The Loop Has Closed: The Artificial Pancreas Program Comes to Life in Israel

Diabetes technology has vastly improved in the last decade, and most people with diabetes who have the opportunity to wear an insulin pump or a continuous glucose monitor are grateful for the assistance they provide.  But even with these advanced tools, the biggest burdens of diabetes – the insulin dosing and blood sugar testing – still lie on the person with diabetes or a caregiver.

Just about every adult with diabetes  will tell you how much they’d like to eat without thinking about each and every bite.  Every parent of a child with diabetes wants their child to be able to eat without having to calculate and dose insulin for them.  And most of all, people with diabetes and their caregivers would like to sleep without the fear of hypoglycemia.  Thanks to the work of Professor Moshe Phillip and his team at the Institute of Endocrinology and Diabetes at Schneider Children’s Medical Center of Israel and Eran Atlas, head of the engineering team at the Diabetes Technology Institute at Schneider Children’s, we’re one step closer to carefree eating and peaceful nights.  We’re one step closer to being relieved of the continuous need to check blood glucose levels, calculate insulin requirements, and inject insulin.

Earlier this month, Prof. Phillip and his team invited 18 children with diabetes in Israel to be part of the world’s first out-of-hospital artificial pancreas trial.  The trial took place on Kibbutz Ma’ale Hahamisha in the hills outside of Jerusalem, and utilized the MD-Logic system developed at Schneider Children’s.  The MD-Logic system allows real-time control of the blood glucose levels based on readings from a continuous glucose sensor. It is based on a model which imitates the logic of diabetes caregivers.*

How did the Artificial Pancreas Program work?

1. 18 children between the ages of 12-15 years were invited to participate.

2. The children gathered to meet each other, play getting-to-know-each-other games, and talk about how many years they’d been living with diabetes.

3. Nine children were connected to the program’s network.  (The other nine children were connected to the network a day later.)

4.  Each child was connected to an insulin pump, a continuous glucose sensor, and an artificial pancreas in the form of a laptop computer which communicated between the pump and the glucose sensor.  The artificial pancreas determined how many units of insulin to deliver, was responsible for suspending insulin delivery in case of low blood sugar, and made adjustments in basal rates.  All of this was done without any human input.

5. Each child wore/carried a backpack which held the laptop computer/artificial pancreas.  When the child slept, the computer sat on a small table beside the bed.

6. Throughout the experiment, including the nighttime hours, the doctors and engineers who developed the Artificial Pancreas Program sat in a control room where they observed and monitored all of the data for all of the children.  If a problem arose, they were able to detect it and correct it immediately.

The trial was considered successful, and though there is still some way to go before the artificial pancreas becomes standard diabetes care, it’s an exciting and promising step.  It’s kind of like giving diabetes a brain, which is a wonderful thing for those of us who feel like our diabetes has a mind of its own.

*Closing the Loop – Towards an Artificial Pancreas – The Schneider Medical Center Experience
Revital Nimri, Eran Atlas, Shahar Miller, Eli Grunberg, Moshe Phillip, http://www.ies.org.il/abstracts09/Stem%20cell%20in%20Diabetes%20Mellitus%20symposia-HW103-106.pdf

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

View Author Blog

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)