The artificial pancreas or closed loop system

Hello, my name is Steven Green and Professor child’s health at the London Diabetes Centre, London medical.

And I’d like to just share with you some information around the new artificial pancreas systems, so called closed loop insulin pump, which were really quite interested in here at London medical as a way of treating type one diabetes, particularly in young people requiring insulin, intensive insulin therapy.

So closed loop systems, the concept has been around for a long time, and it’s been translated very much into practice in the last two to three years. And this is now gathering pace with several systems coming on board. Several new developments. We’re particularly excited here at London medical about our relationship with the newest system which is out, which came out in April of this year, which came from Professor Romanov Walker’s group in Cambridge. And this is the so called cam APS FX system, bit of a mouthful. This is the Cambridge, Artificial Pancreas System FX. I’m not quite sure why they’ve got such a complicated name, but it’s basically taking a standard insulin pump, in this case, a downer pump. Now in the future, they may well be able to link it to other pumps, but at the moment, it’s available with the downer insulin pump, which is very straightforward, very good, very safe insulin pump, and linking it to a continuous glucose monitoring system. In this case, the dexcom six continuous glucose monitor.

And what the Cambridge group have done is they’ve designed an algorithm. This algorithm fits onto a specially designed application and sits on your phone, your iPhone or Android or other phone. So what it does is it links the signals from the glucose sensor to the insulin pump. And the glucose sensor is calculating your blood glucose from the needle which is inserted into the skin once every two to three minutes, and this is then captured it sent to the algorithm and the algorithm works out not just the absolute level of glucose, but the trend of that glucose, what it’s been doing over the previous minutes and hours. What time of day it is, what relation you are to having a food, have you done any exercise recently etc. And also The algorithm develops a personal approach over the following two to three weeks. So in a sense, by the end of two to three weeks, you have very much a personal view of what insulin you should be giving to your own blood glucose levels, and the trend of that blood glucose levels over the preceding minutes and hours. And then tells the insulin pump how much insulin to give, tells it to give its basal rate adjustments.

Now you do have to give bolus doses through the pump for meals. But again, this is a little bit different because of course the pump will automatically adjust to the blood glucose levels which rise after the ingestion of food, and therefore it makes the bolus dosing quite a little bit easier in relation to obtaining good blood glucose control. And the studies that have been done on a whole variety of people, adults, young adults, teenagers, and children, and especially very young children are really showing that this produces an excellent response. And we’re looking at the new markers of achieving blood glucose controls such as time and range, which is the amount of time during the day that you’re in the acceptable range of between four and ten millimoles per litre of blood glucose, and we’re looking at figures of up to 75% to 80% as being the target that we would expect to get on one of these artificial pancreas systems.

So very exciting time for London medical, we’ve trained all our nurses, dieticians have a training in the system, and we’d be delighted to offer that to you through London medical if you were interested this and all the information can be found on our website, Londonmedical.co.uk.

So looking forward to working with children, teenagers, young people and their families with this very exciting new era of how to control your blood glucose. Thank you.