Management of type 1 diabetes is a difficult balancing act that involves finger-prick sampling and insulin injections to keep blood glucose levels in check, but the notion of an “artificial pancreas” promises to lighten the load.
Scientists at the University of Cambridge have been pushing the boundaries of this technology for more than a decade and have now reported promising findings from trials in very young children, where their solution produced “life-changing” results.
Back in 2020, University of Cambridge scientists launched what was billed as the world’s first licensed, downloadable artificial pancreas smartphone app for type 1 diabetes.
Like other artificial pancreas technologies under development, the idea is to fulfill the role of the pancreas in diabetes sufferers, where it is no longer able to produce the insulin needed to absorb glucose from the blood.
The team’s CamAPS FX smartphone app works with a glucose monitor and pump, using a complex algorithm to determine when the user is in need of insulin and delivering it as needed.
The newly published study was designed to investigate how the technology can benefit young children, in which type 1 diabetes management is particularly problematic due to irregular eating and activity, along with high variability in the amount of insulin they require.
The study involved 74 children with type 1 diabetes, aged one to seven, with all subjects using the CamAPS FX artificial pancreas system for 16 weeks.
They then used current technology called sensor-augmented pump therapy, in which parents monitor their child’s glucose levels and manually adjust insulin delivery via a pump, also for 16 weeks. This allowed the scientists to compare the performance of the two.
“CamAPS FX makes predictions about what it thinks is likely to happen next based on past experience,” explains study author Professor Roman Hovorka. “It learns how much insulin the child needs per day and how this changes at different times of the day.
It then uses this to adjust insulin levels to help achieve ideal blood sugar levels. Other than at mealtimes, it is fully automated, so parents do not need to continually monitor their child’s blood sugarlevels.
“CamAPS FX makes predictions about what it thinks is likely to happen next based on past experience,” explains study author Professor Roman Hovorka. “It learns how much insulin the child needs per day and how this changes at different times of the day.
It then uses this to adjust insulin levels to help achieve ideal blood sugar levels. Other than at mealtimes, it is fully automated, so parents do not need to continually monitor their child’s blood sugar levels.”
When using the CamAPS FX app, the children spent 71.6 percent of their day in the target range for glucose levels, around nine percentage points, or 125 additional minutes, higher than the control.
They also spent 22.9 percent of the time with raised blood sugar levels, nine percentage points lower than the control, and also exhibited lower average blood sugar levels, reducing their risk of diabetes-related complications.
“Very young children are extremely vulnerable to changes in their blood sugar levels,” said Dr. Julia Ware, the study’s first author. “High levels in particular can have potentially lasting consequences to their brain development. On top of that, diabetes is very challenging to manage in this age group, creating a huge burden for families.
CamAPS FX led to improvements in several measures, including hyperglycemia and average blood sugar levels, without increasing the risk of hypos. This is likely to have important benefits for those children who use it.”
This study marks the first time the CamAPS FX system has been proven effective in very young children over a period of several months, with parents describing it as “life-changing.”
As it stands, the technology is available through certain hospital trusts in the UK, but the scientists hope as it continues to prove itself through these types of trials, it can change the lives of more and more sufferers of the condition.
From the first clinical trials of our algorithms to today’s findings has taken well over a decade, but the dedication of my team and the support of all the children and families who have taken part in our studies, has paid off,” Hovorka said. “We believe our artificial pancreas will transform the lives of families with very young children affected by type 1 diabetes.”
Nick has been writing and editing at New Atlas for over six years, where he has covered everything from distant space probes to self-driving cars to oddball animal science. He previously spent time at The Conversation, Mashable and The Santiago Times, earning a Masters degree in communications from Melbourne’s RMIT University along the way.
“Diagnosis of Diabetes and Prediabetes”. National Institute of Diabetes and Digestive and Kidney Diseases. June 2014. Archived from the original on 6 March 2016. Retrieved 10 February 2016.
