Is an Artificial Pancreas Good Enough?


Prescript: It’s been a while since I’ve written, I know. I had a beautiful baby boy who is now nearly six months old. Perfect and perfectly healthy, so take that, diabetes! This post is about other things, though.

Four years ago, I left my job as a software engineer to enter the world of biomedical research. My goal? Cure diabetes. I have since learned enough to fill an ocean, with the most important lesson being an ocean is only a drop in the bucket when it comes to the complexity of the human body.

Where are we in terms of a cure? We edge closer and closer to understanding the fundamentals, but it is a long, hard road. I believe we are getting close on a vaccine- that in the next ten years, we will be able to stave off the start of diabetes by at least ten years.

But over the last few months, something has become increasingly likely: the artificial pancreas will win the race. I have been thinking about this for about a year now, since I first heard initial results from the Bionic Pancreas project, led by Dr. Steve Russell and Dr. Ed Damiano. To make a long story short, using both insulin and glucagon, the Bionic Pancreas is able to achieve glucose values equivalent to A1cs of about 6.5% in early short-term trials.

Now, 6.5% is not good enough for me. But in those initial studies, people were eating whatever they wanted. So let’s imagine for a moment: in five years, let’s say there is a device that requires multiple injections per week, and requires wearing a pager-sized machine. That device is imperfect, but can achieve an A1c of less than 6.0% without excursions if I maintain the same diet I do now– which is to say, relatively low-carb, and well-watched. And the device does this without any input from me, without my having to think about it, without highs above 140 mg/dL, and without lows below 70 mg/dL.

That’s not a perfect system. But, hell, that’s good enough for me. I could happily go the rest of my life wearing a pager and never eating a donut or a slice of pizza if that meant I could avoid complications and not have to think about diabetes.

And, crucially, if that system existed, and I were on a funding committee at the NIH or any other research organization, and someone came to me and asked for money for a cure for diabetes– I would have to say, “You know what, there are needier diseases. Let’s put the money to those instead.”

Now, don’t misinterpret me– we aren’t there yet. The current systems are not good enough to avoid excursions, glucose monitoring is not reliable enough, and glucagon does not exist in a stable soluble format. But these are solvable problems that require iterations on current technology, not entirely new discoveries. With enough funding and attention, we will get there.

And when we do, our cry for a cure becomes much less convincing. A vaccine is still very important, and funding for a vaccine should be viewed separately from a cure, as it skips the need for machine-orchestrated treatment and complications due to delayed diagnosis. Similarly, funding for complications research should be viewed separately, as there are many of us already suffering from complications related to diabetes. But funding for a cure, assuming for a moment we have a mechanical solution? Better to spend that money on, say, celiac disease. Or Rheumatoid Arthritis.

Of course, the last thing I would want to see happen is to have the Artificial Pancreas become a foregone conclusion, resulting in the ebbing of funding for it as well as a biological cure. It ain’t over till the fat lady sings, especially in biology, so until we’re there, we shouldn’t give up on any potentially successful research.

All of this is to say: it’s exciting to recognize that we’re getting really close to my life being much easier. And the way we get there might not be how I originally expected to get there, but as long as we get there– count me in.

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8 years ago

Just found your site, thanks.
New CGM user (Dex) and so far I agree with your review of that. To me, it seems like the AP will always be limited by the fact that adjustments to circulating insulin levels are buffered by the (relatively) long travel time from skin to liver, rather than the instantaneous route that the pancreas has. That said, the AP is a great goal, and long overdue — hard to believe it’s taken this long to get this close, and that we’re still not quite there yet.

8 years ago

A cure is still needed as mechanical devices break at the most inopportune times which can leave a T1D person with life threatening issues to deal with. 

8 years ago

I’m so with you!!!  My main concern is for all of those type ones in this country and around the world that will never be able to afford the AP. They still deserve an affordable cure, as soon as possible.

Katy Killilea
8 years ago

Rings so true: “there are needier cases. Let’s put the money to those instead.” I think you make a very good point, and I love your realistic imagined future of the Bionic Pancreas: what it will and won’t be able to do, and how it will still be a box to carry, but that the user’s mind will be largely free from math and second guessing.   You know what, there are needier diseases. Let’s put the money to those instead – See more at: You know what, there are needier diseases. Let’s put the money to those instead… Read more »

Bernard Farrell
Bernard Farrell
8 years ago

Thanks Karmel,

Incisive writing as always. How did you jump from software to biomedical research, that deserves a post of its own.

Next month I’ll have had type 1 diabetes for 42 years. In that time the related technology has changed and evolved enormously.

None of it comes even close to the cure. I’ve confidence that there will be a cure — whatever that ends up meaning. In the meantime I’ll take the advances so I can stay healthier and in better shape while waiting. 

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