Bluetooth pancreas to help people with type 1 diabetes

An artificial pancreas now approved by the National Institute for Clinical Excellence - NICE - is set to help tens of thousands of children and adults living with type one diabetes. The ground-breaking device monitors a person’s blood glucose, and automatically adjusts the amount of insulin given to them through a pump. It’s all done wirelessly through bluetooth. It was developed by Cambridge University’s Professor Roman Hovorka...

Roman - So what we are talking about is a system which can control glucose levels in people who have type one diabetes. So we have a sensor which reads glucose. It goes into the computer program interpreter, which analyses the data, and then it has a device which delivers the right amount of insulin to give.

Chris - How does it all work and wire together and operate?

Roman - So we live now in the 21st century. So all the communication is Bluetooth. The computer program can sit on your smartphone.

Chris - In essence, then, a sensor is tasting the tissue fluid to work out what your blood glucose is. It's telling the computer program running on the smartphone that level all the time. And the smartphone is then computing what level of insulin to tell the pump to inject. Why is that better than the way we used to do it where you would just prick a finger, test a blood sample, inject insulin?

Roman - The reason is because we are all different and, not only we are all different, we are all different all the time. And glucose levels in your body need to be well controlled to avoid long term complications or health consequences. And it relates to the problem with your feet, with your kidney, with your eyes, with your heart. And it is very difficult for people to do so without this automatic management. They can do it, but it doesn't generally burn themselves out. Like parents would be waking up four or five times a night every night to manage and to check glucose levels. This device can do it on its own.

Chris - Presumably you've now got data showing that people who use this system achieve better long-term control of their glucose levels and therefore we think are likely to have better health outcomes compared to the more traditional way of managing diabetes.

Roman - So we should not forget that before 1920, when insulin was discovered, people uniformly died. Since then, there was a gap between the life expectancies, which until recently was about 20 years with type one diabetes. So that gap is closing and it's closing because we have better management of glucose levels and this technology will close the gap faster as well, but also will avoid the need of the mental burden of the challenge of managing it. Not just for the person with type one diabetes, but the whole family. So it's fantastic news before we have a cure, which would be fantastic as well. But right now this is the best thing we have before cure.

Chris - Is there a risk that people might get into bad habits if they know that there's something taking care of their blood glucose level all the time? Where previously they would've behaved themselves, is there a danger that they might adopt bad eating habits, just bad lifestyle habits, which are a plague of modern life anyway, but because they've got this looking after them, they can afford to take those risks, which previously they wouldn't have done.

Roman - Yeah, so our data does not show that. If anything, the amount of insulin needed is very similar. So we don't give more insulin without the system.

Chris - What's its fail safe mode? In other words, if it goes wrong, the phone goes flat or something. What does it do then to keep you safe?

Roman - That's a really important issue. Safety is the most important. On the insulin pump, which is part of the system, there is a pre-programmed rate. So if everything fails, people will still give the expected right amount of insulin.

Chris - With any kind of medical intervention, one always has to look at the bottom line - what is the cost? So what's the upfront cost of doing this? And is that more than mitigated by not just obviously the benefit to a person's quality of life, which you've outlined, but also if they avoid a lot of those healthcare related problems later because they've got better glucose control, does the saving later more than mitigate the increased upfront cost?

Roman - So the current calculation of the whole system is about 5,000 pounds per year, but some of the cost is already included because people are already allowed to use some of the technology itself. So the additional cost is much less than that. And indeed, if you look at the calculation, how much we save in terms of saving for long-term complications, how people live longer as well. So it's something which NICE considers when they do review the technology. And that was the reason why I accepted it because it is cost effective, the treatment as well. One thing which is becoming quite important. In the past it would be really just hard calculations. So you look at the cost. What is, for example, difficult to cost is the quality of sleep and quality of life. And I think it's very nice that the NICE right now acknowledges and they took the feedback from people with diabetes and their families and they didn't look just at their hard figures, but they also look at it, 'Hey, people can go back to work.' The moms, they can sleep through the night. All these things need to be added just to these hard calculations.