“Causes of Diabetes”. National Institute of Diabetes and Digestive and Kidney Diseases. June 2014. Archived from the original on 2 February 2016. Retrieved 10 February 2016.
It’s 10 years since Professor Roy Taylor revolutionized treatment for type 2 diabetes with a groundbreaking study that showed the disease could be reversed through rapid weight loss. Until his research was published, type 2 diabetes was thought to be an incurable, lifelong condition. Now, for many people, we know it is not.
But his achievements – and the thousands of people he has cured – are not something he dwells upon. “I’m in a very lucky position of being able to do this research,” he says, “which really extends what I’ve been doing as a doctor throughout my life.” He laughs at the suggestion that he must occasionally marvel at his own success: “No, no,” he chuckles. “Lots of occupations make a useful contribution to society. I wouldn’t set myself apart.”
Modest words for a man whose “useful contribution to society” has given hope to the 3.9m people diagnosed with the condition in the UK and who has shown doctors a new way to fight a disease which causes 185 amputations and 700 premature deaths every week.
Now, he wants to go one step further and share everything he has learned directly with the public, in a new book, Your Simple Guide to Reversing Type 2 Diabetes. It’s a 153-page paperback that takes you through the latest research on how the disease develops and explains why rapid weight loss can be so effective at reversing the condition in the early stages – which usually means during the first six years of a diagnosis.
“If people really do want to make it happen, then in the first few years of diagnosis, it’s almost universal that their health can be returned to normal,” says Taylor, who is professor of medicine and metabolism at Newcastle University. In one study, he found that nine out of 10 people with “early” type 2 diabetes were cured after losing more than 2½st (15kg).
The book also explains who is at greatest risk and why some people who have a “normal” Body Mass Index (BMI) develop the disease, when many people who are more overweight – or even obese – do not.
Taylor’s “Newcastle” weight loss program is a clinically proven method of reversing early type 2 diabetes and his approach is currently being rolled out to people with the condition by the NHS. It involves cutting your calorie intake to 700-800 calories a day. In the book, he explains how the people in his program managed to do this – typically by consuming only slimming meal shakes and non-starchy vegetables, plus one cup of tea or coffee each day with skimmed milk – lost a life-changing amount of weight in just eight weeks. And how you can do the same, safely, at home.
In other words, it is a book that has all the hallmarks of becoming a massive bestseller. But Taylor himself will not make a penny from it. He is donating 100% of his proceeds from the book to the charity Diabetes UK, which is “only logical”, he tells me, because they funded his original 2011 study. “That was so far sighted of them,” he says. “They supported research that I know the experts thought was outlandish.” He says just one person at the research committee meeting spoke up for his proposal and convinced the others by saying: “It might sound crazy, but if he’s right, it would be really important.”
Taylor decided to write the book because, even though most diabetes experts in the UK have now accepted that his rapid weight loss program works, many doctors in Europe and the USA remain unconvinced. “It’s not easy to get new ideas accepted in medicine. So it will be a while before this gets into the textbooks and generations of doctors are taught about it.”
In the meantime, he feels it is his job – his “duty” even – to make people aware of the discoveries he and others have made in recent years. “I feel a responsibility for passing on this knowledge.”
One of Taylor’s most important new discoveries is that everyone has their own fat threshold: an individual level of tolerance for levels of fat in the body. “It’s a personal thing. It’s nothing to do with the sort of information that’s often provided about obesity, which is about average BMI and what the population is doing. The bottom line is, a person will develop type 2 diabetes when they’ve become too heavy for their own body. It doesn’t matter if their BMI is within the ‘normal’ range. They’ve crossed their personal threshold and become unhealthy.”
He is currently in the middle of research to find out whether there’s any way of discovering, via a blood test, when people are heading into this dangerous territory and their fat cells are putting out what he describes as “distress signals”.
What we do know already is that our bodies start to have trouble controlling blood sugar when fat can no longer be stored safely under the skin and it spills over into the liver and then the pancreas. If these organs get clogged with fat, they stop functioning properly and that is when you develop type 2 diabetes.
