The Lancet recently announced new research into the effectiveness of a closed-loop ‘artificial pancreas’.  What follows is some background on the dangers of hypoglycaemia and Paradigm Veo, the first commercially available device to mimic key elements of the human pancreas.  The device can automatically suspend insulin delivery to reduce the severity of low blood sugar, a dangerous and often frequent occurrence in diabetes management. 

The Paradigm Veo system (produced by Medtronic) combines insulin pump therapy and continuous glucose monitoring with a unique capability to automatically suspend insulin delivery temporarily if glucose levels become too low, protecting against the risk of low blood sugar (also known as hypoglycaemia) even when a person is asleep or unable to react.

  Hypoglycaemia and the ‘artificial pancreas’

Hypoglycaemia is common and can be one of the most frightening aspects of living with type 1 diabetes.  If left untreated, hypoglycaemia can cause loss of unconsciousness, seizure, coma or even death.¹ Experts estimate that the annual direct cost of treating severe hypoglycaemia could be in excess of £13 million in the UK.² 

Research indicates that on average a person with diabetes will experience more than one low blood sugar event every fortnight. Additionally, each year nearly one in 14 people with insulin-treated diabetes will experience one or more episodes of severe hypoglycaemia, which requires urgent treatment by healthcare professionals.²

A third of diabetes patients suffer from hypoglycaemia while asleep, which may impair their ability to recognise or act to prevent a serious episode.³ Around 33% of diabetes-related deaths are as a result of acute complications such as hypoglycaemia.⁴ There are currently more than 2.5 million people with diabetes in the UK, and it is estimated that 350,000 people have type 1 diabetes.^5,6

The Paradigm Veo System includes an insulin pump with continuous glucose monitoring (provided by means of a separate sensor and transmitter). The patient uses readings from the monitor in conjunction with occasional confirmatory fingerstick measurements to understand their current glucose level, and program the insulin pump to deliver the appropriate amount of insulin. Insulin combats high blood sugar, a key cause of heart disease and other long-term complications in type 1 diabetes.¹ However, if data transmitted from the sensor show that the patient’s glucose levels have dropped below a defined threshold, the insulin pump automatically suspends insulin delivery for up to two hours.  This helps to protect against potentially dangerous hypoglycaemic events. 

While some patients can experience ‘warning signs’ before a hypoglycaemic event (such as feeling shaky, sweating, tingling in the lips, going pale, heart pounding, confusion and irritability), others do not experience any warning signs at all.

References

1. Diabetes UK: http://www.diabetes.org.uk/en/Guide-to-diabetes/Complications/Short_term_complications/Hypoglycaemia/ (Accessed 23^rd April 2009)

2. Leese GP, Wang J et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes. Diabetes Care 26:1176-1180, 2003.

3. Pramming S, Thorsteinsson B et al. Nocturnal hypoglycaemia in patients receiving conventional treatment with insulin. British Medical Journal 291(1985):376-379

4. Orchard TJ. International evaluation of cause-specific mortality and IDDM. Diabetes Care 14:55-60, 1990

5. Diabetes UK: http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/ (accessed 23^rd April 2009)

6. Juvenile Diabetes Research Foundation: http://www.jdrf.org.uk/page.asp?section=25&sectionTitle=About+Type+1+Diabetes (Accessed 23^rd April 2009)

Further information:   Candice Pillips at Cohn Wolf on 0207 331 5343.  Please mention Country Doctor.

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