Can the artificial pancreas automatically adjust the insulin dose based on individual requirements?

This trial investigated whether an artificial pancreas could automatically adjust the insulin dose when an initial insulin  dose was administered based on an individual's weight. 

A bihormonal bionic pancreas is an artificial pancreas. This system consists of a continuous glucose monitor (CGM) and an insulin pump which releases insulin (hormone to break down blood sugar) and glucagon (promotes the formation of blood sugar). It is difficult to design a safe artificial pump due to the variation in insulin dose between patients. The insulin dose also varies within an indivdiual at different times duringthe day, and during life. Adolescents tend to require more insulin than pre-adolescents or adults. A system which can automatically adapt to the requirements of pre-adolescents, adolescents and adults would provide better control of blood glucose.

This trial involved 24 type 1 diabetes patients (12 adolescents and 12 adults). Patients were fitted with an artificial pancreas and followed for 51 hours, during which patients also undertook 30 minutes of exercise. Prior to their first meal, half of the patients were randomly assigned to receive an insulin dose based on weight (0.5 U/kg). For every susequent meal, patients then received an insulin dose that was adapted by the control system based on how effective the dosing at the first meal was. The other half did not receive an insulin dose prior to their first meal. Blood glucose levels were measured every 15 minutes.

In adults, the 48-hour average blood glucose level was 132 mg/dL for those who had received an adaptive insulin dose prior to their first meal and 146 mg/dL for those who had not. The average night-time blood glucose was 112 mg/dL for those who received the adaptive insulin dose compared to 110 mg/dL for those who did not. Though blood glucose levels were higher overall in adolescents, those who received an adaptive insulin  dose prior to their first meal still had lower blood glucose overall (162 mg/dL) compared to those who did not (175 mg/dL). 

For those who received an adaptive insulin dose prior to the first meal, the average insulin dose released prior to each subsequent meal automatically increased, particularly in adolescents where the amount of insulin released was 2.5 – 3.5 times larger than the first, adaptive dose. 

The authors concluded that their artificial pancreas can safely and effectively control plasma glucose levels in individuals with various requirements, particularly following administration of an adaptive insulin dose based on body weight prior to the first meal. 

If you are considering an artificial pancreas, talk to your doctor about the current state of the art, and whether it is the most suitable option for you.