It is particularly important to note that if you have a family history of type 2 diabetes, you are more susceptible genetically. People in these circumstances need to be “very careful” about weight, especially in adult life, Taylor says. “If you’ve increased weight quite a lot above what you were at the age of 21, you’re in the danger zone – and you should get out of it. If you’ve got a family tendency for diabetes, then you really want to avoid weight gain in adult life.”
As Taylor explains in his book, if you have increased your BMI by three units or more since you were in your early 20s, you are at risk. It doesn’t matter how slim you look to other people. “People imagine that if everybody says they’re slim, they won’t get type 2 diabetes, but in fact that’s not true. Our present research involves people who are not obese, and indeed, have a normal BMI.”
This explains why only half of people are clinically obese when they are first diagnosed with type 2 diabetes, and why studies have shown that almost three-quarters of extremely obese people, with a BMI of over 45, do not suffer from type 2 diabetes. “Some people can put on glorious amounts of fat and store it all under the skin without any metabolic problems at all.”
Taylor also says that it’s important to bear in mind that type 2 diabetes can, at first, be symptomless, so people at risk may wish to get an annual test done via their GP. A simple finger-prick blood test, which gives an immediate blood sugar level result, can be done in many chemists. Signals to look out for include increasing tiredness and, especially, increasing thirst, and a tendency to have more skin infections, “like boils for instance, or candida,” Taylor says.
Rapidly decreasing body weight by 2½st (16kg) will take most people below their personal fat threshold, dramatically lowering their risk. For this reason, “the book goes through the steps that people need to follow to lose a substantial amount of weight and then keep it off”.
Taylor hopes that by writing a paperback in simple, accessible language, he will reach people who are heading towards or have already received a diagnosis and want to learn more about his research. “I’ve realized there is an enormous thirst out there for exact knowledge about how people can deal with this disease themselves, using the new information that we have.” He also wants to explain to as many people as possible what causes type 2 diabetes so individuals feel empowered to make healthy decisions about their body and the food they eat.
“This book is for anyone who wants to understand what happens to food after they swallow it and how that’s handled by their body. And also, critically, how that affects their health.” For example, he has found most people don’t realise that if you eat more carbohydrates or protein than your body needs, the excess is converted into fat and then stored.
This is a million miles from “fat shaming”, he says, and it is up to each person to decide for themselves whether they are too heavy for their own health and happiness. “What I can point out as a doctor are the circumstances that come about when people have crossed their personal fat threshold,” he says. “There’s no judgment on a person who happens to be heavy, compared with someone who happens not to be. It’s about helping individuals who would otherwise run into trouble.”
“Diagnosis of Diabetes and Prediabetes”. National Institute of Diabetes and Digestive and Kidney Diseases. June 2014. Archived from the original on 6 March 2016. Retrieved 10 February 2016.
Fasanmade OA, Odeniyi IA, Ogbera AO (June 2008). “Diabetic ketoacidosis: diagnosis and management”. African Journal of Medicine and Medical Sciences. 37 (2): 99–105. PMID18939392.
“Causes of Diabetes”. National Institute of Diabetes and Digestive and Kidney Diseases. June 2014. Archived from the original on 2 February 2016. Retrieved 10 February 2016.
Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, Chu Y, Iyoha E, Segal JB, Bolen S (June 2016). “Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis”. Annals of Internal Medicine. 164 (11): 740–51. doi:10.7326/M15-2650. PMID27088241. S2CID32016657.
Melmed, Shlomo; Polonsky, Kenneth S.; Larsen, P. Reed; Kronenberg, Henry M., eds. (2011). Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN978-1-4377-0324-5.
