The “artificial pancreas” is not an organ that would be implanted. It is a connected device intended for people with type 1 diabetes. But if it greatly improves the quality of life, it does not work completely autonomously.
Diabetes is characterized by chronic hyperglycemia, that is to say an excess of sugar in the blood (too high glucose level). In the long term, this permanent elevation causes damage, among other things, to the small blood vessels of the eyes, kidneys, etc. Type 1 diabetesan autoimmune disease in constant progression for 20 years, affects around 200,000 people in France and appears more and more early, especially in children under 5 years old, according to the French Federation of Diabetics.
How do you become type 1 diabetic?
At the origin of type 1 diabetes, a failure of the pancreas or rather of its beta cells (present in the islets of Langerhans). Normally, these cells secrete insulin which allows glucose to leave the bloodstream and enter muscle, fat and liver cells (where it will be stored).
Another hormone, glucagon (produced by the alpha cells of the islets of Langerhans), releases the glucose stored in the liver, if needed during a sporting activity or a drop in blood sugar outside of meals. . “It is the balance of these hormones that keeps blood sugar stable in the body” explains Professor Éric Renard, diabetologist.
In people with type 1 diabetes, this regulatory system does not work because the body itself has destroyed its beta cells, so it can no longer produce insulin. Glucose cannot enter insulin target cells and stays in the blood, raising blood sugar levels to a level that is fatal without insulin.
Insulin injections: a binding treatment
The only way to treat type 1 diabetes (or advanced type 2 diabetes) is to supply the body with insulin. The oldest method consists in injecting several times a day doses of insulin (syringe or pen) under the skin.
It is a restrictive treatment which requires a great investment from the person (or from his parents if it is a young child), because it is necessary to calculate and adapt the doses of insulin according to the blood sugar level.
This is measured at the fingertip, by taking a drop of blood or indicated by a sensor in the form of a patch placed on the skin, which is read using a scanner or smartphone. Dosage errors lead either to harmful long-term hyperglycaemia or to immediately disabling and potentially serious hypoglycaemia (coma).
Insulin pump: the newest technique
More recent, the insulin pump appeared in France about forty years ago. “This portable device the size of a phone delivers insulin continuously under the skin, via a catheter. Several times a day, the person with diabetes measures their blood sugar to adapt the flow of the pump if necessary or as needed. on the contrary, take sugar if his blood sugar drops too much.
This technique avoids injections and reduces glycemic deviations, but as with injections, the person must always adapt his treatment to his glycemia.
Artificial pancreas: what is it?
It is with the aim of minimizing these constraints that what is wrongly called the “artificial pancreas” was born.
“In fact, it is a semi-automated insulin delivery system, says our expert. The result of the glucose sensor is transmitted by Bluetooth to the pump and the artificial intelligence (algorithm) it hosts allows this pump to automatically adapt its flow according to the results.” The patient no longer has to take decision is a great relief.
Artificial pancreas: what are the advantages?
Today, three of these devices (Diabeloop, Medtronic 780G and Tandem Control IQ) are covered by National Health Insurance and several thousand people are already benefiting from it. “This device is particularly effective between meals, outside of any physical activity and especially at night, observes the diabetologist. Parents can finally sleep peacefully without constantly fearing that their child is in hypoglycemia.“
When blood sugar levels go down or up, the artificial pancreas makes decisions and limits the risk of hypo or hyperglycaemia. “So this is considerable progress in patient care. »
Artificial pancreas: what are the disadvantages?
For the moment, this algorithm is not yet capable of instantly taking into account an unforeseen event likely to cause blood sugar to vary. We must tell him that we are going to play sports or that we are going to have a meal and what will be his quantity of carbohydrates.
It also does not know how to anticipate peaks of stress and strong emotions that can have an impact on blood sugar, but it will correct the resulting blood sugar deviations, by adapting the insulin supply.
Artificial pancreas: who can use it?
So far, the artificial pancreas is only offered to people with type 1 diabetes, from the age of 6 or 7 (depending on the model), who have already been on an insulin pump for at least 6 months and use a glucose sensor without achieving sufficient glycemic control.
Before being equipped, the “candidates” benefit from therapeutic education courses to know how to use this device and how to react in the event of a glycemic deviation not controlled by the algorithm or the triggering of any safety alarms.
We learn for example that the measurement of glucose under the skin has a delay of 5 minutes compared to the level of glucose in the blood and when the pump delivers insulin, it takes 20 to 30 minutes for this insulin to have action on blood sugar.
Good news: “A study will begin to demonstrate that we can initiate treatment with an artificial pancreas as soon as the diagnosis is announced. It would be a shame to deprive ourselves of it, because it is the most effective treatment” rejoices Professor Fox.
Our expert: Pr Éric Renard, head of the endocrinology-diabetology department at Montpellier University Hospital.