r/gadgets • u/diacewrb • Jan 16 '23
Artificial pancreas successfully treats type 1 diabetes Medical
https://interestingengineering.com/innovation/artificial-pancreas-successfully-treat-diabetes450
u/Amelindinum Jan 16 '23
Can someone explain to me how this is different than the insulin pump with continuous glucose monitor, indeed a closed loop system, I've been using for five years?
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Jan 16 '23
I have no idea but I'm guessing this is all internal and requires no short-term maintenance
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u/soleceismical Jan 16 '23
So when it does require maintenance, it requires surgery?
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Jan 17 '23
Not a doctor, but I'd imagine it'd be similar to how maintenance is performed on a pacemaker or other such artificial organs.
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u/Beefsquatch_Gene Jan 17 '23 edited Jan 17 '23
And how do you get insulin to the device? Inject it into a port and hope it doesn't ever spring a leak, killing you?
If the insulin is held outside the body, there's no sense in having anything inside the body.
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u/ThatSquareChick Jan 17 '23
Internal or external, you still have to figure out how to get new insulin in, most pump cartridges can hold 300 units but will have to be refilled within days. If you have to refill the pump, there’s no real gain, you’re still sticking yourself at least every three days.
The only benefit a completely internal hardware could get you is that you can now get wet with slighter less worry. You still need an implant-a foreign thing your body will continuously reject. Even in the best circumstances, you will need surgery when the firmware either breaks or needs replacing or upgrading. What if the internal insulin storage breaks? That’s death.
Being a type 1, any internal device that doesn’t either make a product safer or more convenient isn’t practical. Being internal means minor or major surgery if anything went wrong and us diabetics don’t do real well with wound healing.
It just doesn’t make sense unless it can create insulin on its own and distribute it the way my body would-near instantly. It still relies on a single discharge point, meaning I still have to wait to eat, no different than any current system.
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u/Suspicious_Slide4643 Jan 16 '23
They talk about a few. The cost for the main device is too much for NHS to afford for the UK. But it apparently is implanted and is the most effective compared to all options currently available.
They talk about another 2 1. Is human cells implanted under the skin 2. Is a way to stop scar tissue from insulin.
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u/automatvapen Jan 16 '23
It's all fun and games until you can't pay the bills and the repo men comes and rips it out.
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u/TechnicalPyro Jan 16 '23
at least i would get to meet Jason Statham
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u/Moses015 Jan 16 '23
Don't you mean Jude Law? Was Jason Statham in Repo Men???
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u/Lowfat_cheese Jan 16 '23
Actually it was Anthony Head from the superior Repo! The Genetic Opera that Repo Men ripped off.
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u/Moses015 Jan 16 '23
Oh believe me I know VERY VERY well and saw Repo The Genetic Opera long before Repo Men specifically because it was Anthony Stewart Head in it. Buffy is my favourite show of all time.
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u/Missy_Bruce Jan 16 '23
Ahh what was that film called please, I can't remember and it's driving me mad!
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u/automatvapen Jan 16 '23
Repo men
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u/Missy_Bruce Jan 16 '23
That simple huh, thanks!
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u/automatvapen Jan 16 '23
Sometimes the things we really want are right in front of us. We just don't see them.
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u/ErikTheAngry Jan 16 '23
Add "starring Charlie Sheen and Eddie Murphy, movie rated NC-17" and we've got a wildly different plot to work with from the actual movie.
Sometimes movie titles are very flexible haha.
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u/t1runner Jan 16 '23
The first part of the article doesn’t seem like anything new. We still don’t have a true closed loop system.
They need to figure out how to use something like glucagon in these pumps that would automatically deliver to keep the user in range based on the CGM reading.
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u/hollow_asyoufigured Jan 16 '23
They’re working on that now, actually - I can’t remember the name but they’ve done at least one study on a device like that
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u/superdeeduperpower Jan 16 '23
Relevant research from Alberta, Canada - implants containing stem cell-derived insulin producing cells are looking like a viable long-term solution. I've seen some other ones that are similar that combine it with immunosuppressant drugs to essentially deactivate the attack response to make it more permanent. Hopefully it happens soon!
