- A new study finds that an artificial pancreas may help people with type 2 diabetes.
- Blood glucose levels show improvement without increasing the risk of severe complications.
- The system was originally developed to manage blood glucose levels in people with type 1 diabetes.
Roughly 415 million people around the world have type 2 diabetes — and keeping their blood glucose levels within a specific range is critically important to reducing their risk of long-term diabetes complications.
New research suggests that fully closed-loop insulin therapy may help people with type 2 diabetes improve blood glucose levels without raising their risk of severe hypoglycemia, or dangerously low blood sugar.
The study was published January 11 in Nature Medicine by researchers from the Wellcome-MRC Institute of Metabolic Science at Addenbrooke’s Hospital and the Wolfson Diabetes and Endocrine Clinic in Cambridge, UK.
The researchers evaluated the CamAPS FX® Android app, which functions as an artificial pancreas by integrating a continuous glucose monitor (CGM) with an insulin pump to automate blood glucose testing and insulin delivery.
The system was originally developed to manage blood glucose levels in people with type 1 diabetes, but the new study found it also benefited people with type 2 diabetes by doubling the amount of time they spent in a specific glucose range and halving the time they spent with high glucose levels.
“Many people with type 2 diabetes struggle to manage their blood sugar levels using the currently available treatments, such as insulin injections,” Dr. Charlotte Boughton, co-leader of the study, said in a press release.
“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,” she added.
Closed-loop vs. standard insulin therapy
For people with type 2 diabetes, keeping blood glucose within target range helps prevent organ damage that can lead to potentially life-altering complications.
When people first develop type 2 diabetes, many of them can manage their blood glucose levels using a combination of lifestyle changes and oral medication such as metformin.
But as time goes on, up to 20–30% of people with type 2 diabetes require treatment with insulin injections.
In standard insulin therapy, people manually test their blood glucose levels and manually inject insulin multiple times per day to keep their blood glucose within target range.
In comparison, closed-loop systems collect information about a person’s blood glucose levels through a wearable CGM and deliver insulin through a wearable insulin pump.
This provides more glucose-responsive treatment and eliminates the need for manual testing and insulin injections, while helping to support glucose control.
“Until there’s a cure for diabetes, app-based software that can automate insulin delivery is crucial to making treatment progress,” Dr. Thomas Grace, MD, Medical Director of the Blanchard Valley Diabetes Center in Findlay, Ohio, told Healthline.
“Any device that can help automate insulin delivery has benefits for people with type 1 or type 2 diabetes,” Grace, who was not involved in the new study, continued. “The goal is to get people’s blood sugar so well controlled that they never have to worry about having diabetes complications like amputations, blindness, kidney disease, heart attacks, and stroke.”
Improving glucose management
To evaluate the CamAPS FX® closed-loop system, the authors of the new study randomly assigned 26 adults with type 2 diabetes to receive treatment with this system or with standard insulin therapy for 8 weeks. Then participants took a 2-4 week break, before switching to the other treatment for another 8 weeks.
Closed-loop insulin therapy significantly improved participants’ glucose management.
Participants spent 66% of their time in the target glucose range while receiving closed-loop insulin therapy, versus 32% while receiving standard insulin therapy.
Closed-loop insulin therapy was also linked to lower mean glucose and HbA1C levels. HbA1C is a test used to evaluate average glucose levels over the past 3 months.
“The benefits are around improving glucose levels, which was seen here, and ultimately through reducing the risk of complications of diabetes,” Dr. Robert Gabbay, MD, Chief Scientific and Medical Officer at the American Diabetes Association, told Healthline.
Gabbay added that more research is needed to evaluate the potential risks of closed-loop insulin therapy but noted that the findings from this study are promising.
None of the research participants developed severe hypoglycemia while receiving either closed-loop or standard insulin therapy, but one developed an abscess at the site where the closed-looped system’s insulin pump attached to the body.
“At this point, we need more studies like this one to show the effectiveness of automated insulin delivery for people with type 2 diabetes,” said Gabbay. “Most of the research [on closed-loop systems] has been around type 1 diabetes, and we are excited about this work looking at a group of individuals [with type 2 diabetes] who could benefit from this innovation.”
Using smart tech to close the loop
Multiple closed-loop insulin therapy systems are already available for people with type 1 and type 2 diabetes in the United States, but they’re hybrid systems—which means users still need to enter some information about their food consumption.
In comparison, the CamAPS FX® app in the new study provides a fully closed-looped system that doesn’t require users to enter any information about their snacks or meals.
This functionality relies on the app’s artificial intelligence-powered algorithm, which analyzes users’ CGM data to provide tailored insulin doses.
“Over time, the algorithm adapts to the observed glucose patterns, enabling more tailored and accurate settings,” said Grace. “So as it learns from you, it helps to minimize the variability in your glucose levels. Super exciting.”
Grace expects more fully closed-loop systems to become available in the future, including in the United States.
Reducing worry, increasing confidence
In some states, people who require insulin to manage type 1 or type 2 diabetes may already have access to CGM and closed-loop insulin therapy systems through their health insurance.
However, insurance coverage for these technologies varies across states and insurance plans.
Grace hopes that access to these technologies will continue to improve for people in the United States and other countries, which may not only reduce rates of diabetes complications but also improve quality of life.
Grace lives with type 1 diabetes himself and has experienced firsthand the improvements that automated diabetes technologies can provide.
“Five years ago, I was still poking my finger and delivering insulin injections,” he said. “Now I can wear my Dexcom CGM, and it’s hooked up to my Omnipod 5 [insulin delivery system], and the amount of stress that’s been relieved, the amount of worry that’s been relieved, and the overall sense of well-being and confidence in managing my diabetes have just gone through the roof.”
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