Testing an Artificial Pancreas System

Tom Brobson

Living with type 1 diabetes (T1D) requires constant care and attention: blood-glucose monitoring, carbohydrate counting, insulin dosing, and monitoring for high and low blood-glucose levels. But new technology is changing T1D management—and for the good. Just ask Tom Brobson, JDRF’s national director of research investment opportunities, who has doubled as a test subject for JDRF’s Artificial Pancreas Project for the past six years.

An artificial pancreas system—which uses computer algorithms (step-by-step procedures that calculate everything from insulin doses to blood-glucose levels) to link insulin delivery to continuous glucose monitoring (CGM)—can respond to glucose fluctuations in real time. The technology has the potential to dramatically improve the lives and health of millions of people with T1D by reducing life-threatening extremes in blood-glucose levels.

We spoke to Tom about his experience testing an artificial pancreas system. Tom has been in three artificial pancreas trials at the University of Virginia, and the latest took place in the fall of 2012.

Why do you participate in artificial pancreas system tests?

It’s amazing—it’s the opportunity to be on the cutting edge of JDRF research. The system I tested did everything I could have hoped for—it gave me perfect overnight control and kept me pretty much in the target range just as “advertised.” I felt like it freed up so much of my hour-to-hour living, allowing me to be less preoccupied with managing my T1D. It was pretty tough to let them turn it off at the end of the trial!

What was this trial like?

This is one of many steps to create and advance the technologies and systems that will give rise to commercial products available to all. This trial began on the afternoon of one day, lasted through the next, and concluded on the morning of the third. We were out in the “real world,” not in a hospital. We were closely monitored, but we got to go about our lives while the system—which lives on a smartphone—did its thing. It’s hard to understate how much fun it was even while it was a lot of work.

Your latest trial tested a control-to-range system, in which the artificial pancreas works to keep blood-glucose levels within a set range through the delivery of insulin.

In this case of control-to-range, I still made some of the decisions—telling the system that I was doing specific things? so that the system could perform optimally. For instance, it was important that I let the system know I was eating a meal. The system is like a plane running on autopilot—a jet can fly from L.A. to New York on autopilot, but to take off and to land, it needs the pilot. Similarly, the artificial pancreas is going to automate significant pieces of managing our T1D and insulin, but will still need us to help it make really big decisions.

What types of smartphones do AP systems use?

The system that I was testing operated on an Android phone, but I have seen JDRF-funded artificial pancreas systems that run on Windows phones and iPhones. It’s most important that the smartphone is able to communicate with the pump and sensor. Ultimately, a system might run on any smartphone that has appropriate wireless communications. The smartphone essentially becomes a pocket computer, with all of its other functions are disabled (e.g., making calls or playing games).

Can the artificial pancreas be used with any pump?

Any pump with the right wireless communication capabilities could potentially be integrated into these systems. In my trial, I used the Tandem T:slim pump with the Dexcom Platinum G4 sensor.

Where are these trials being done?

Clinical trials associated with the artificial pancreas are being conducted across the globe. JDRF’s Artificial Pancreas Consortium includes research sites in Canada, the U.K., the U.S., France, Italy, Australia, and Israel. My most recent trial was led by JDRF’s fantastic research partners at the University of Virginia.

What are the next steps in developing artificial pancreas systems?

Additional real-world testing is needed. With each study, the testing period will last longer and the situations the systems test will become more realistic so that the systems can prove that they work. Future trials will have more participants spending more time on artificial pancreas systems to generate the data needed to accelerate commercial delivery. For example, researchers will acquire more data on how much time people spend in- or out-of-range, how A1c levels are impacted, and how well it avoids lows and prevent highs.

When will this be available?

Living with T1D, I’m very sensitive to folks saying this or that will happen in X number of years. While I can’t say when this system I’m using will be commercially available, I can certainly say that artificial pancreas technologies are moving ever closer to real-world use. Low-glucose suspend systems are already coming to market, and the next big step will be systems that predict low blood sugar and adjust insulin to prevent it. Each new advance will bring us a more sophisticated artificial pancreas system. Without JDRF-funded research, we wouldn’t be as close as we are today.

What is your biggest takeaway from your most recent trial experience?

It’s a giant emotional high. I thought, ‘Holy cow, I get to have so much more of my life back and with a greatly improved quality of life that I didn’t even realize I didn’t have.’ I think most people who try an artificial pancreas system will be excited about having more freedom and flexibility to live their lives.

I also realized small advances make huge differences. It may seem like a small thing to say, ‘I had perfect overnight control,’ but that is a huge advance. How many parents get up every night to check a child’s glucose level? The seemingly small step of terrific overnight control will change lives. None of us will ever stop pushing for other advances?we are all part of JDRF’s vision of a world without T1D, and together we’ll make it happen.

How can someone join a similar trial?

The JDRF Clinical Trials Connection is an online service that allows you to “opt-in” to get information about trials, and access to them. It contains information about all currently active diabetes trials in the U.S. You can sign up at https://trials.jdrf.org/ and provide some basic information. The service then gives you access to customized information about clinical trials, the option to sign up for monthly emails with up-to-date information about newly launched trials, and contact information for the researchers conducting the trials you are interested in.