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CGM update: Use of bionic pancreas within sight
LAS VEGAS — Patients with diabetes are improving HbA1c and reducing hypoglycemia through regular use of continuous glucose monitoring, and use of the bionic pancreas is on the horizon, according to a presentation at American Association of Clinical Endocrinologists 23rd Annual Scientific and Clinical Congress.
“The progress is moving at a dramatic pace,” Jay S. Skyler, MD, MACP, of the University of Miami, Miller School of Medicine, said in a presentation after receiving the Distinction in Education award, one of the highest honors bestowed by the association.
Jay S. Skyler
An initial road map from continuous glucose monitoring (CGM) to the bionic pancreas laid out a few years ago predicted the advance would come by 2023, Skyler said. But he said the endocrine world can optimistically expect to see it in the next few years, as highlighted in a review of the field in the Annals of the New York Academy of Sciences.
Skyler explained why he prefers the term bionic instead of artificial pancreas: “It’s not artificial, it’s real. It’s just not natural, or something we’re born with.”
Examples of bionic pancreas systems already in development, utilizing both iPhone and Android technology, showed successful results in several studies —with kids at summer camp (n=32) and with patients in their homes (n=10). In these studies, the time patients spent with sugars in target range went from 55% to 73% and 39% to 82%, respectively.
Researchers have combined an iPhone with a G4 Platinum CGM receiver to predict glucose trends and control Tandem t-Slim pumps that deliver insulin and glucagon, Skyler explained. An alternative Android system uses a built-in diabetes app with a traffic light interface: green indicates no danger, yellow encourages patients to take a moment and think about their next choices, red means take action immediately.
Additionally, current CGM monitoring is improving in accuracy, Skyler said, as evidenced by a comparison of commercial sensors that look at mean amplitude of relative difference and paired average relative difference.
“If you use it, and continue to use it, you’re going to have continued benefits,” Skyler said. “With the introduction of continuous glucose monitoring, we can achieve HbA1c control AACE advocates for with minimal risk of hypoglycemia.”
In the last piece to the puzzle, reimbursement for CGM for patients with type 1 diabetes has been approved by almost all major carriers, Skyler said. He highlighted the reimbursement codes for providers.
“The more we submit it and lobby for it,” Skyler said, “the more I think we’ll continue to provide it.”
For More Information:
Skyler JS. TGS-3. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosure: Skyer reports financial relationships with AstraZeneca, Boehringer Ingelheim GmbH, Dance BioPharm, Dexcom, Inc., Halozyme, Inc., Ideal Life, Intarcia Therapeutics, Inc., Minimed (before acquisition by Medtronic), Novo Nordisk A/S, Orgenesis Inc., PhaseBio Pharmaceuticals, Inc., Sanofi, Tandem Diabetes Care, Valeritas, Inc., and ViaCyte, Inc.
Perspective
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Unfortunately many diabetic patients cannot reach the recommended glucose goal. The burden of managing the disease is heavier for patients who depend on insulin like patients with type 1 diabetes or those with type 2 who are on insulin therapy. Depression and diabetes burnout are common due to the extra work needed to manage the disease properly. The bionic pancreas, even if it is not as perfect as a natural pancreas, will be able to lift the heavy load from these patients and help manage day to day blood sugar levels closer to normal without too much fear of hypoglycemia.