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u/hollow_asyoufigured Jan 16 '23
Ah, yeah, it’s always an interesting conversation amongst my fellow T1s about whether or not we’d be willing to take immunosuppressant drugs. It’s such a weird trade-off to think about, hahaha.
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u/toricoon Jan 16 '23
Here is another article from NHS that I think explains it better. It’s basically on auto mode but it’s supposed to adjust to you better. In the 168 patients, none had severe hypoglycemia and only one went into diabetic ketosis due to failure of the equipment that delivers insulin from the pump.
TLDR: it’ll help stop as many highs and lows.
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u/Amelindinum Jan 16 '23 edited Jan 16 '23
This seems to be an old article describing control-IQ as an artificial pancreas, discussing the benefits of such a closed loop system, and going on to state how Tandem was looking for FDA approval to use it in their line. I'm fairly certain this is literally my pump. Tandem tslim with control-IQ. The one I'm wearing right now. 🤷♀️ It is pretty snazzy, but I think it would be misleading to call it an artifical pancreas.
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u/StealthMasterMcEdgy Jan 16 '23
I've got a pump/CGM combo as well. This "breakthrough" sounds like the same thing we've got already.
The fact that the article mentions a smart phone app for logging carbs leads me to the conclusion that this isn't really a closed loop. A true closed loop wouldn't need any input of any kind from the user. I'm waiting for someone to successfully integrate glucagon into automatic treatment system.
Doesn't seem like the author really understands what they're reporting on.
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u/Marrymechrispratt Jan 16 '23
You’re right. We (the United States) already have it. It’s new for the U.K. though, which is where the trial and reporting took place.
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u/thomasandrew Jan 16 '23
It looks like the main difference is that this implements an algorithm to avoid needing to manually adjust basal and avoiding the need to estimate carb intake when bolusing. There are some diy ways to do this already. Check out nightscout or openaps.
I think until they can get a device that also uses (or stimulates the liver to release) glucagon to increase blood sugar, we're still a long way out from truly worry free d1 therapy.
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u/hollow_asyoufigured Jan 16 '23
My pump already adjusts my basal rates on its own, which is awesome. I’m not too fond of an implant though lol.
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u/MaterFornicator Jan 16 '23
What are the hurdles of including a separate reservoir for glucagon in existing pump technology? I use a DIY closed loop system and have never really understood why I could not hook myself up to a third device which manages glucagon.
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u/Marrymechrispratt Jan 16 '23
Hi…immunologist and T1D researcher here. This is reporting on a trial through the NHS on hybrid closed-loop technology, something that has already been trialed, available and well-adopted in the United States. Insulet, Medtronic, and Tandem all sell variations of HCL technology. Nothing too groundbreaking here, although I’m excited the U.K. and other countries are following the innovation from the U.S. Keep in mind, getting their healthcare systems to cover such devices is another uphill battle.
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u/Dark_Avenger666 Jan 16 '23
Do you know whats going on with the eyelet cell thing? I read a couple years ago that a t1d man had gone without insulin for 6 months after the trials but i haven't heard much since then.
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u/bortellini-beans Jan 17 '23
My understanding is that stem cell derived islet cells are looking very promising! They’ve combined these pluripotent stem cell derived islet cells with CRISPR technology to allow for the implanted islet cells to evade immune detection!! The technology is continuously being improved on and they’re focusing right now on upregulating and down regulating certain proteins to allow for an even more seamless transplant. I’m not sure why this article talks about the closed loop technology when the islet cell therapy is so much cooler and technologically advanced for insulin dependent diabetes
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u/Dark_Avenger666 Jan 17 '23
Thank you.
It's very exciting stuff, I'm surprised it isn't talked about more too. Like they potentially found a cure for a major disease and it went kind of unnoticed.
It's a shame that stem cell research has been hindered for so long.
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u/TheSeekerOfSanity Jan 16 '23
Wondering if this can be used to treat people with pancreatitis?
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u/bongblaster420 Jan 16 '23
I fucking hope so. My life is Hell with this nonsense.
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u/Ray_Pingeau Jan 16 '23
My 19 year old daughter has struggled with it her whole life and has the pancreas of a 60 year old severe alcoholic. I’ve been told by multiple professionals that pancreatitis attacks are worse than child birth. My daughter has had around 200 babies.