Saenz A, Fernandez-Esteban I, Mataix A, Ausejo M, Roque M, Moher D (July 2005). Saenz A (ed.). “Metformin monotherapy for type 2 diabetes mellitus”. The Cochrane Database of Systematic Reviews (3): CD002966. doi:10.1002/14651858.CD002966.pub3. PMID16034881. (Retracted)
Moscou, Susan (2013). “Getting the word out: advocacy, social marketing, and policy development and enforcement”. In Truglio-Londrigan, Marie; Lewenson, Sandra B. (eds.). Public health nursing: practicing population-based care (2nd ed.). Burlington, MA: Jones & Bartlett Learning. p. 317. ISBN978-1-4496-4660-8. OCLC758391750.
Ripsin CM, Kang H, Urban RJ (January 2009). “Management of blood glucose in type 2 diabetes mellitus”. American Family Physician. 79 (1): 29–36. PMID19145963.
Pasquier F (October 2010). “Diabetes and cognitive impairment: how to evaluate the cognitive status?”. Diabetes & Metabolism. 36 Suppl 3: S100-5. doi:10.1016/S1262-3636(10)70475-4. PMID21211730.
Akinpelu, Olubunmi V.; Mujica-Mota, Mario; Daniel, Sam J. (March 2014). “Is type 2 diabetes mellitus associated with alterations in hearing? A systematic review and meta-analysis”. The Laryngoscope. 124 (3): 767–776. doi:10.1002/lary.24354. ISSN1531-4995. PMID23945844. S2CID25569962.
Abdullah A, Peeters A, de Courten M, Stoelwinder J (September 2010). “The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies”. Diabetes Research and Clinical Practice. 89 (3): 309–19. doi:10.1016/j.diabres.2010.04.012. PMID20493574.
A potential medical breakthrough that could put an end to the daily insulin injections endured by people living with diabetes has been unveiled by Dutch scientists. By destroying the mucous membrane in the small intestine and causing a new one to develop, scientists stabilised the blood sugar levels of people with type 2 diabetes. The results have been described as “spectacular” – albeit unexpected – by the chief researchers involved. In the hourlong procedure, trialled on 50 patients in Amsterdam, a tube with a small balloon in its end is inserted through the mouth of the patient down to the small intestine………
The health authorities have identified one of their top concerns as they wage war on diabetes: white rice. It is even more potent than sweet soda drinks in causing the disease. Sharing his battle plan to reduce the risk of diabetes, Health Promotion Board chief executive Zee Yoong Kang said that obesity and sugary drinks are the major causes of the condition in the West. But Asians are more predisposed to diabetes than Caucasians, so people do not have to be obese to be at risk…….
An international collaboration co-led by researchers at the Walter and Eliza Hall Institute has made a discovery that could make therapeutic insulins more effective by better mimicking the way insulin works in the body. The findings could improve treatments for diabetes, a disease that impacts the lives of millions of people worldwide.Published today in Nature Communications, the study reveals the first definitive 3-D image of how insulin successfully interacts with its receptor—a ‘gatekeeper’ for transmitting information into cells—in a process that is crucial for instructing cells to lower blood sugar levels in the body…….
Management of type 1 diabetes is a difficult balancing act that involves finger-prick sampling and insulin injections to keep blood glucose levels in check, but the notion of an “artificial pancreas” promises to lighten the load.
They then used current technology called sensor-augmented pump therapy, in which parents monitor their child’s glucose levels and manually adjust insulin delivery via a pump, also for 16 weeks. This allowed the scientists to compare the performance of the two.
“CamAPS FX makes predictions about what it thinks is likely to happen next based on past experience,” explains study author Professor Roman Hovorka. “It learns how much insulin the child needs per day and how this changes at different times of the day.
“Very young children are extremely vulnerable to changes in their blood sugar levels,” said Dr. Julia Ware, the study’s first author. “High levels in particular can have potentially lasting consequences to their brain development. On top of that, diabetes is very challenging to manage in this age group, creating a huge burden for families.
From the first clinical trials of our algorithms to today’s findings has taken well over a decade, but the dedication of my team and the support of all the children and families who have taken part in our studies, has paid off,” Hovorka said. “We believe our artificial pancreas will transform the lives of families with very young children affected by type 1 diabetes.”
