Vincent’s teams, the access to the latest clinical trials, and holistic guidance from staff, including diabetes educators, podiatrists and dietitians,” says Dr McLachlan.
Type 1 diabetes is on the rise. In 2016 alone, there were 2,600 new cases of type 1 diabetes in Australia, and an estimated 6,400 children under the age of 14 are currently living with the disease. With a growing diabetic population, better treatment (and even a cure) is more important than ever.
Dr Kylie McLachlan
Dr Kylie McLachlan is an endocrinologist with an MD in gestational diabetes. Dr McLachlan works at the pituitary and diabetes clinics at St Vincent’s Hospital Melbourne, with admitting rights to St Vincent’s Private. Dr McLachlan’s focuses include pregnancy endocrine conditions, pituitary disease, diabetes and insulin pumps.
Dr McLachlan consults primarily at:
Central Melbourne Endocrinology
Suite 7, Level 1
55 Victoria Parade
Fitzroy VIC 3065
Phone: (03) 9417 6541