Artificial Pancreas Revolutionizes Management of Type 1 Diabetes

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The artificial pancreas, a technology based on artificial intelligence, represents a major breakthrough in the management of type 1 diabetes as it relieves patients from the constraints imposed by the disease, particularly those related to insulin doses. This device also allows control of the patient’s blood glucose levels 80% of the time, significantly reducing complications associated with the disease. 

The management of type 1 diabetes has never been easier since the development of the artificial pancreas, an external medical device that compensates for the lack of insulin in the body. This technology, based on artificial intelligence, has been developed by international research teams, including the Endocrinology-Diabetes department of the University Hospital of Montpellier. Led by Éric Renard, this department specializes in the development of new technologies applied to diabetes treatment.

Implemented in common practice nearly six years ago, the artificial pancreas consists of a continuous glucose monitor and an insulin pump equipped with artificial intelligence, which are interconnected through wireless communication. “Artificial intelligence determines the amount of insulin to be delivered to the patient based on the current blood glucose level and its predicted evolution,” explains Dr. Renard in an interview with Ici Beyrouth on the sidelines of a conference recently organized by the French Hospital of Levant, the Chronic Care Center, and Hôtel-Dieu de France-CHU, in collaboration with the University Hospital of Montpellier, at the initiative of Elie Abboud, a former hospital practitioner in Narbonne and a former member of parliament for Hérault. “This device represents a revolution since individuals with type 1 diabetes are significantly freed from the constraints imposed by the management of their disease, such as calculating insulin doses, which make the daily treatment burdensome,” he rejoices.

Autoimmune Disease

Type 1 diabetes, formerly known as insulin-dependent diabetes, is an autoimmune disease, meaning that the immune system attacks the body itself. In this case, the T lymphocytes, which are cells of the immune system, perceive the beta cells of the pancreas, which produce insulin, as foreign. As a result, they attack these cells, leading to a complete deficiency of the insulin needed to regulate blood glucose levels.

According to the World Health Organization and the International Diabetes Federation, 10% of diabetics worldwide have type 1 diabetes. In Lebanon, it is estimated to affect 1.3% of people with diabetes, according to a national study conducted in 2016 by Salim Adib, a professor of epidemiology and public health at the American University of Beirut, in collaboration with Ibrahim Bou-Orm, the coordinator of activities for non-communicable diseases at the Ministry of Public Health.

Type 1 diabetes is the most challenging form of diabetes to treat since the patient’s insulin requirements continuously change throughout the day due to emotions, exercise, food intake, and other factors. “With the conventional insulin pump, the patient guides the device,” explains Dr. Renard. “Based on the blood glucose measurement from a finger prick or provided by a sensor, the patient needs to instruct the pump on the amount of insulin to deliver. However, with the artificial pancreas, the calculation is done automatically. The patient still needs to input the quantity of carbohydrates he will consume or the physical activity he plans to engage in so that the system can adjust accordingly. If the patient makes an error, the artificial pancreas will deliver a higher or lower amount of insulin, depending on the situation, to prevent the patient from experiencing hypoglycemia. This allows the patient to maintain normal blood glucose levels for 80% of the time, approaching those of individuals without diabetes. Therefore, with the artificial pancreas, the patient has fewer decisions to make, reducing the mental burden associated with managing this disease. The system takes care of automatic corrections and calculations.”

Positive Feedback

In France, nearly 12,000 patients are using the artificial pancreas, while 60,000 others are using insulin pumps. “The feedback has been very positive,” says Dr. Renard. “This system has allowed patients to avoid nocturnal hypoglycemia, which remains a major concern for patients and their parents.”

When it comes to diabetes complications, Dr. Renard says that “we don’t have long-term results yet to know for sure, but we know that if diabetes is controlled for 80% of the time, the patient has very little risk of developing retinal, renal, or cardiac complications. Patients who are equipped with an artificial pancreas report that within twenty-four hours of using this technology, their blood glucose levels automatically approach normal ranges. Therefore, given the performance achieved, we should be able to prevent the complications of the disease.”

The team in Montpellier, along with those in Paris-Robert Debré, Tours, and Angers, are following a cohort of 120 children who have been using the artificial pancreas for nearly five years. “When these children were included in the study, they were between 6 and 12 years old. Today, they are adolescents, and their blood glucose levels are well controlled,” notes Dr. Renard. “It’s extraordinary because we know that during the turbulent teenage years, blood glucose is difficult to control. Yet, these young individuals have not experienced severe hypoglycemia. They have never been hospitalized again, nor have they had episodes of ketosis (which can lead to diabetic coma due to the presence of high levels of ketone bodies produced by the body when it lacks sufficient carbohydrate reserves; Editor’s note).”

Implementation of the Technology in Lebanon

The meeting held in Beirut aimed to introduce this technology in Lebanon. “Teams from Hôtel-Dieu de France, the Chronic Care Center, and Hôpital français du Levant, consisting of adult and pediatric physicians, nurses, and dietitians, will be trained for this purpose in our department in Montpellier and will receive an interuniversity diploma,” explains Dr. Renard. In Lebanon, individuals with type 1 diabetes could be equipped with this system. However, there is a catch: the cost of this technology. “The price of the artificial pancreas is slightly higher than that of an insulin pump,” notes Dr. Renard. “So, in principle, patients with a pump have access to it.”

According to Elie Abboud, “the cost should not be an obstacle; it should be the solution.” “We need to prove to insurers that by covering the expenses of this artificial pancreas, they will save money since the morbidity (retinal, renal, cardiac damage, etc.) associated with the disease will be avoided,” he emphasizes. “I will do everything in my power to ensure that Lebanese patients benefit from this technology.”

Currently, the artificial pancreas is limited to the treatment of type 1 diabetes, but its use may be expanded to any form of diabetes treated with insulin.