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Artificial pancreas successful in type 2 diabetes tests

Cambridge researchers say 89 percent of study patients reported spending less time managing their condition

Medical researchers from Cambridge University have completed successful trials of an artificial pancreas that they say is nearly ready for commercial use by outpatients with type 2 diabetes – and it's even automated.

In a paper published in Nature the team said their device halved the amount of time patients spent with high glucose levels, doubled the amount of time glucose levels were safe, lowered overall glucose levels and reduced levels of glycated hemoglobin – a compound that can cause diabetes-related complications. 

To top it off, the researchers said they didn't have any patients experience hypoglycemia – dangerously low blood sugar levels – during the trials. Low blood sugar has been a complication for long-term users of insulin pumps. 

Type 2 diabetes is often linked to lifestyle and develops over time, causing the body to make insufficient insulin or to become insulin resistant. Those with type 1 diabetes are often born with the condition, which causes their immune system to attack the cells of their pancreas, preventing it from producing insulin. 

According to the researchers, some 90 percent of the 4.9 million people suffering from diabetes in the UK have type 2, costing the National Health Service (NHS) £10 billion ($12B) per year. Globally, the team said, 415 million people are believed to have type 2 diabetes, costing an estimated $760 billion per year. 

A type 2 breakthrough

This artificial pancreas isn't the first. The Cambridge team behind the device previously designed an artificial pancreas for type 1 diabetes patients, which required the wearer to tell it when they planned to eat so it could adjust insulin levels accordingly.

The team has also trialed a similar device for type 2 diabetes patients undergoing kidney dialysis, Cambridge said. The latest device was the first trialed in a "wider" population (of 26 people) living with type 2 diabetes who don't require dialysis. 

According to the university, It's also the first fully "closed loop" automated device that requires no intervention from the user.

Consisting of an off-the-shelf continuous glucose monitor and insulin pump, the real innovation of the Cambridge design is its mobile app, CamAPS HX, which uses an algorithm developed by the team that Cambridge University states "predicts how much insulin is required to maintain glucose levels in the target range." 

"Many people with type 2 diabetes struggle to manage their blood sugar levels using the currently available treatments, such as insulin injections. The artificial pancreas can provide a safe and effective approach to help them, and the technology is simple to use and can be implemented safely at home," said study co-lead Dr Charlotte Boughton of Cambridge's Wellcome-MRC Institute of Metabolic Science.

Pump or, alternatively, dump

For the millions of people with type 2 diabetes who are beyond the help of more conservative treatment methods, the news from Cambridge is fantastic. Participant feedback makes it even better news, as the researchers said 89 percent of participants spent less overall time managing their diabetes. 

But for millions of people with early type 2 diabetes – classified as within the first six years since diagnosis – the condition may be reversible through rapid weight loss, says Roy Taylor, Newcastle University professor of medicine and metabolism.

According to Taylor's research, each individual has a "fat threshold" that, if surpassed, can lead to type 2 diabetes. When that threshold is passed, fat can't be stored under the skin, so it's shifted to the liver and pancreas, and that fat buildup leads to type 2 diabetes. 

This fat threshold theory isn't controversial. Previous studies have shown that fat accumulation on the liver and pancreas increases the risk of type 2 diabetes. Which comes first – the type 2 diabetes or fat accumulation around the liver and pancreas – is less clear, though. According to the Mayo Clinic, health conditions like obesity, insulin resistance, prediabetes and diabetes "appear to promote the deposit of fat in the liver." 

Regardless, Taylor claims that an increase in weight after age 21 is a risk for developing type 2 diabetes, and losing that weight can prevent or reverse the condition.

"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," Taylor said. He defines that increase as three BMI units or more since 21. 

Taylor's crash diet solution to type 2 diabetes is simple: Eat 700-800 calories (3000–3400 kilojoules) a day for several weeks to force the body below its fat threshold rapidly. 

While that sort of eating pattern is not pleasant, Taylor's Newcastle diet [PDF] appears to have some evidence supporting its claims, at least according to Taylor. He told The Guardian that nine out of ten people who've undergone the diet "were cured after losing more than 15kg [33lbs]."

Other advice, from the Harvard School of Public Health suggests "type 2 diabetes is largely preventable by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking."

The Cambridge artificial pancreas offers another possibility to manage the disease, as the team behind it has reportedly submitted it for regulatory approval in the UK and plans to make it commercially available – eventually. ®

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