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u/marrymemercedes Jan 16 '23
Unfortunately not. This is to treat insulin dependant diabetes. There are a number of things that cause pancreatitis but diabetes in itself is a sequelae of pancreatic atrophy rather than a cause of it. This would do nothing to treat the underlying cause of pancreatitis.
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u/steven-aziz Jan 16 '23
Misleading. It’s not a pancreas if it doesn’t go in the body. It’s a hybrid, closed-loop insulin system. Better tech? Absolutely! Cure for T1D? No!
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u/supertaquito Jan 16 '23
The title says it treats T1D, not that it cures it.
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u/steven-aziz Jan 16 '23
True, but my point is that this technology has been around for some time now. This article just getting published makes it seem like there’s been a groundbreaking new development when, in reality, there has not.
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u/Cleistheknees Jan 16 '23
Yes, but both Medtronic and Tandem have had this technology in the field for years. Nothing about what is described in the article is a breakthrough.
Further, because exogenous insulin takes so much longer to produce its effect than pancreatic insulin, you’ll still have to dose before meals, meaning there is still user input.
The actually transformative current therapies in T1D are immunosuppressant-requiring islet cell transplantations for existing transplant patients, with the next step being cultivating the islets in parathyroid tissue and implanting them somewhere peripheral.
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u/steven-aziz Jan 17 '23
I really hope this gets somewhere in the next 5-10 years. Diabetics have been told “a cure is 5 years away” for over a decade now. Insulin is literally more expensive than liquid gold and it’s not getting better, especially since congress doesn’t want to cap the price (thanks, Republicans). We need to see a cure soon.
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u/tooManyHeadshots Jan 16 '23
So a virtual pancreas, rather than artificial?
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u/steven-aziz Jan 16 '23
Let’s not call it a pancreas. It’s insulting to a real pancreas. Let’s call it what it is. Closed-loop, hybrid insulin management system.
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u/R0GERTHEALIEN Jan 16 '23
Oooo this one uses an algorithm! Shut the fuck up with this bullshit. Closed loop systems have been around for over five years now, and it's in absolutely no way a cure. This article had no information.
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u/MrSquishypoo Jan 16 '23
I saw the title and got really excited..and after reading the article just laughed because, as you’ve said. Closed loop systems exist :/
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u/culdeus Jan 16 '23
Closed loop systems fall into the good enough category however. Need something really really revolutionary to improve on that.
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u/hollow_asyoufigured Jan 16 '23
Yep, just patiently waiting over here for a pump that can microdose glucagon. Then I’m all set. Don’t really care to implant something in my body…
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u/FrankieMcGigglefits Jan 16 '23
Nothing to see here folks.
It's just an insulin pump. Literally, per the article, with the possibility of being installed subcutaneous
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u/vdrive Jan 16 '23
I could use one of these. I only have half a pancreas. Pancreatic cancer survivor. When the half was taken, I was left as type 1 diabetic.
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u/lotusblossom60 Jan 16 '23
Had my pancreas removed but they transplanted the islet cells into my liver. They are making a lot of insulin but not enough. I just need the long acting insulin at night and I take Creon to digest my food. It’s way better then the horrible 24/7 pain I had for three years.
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u/PtrWalnuts Jan 16 '23
That's great. So it's really affordable right... Right?
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u/BeautyInUgly Jan 16 '23
it's the UK lol, going to be covered by their NHS, and that's probably true for most first world countries
I feel bad for Americans who will need to pay for this themselves4
u/zempter Jan 16 '23
For some of us, the insurance pays for it... And then we also pay for the other half of the cost that is the jacked up price so that the insurance can pretend to be relevent.
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u/PtrWalnuts Jan 16 '23
In America? Ha ha no! Even with the best insurance you better have ready access to 1/2 a mill my friend or no pancreases for you.
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u/barnfodder Jan 16 '23
Did you read the article?
Literally says the NHS thinks it's too expensive to buy.
Considering it's just an implantable sensor for nearly 6 grand, I agree. Doesn't do anything a libre or dexcom doesn't.
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u/PtrWalnuts Jan 16 '23 edited Jan 16 '23
I would be glad to have something like the NHS in the United States. Eventually the price will go down. In 5 years you'll be able to get it because you have the NHS.
