Camilla Levister on the Benefits of Artificial Pancreas Systems for Type 1 Diabetes

Camilla Levister, MS, ANP-C, CDCES, a nurse practitioner at the Icahn School of Medicine at Mount Sinai Hospital in New York, discusses how closed-loop systems benefit patients managing type 1 diabetes.

Transcript

What is an artificial pancreas or closed-loop insulin delivery system, and how does it work?

An artificial pancreas system consists of 3 different components, which include an insulin pump, a continuous glucose monitor, and an algorithm that is usually embedded within the pump itself, so not a separate device. There are several that are out on the market and approved right now. I think initially, when people would hear the term "artificial pancreas," they thought it was something that you were getting a surgical procedure for. But it's basically an insulin pump system that will adjust the delivery of insulin based on what your glucose is, what your predicted glucose is going to be based on the CGM, or continuous glucose monitoring reading, and other factors that you have that are set in the pump, and are also algorithm,specific.

So the goal is to try to keep the person within a given target by increasing and decreasing that insulin delivery in the background, so that, for example, when they're sleeping, instead of the pump just giving a specific amount of insulin—which is how older systems were, where you only had the option of getting X amount of insulin per hour—with this, it's making decisions every few minutes and determining if the person needs a little bit more insulin, a little bit less insulin, no insulin for a little while. It's very dynamic in trying to achieve those targets, so that's one of the main benefits of it for a lot of people.

In the research you’ve taken part in, how has integrating closed-loop systems impacted disease management and quality of life for patients?

It's had a positive impact for a lot of patients and research subjects that I've seen. One of the biggest factors is overnights. A lot of people might have concerns overnight with blood sugars going low and having hypoglycemia. It's not fun to wake up with a low blood sugar—you have to get up, you have to have something to drink. Some people also have had severe hypoglycemic events before, where they needed assistance from someone or needed EMT [emergency medical technicians] called or a medication called glucagon. So that makes people a little bit more hesitant sometimes to keep their blood glucoses in a target range, because they have that concern of hypoglycemia.

But with these closed-loop systems, I had so many people that said, “I sleep so much better because I have this peace of mind.” Now, do you still sometimes have hypoglycemia? Yes. Do you still sometimes have hyperglycemia? Yes. But that is reduced with a closed-loop system, so that is one of the things. We did have a study before when the participants were ending the study, and they were like, “I'm really going to miss this because I've been sleeping so well since I've been on this system.” So that's one of the biggest key factors.

One of the pros about wearing an insulin pump in general is not having to always take out an insulin pen if you're going to eat or if your blood sugar is running high and you need to give a correction dose of insulin. You can be a bit more discreet with an insulin pump, where you can either use the pump screen—or some pumps have what's called a PDM device that you can use—and then other pumps are compatible with your phone and have cell phone applications where you can just request a dose of insulin by tapping a few things on an app on a phone, which is very similar to what you know a lot of people are doing in general, like being on their phones.

So basically, with not having to take out an insulin pen or insulin vial and needle and having to fumble with those things, this can help people stay more on top of giving insulin doses before they eat because you still do have to give insulin or request insulin through the pump if you're going to eat something with carbohydrates, in order to prevent from having high glucose spikes. But this is something where a lot of patients are more likely to do that and not miss doses, as opposed to when you might be out at a restaurant or something or be self-conscious—or even just forget to bring the insulin pen with you. The pump you're wearing, so you have it on your body, and you know you're good to go in that regard.

Another point where I've seen people benefit is people that have very active jobs—particularly, for example, other people that work in the hospital, [such as] nurses, physicians. In the past, I've had some patients where they intentionally kept their blood sugars on the higher end, because they were concerned about having hypoglycemic events at work. Even if it wasn't a severe event, having low blood sugar does slow things down a bit for you. And nobody wants that, especially when you're working in a high-pressure type of setting.

With closed-loop systems, because you have the insulin pump increasing or decreasing that delivery that you're getting, there's less risk of hypoglycemia, and therefore, those patients feel a bit more comfortable having their blood sugars in what would be considered a target range that we would aim for as opposed to having to run themselves on the higher end to prevent those hypoglycemic events.