A predictive control algorithm operated via an Android smartphone which acts as an artificial pancreas system has proven successful, eliminating manual insulin dosing and improving glycaemic control for adults with type 1 diabetes.
Baker Heart and Diabetes Institute researchers alongside New Zealand collaborators have completed a three-month randomised multi-centre trial of the open-source app, AndroidAPS, thanks to funding from Breakthrough T1D. A 12-month extension of the trial is now underway.
Achieving time in range 70 per cent of the time is difficult for people living with type 1 diabetes. The results showed participants were achieving close to this using this automated system (66–69%). This successful study comes amid a growing movement of DIY closed-loop technology. This is the first study to show acceptable glucose control in the fully closed loop space maintained over a 3-month period. The exciting findings have just been presented at the Advanced Technology, Therapeutics and Diabetes Conference in Amsterdam.
People with type 1 diabetes try to self-manage the complex interplay of lifestyle, diet and insulin dosing. It is estimated they need to make over 100 decisions per day to stay within range with their blood sugar, and improve glycaemic control. The AndroidAPS system has the capability to administer discrete amounts of insulin frequently, and adjust insulin infusion rates based on current and predicted glucose levels. It effectively removes the need for people to make all those decisions.
The algorithm is housed on a mobile phone which communicates with a glucose monitor and insulin pump.
Diabetes clinician and researcher, Associate Professor Neale Cohen, says they have gathered safety and efficacy data using this advanced algorithm. The studies have shown improved glycaemic control both in real-world and clinical trial settings.
The CLOSE IT study involved 73 adults aged from their 20s to their 70s with established type 1 diabetes. Half were using multiple daily injections and half were using insulin pump therapy prior to the trial. Some had good glycaemic control and some had found it more challenging.
In the trial, half the group were randomised to using a hybrid system that wasn't fully closed where they still needed to announce their meals for their pump to provide insulin doses. The other half used the fully closed-loop where all the dosing was done automatically for them. At the end of the study, the hybrid group were in range 69% of the time and those using the fully closed-loop were in range 66% of the time.
A/Prof Cohen says the technology has shown it can provide significant improvements in a person's quality of life by removing the stress of self-management, which we know can impact blood sugar levels.
First patient Siba Diqer, a lawyer and mum of two explains, "It's like a functioning pancreas. Before, I had to inject insulin multiple times a day for every meal and every snack I ate, but this has been a huge improvement for me and taken away many of those extra decisions I've had to make.
"With this technology, there's less stress and less fear. Knowing that my risk of developing diabetes complications has been reduced significantly, I can focus on living a fuller life and being there for my family."
A/Prof Cohen says, "We are now looking to commercialise and make this accessible to a wider population".