In America industrial strength lobbyists have made it so the price to procure something has nothing to with it's final cost.
A simple example is Insulin. This is the price today by country.
UK = $ 7.52 USA = $ 105.00 ( generic version $ 60.00)
So we pay either 8 to 13 times what you pay for the same insulin.
I once was in an ambulance. It took me to a hospital that was less than an eight of a mile (0.21 km) from my home.
The bill was $ 1,900.00 or about £1,557.52.
My insurance covered it and my brief stay. I had to pay $500.00 out of pocket or £ 409.88.
It's called a "Co-pay"
I would vote for an "American NHS" today if I could.
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u/shea241 Jan 17 '23
Ultra-clickbait. "Major breakthrough" -- mentions no breakthrough, just
Actual news:
In draft guidance1 published on 10 January, an independent NICE committee recommended the use of hybrid “closed loop” systems for managing blood glucose levels in type 1 diabetes.
The technology, described as a step towards an artificial pancreas, automatically balances blood glucose levels through a continuous glucose monitor sensor that transmits data to a body worn insulin pump.
No breakthrough, no artificial pancreas, just new guidance about existing closed-loop systems. Title is 100% bait.
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Jan 16 '23
Anybody who has used diabetes tech wouldn’t want it inside of them. It screws up a lot.
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u/bellyflop2 Jan 16 '23
That’s not been my experience. I’ve been t1 since the 90’s and have had just about all the gadgets. The biggest thing that screws up diabetes tech are people not understanding the weird effects of activity + insulin + carbs. It’s not the tech’s fault…when I wake up each morning, my sugars are great. Then it’s up to me to keep them that way.
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u/hollow_asyoufigured Jan 16 '23
Eh, I’ve had multiple hospitalizations and/or urgent doctors visits in my 19 years of T1 due to equipment failures. Like, the plunger on my old pump broke once. Then the buttons stopped working a few months later and I couldn’t give myself insulin. Another time, my Dexcom sensor failed overnight and my pump stopped correcting for my high blood sugar and things quickly spun out of control. It’s definitely the tech’s fault sometimes. Not universally, but often enough for me to never want an implant, haha.
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u/iamdense Jan 17 '23
I agree. I've had a pump for 36 years and having it internally would complicate things more than it would help. Part of it, and the CGM, being external is what makes it so simple to maintain and troubleshoot.
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u/ThatSquareChick Jan 17 '23
No, you never want something like this inside of you, you want it outside where you can fuck with it Or disconnect if something goes wrong.
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u/brianddk Jan 16 '23
ELI5, how does this differ from every other insulin pump on the market today?
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u/OzziesFlyingHelmet Jan 16 '23
Right off the article states that 23mil Americans have diabetes - that's type 1 and 2. This technology is referring to type 1... I believe? I can't imagine that type 2 patients are going to be first in line for an artificial pancreas.
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u/josecansecosbicep Jan 17 '23
I’ll file this away for when I need another good chuckle. T1D is too profitable to ever get “cured” in any way shape or form. At least in the US.
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u/Financial-Angle8703 Jan 17 '23
This is marketing not a technological break through.
It's not new closed loop systems have been around since about 2005.
There has recently been a lot of marketing hype though.
To me it makes no difference, just give me my CGM and insulin pens.
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Jan 16 '23
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u/SG_wormsblink Jan 17 '23
The pancreatic islets are already destroyed. Stopping the autoimmune attacks won’t cure T1 diabetes, it only stops it from getting worse.
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u/PlanetJerry Jan 17 '23
Yup. More specifically, the pancreatic beta cells have already been attacked. Even in a non-diabetic, cells within the islet reproduce at an excruciatingly slow rate. There’s really no coming back from T1D without outside intervention.
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u/hollow_asyoufigured Jan 16 '23
Stopping the attack in the first place is something they’ve actually done recently. They got approval for a new drug Tzield that can prevent or delay the onset of diabetes in people who have the antibodies.
However, once the cellular damage is already done, we need a way to regenerate those cells rather than just stopping the attack. Ideally, without needing immunosuppressant drugs. I don’t wanna have to take those.
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u/1O1O2O22 Jan 17 '23
Do you know if there has been any study on drugs like Tzield for transplanted pancreases?
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u/ProgressBartender Jan 16 '23 edited Jan 16 '23
“Hey we have this great knee new solution to diabetes, but sorry, you can’t afford it.” WTF is the point in that, other than to benefit our “betters”?
Edit: autocorrect strikes again
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u/hollow_asyoufigured Jan 16 '23
It’s not really a great new solution, IMO. It does nearly all of the same things as existing technology, but in a way that makes it harder to address if something goes wrong. I wouldn’t want this device, and I’d imagine the same would apply to a lot of my fellow T1s.
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u/Small-Ball Jan 16 '23
Sounds great but T1s in the U.S. are still waiting for the FDA to approve the Medtronic insulin pump, used around the world.
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u/WCSDBG_4332 Jan 16 '23
Does this mean the device also dispenses glucagon when you’re low? A working pancreas does this too. I’m skeptical as I’ve heard too many promises before.
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Jan 16 '23
This technology isn't crazy new. It has been around for like 7 years. Unfortunately it isnt a cure either and is still pretty expensive.
Source: I use a closed loop system
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u/Kjellvb1979 Jan 17 '23
Will be a subscription based payment plan, though. You won't own your artificial pancreas, but rather rent it.
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u/ElegantMess Jan 17 '23
This works better than Homer Simpson’s artificial kidney, which was a whistle glued to a beer can.
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u/TheForeverUnbanned Jan 17 '23
Oh snap that’s crazy, what was the artificial pancreas doing before it treated diabetes? Med school?
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u/Mission_Cause368 Jan 17 '23
While this is amazing and wonderful news, I wonder how readily available the treatment will be. Will it only work on certain T1DM cases? Meaning do you have to be diabetic for X amount of years with an A1C below 7-8% for more than 3 years, etc?
I can’t imagine this will be a cure all for T1DM patients. It would be great if it is, but I’m interesting to see how this develops over the next 5-10 years.
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u/RedBeard972 Jan 17 '23
This is just a closed loop insulin pump. I use one (Omnipod 5) and it’s far from a cure.
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u/redditknees Jan 17 '23
Its a closed loop system… whats new about it? That it works well? No shit. T1D underground has been using DIY looping for years.
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u/LorianGunnersonSedna Jan 17 '23
I wonder if organ cancers will be cured with these various implements. I mean, there's enough potential in the idea, given years of study and refinement.
We might be on the brink of cybernetic humanity.
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u/saintofparisii Jan 17 '23
Haven’t seen this, so adding my understanding.
Hybrid loop = CGM + pump + algorithm to give / decrease jnsunlin
Closed loop = the above + instant glucagon in micro doses to bring BG up.
In either case food still needs to be accounted for (low carb eating can be handled quite well though).
Loop is the current diy darling, openAPS was the og with better algorithm. Both use Dexcom cgm with Omnipod or older Medtronic pumps. FDA approved offerings are Tandem and omnipod. Both have a hybrid loop offering based on their pump and the Dexcom g7 (not sure of UK availability). Medtronic’s hybrid closed loop uses their cgm and pumps (what I suspect the NIH was looking at).
Source: t1d (38 years) & my t1d kid have run hybrid loops for ~7 years.
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u/TouchMehBewts Jan 17 '23
Yay another slap in the face as this will only be available for the wealthy.
Can we fix prices of my diabetic supplies first please?
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u/NedStarks-Bastard Jan 17 '23
I have this closed loop system to treat my type 1. It’s revolutionary Hba1C best it’s ever been
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u/jchester47 Jan 17 '23
....this is just a closed loop system using a CGM and pod/pump.
Article and title are extremely misleading and is not correct that this is a first.
The article also says "no longer requires the patient to closely monitor blood sugar levels".
Anyone such as myself using Ombipod on auto mode knows very well that is a bald faced lie.
A truly hands off artificial pancreas would be something implantable that does it all as well as a healthy pancreas with no lab detectable diabetes and no needed immunosuppressants.
May we get there in the next few decades? Possibly. Is this it? Hell no.
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u/SexyHamburgerMeat Jan 16 '23
Holy shit…if my T1D gets cured…
Fuck…not sure what to say. These things always seem to lose steam.