The life-changing artificial pancreas

An artificial pancreas is helping protect very young children with type 1 diabetes.

Develop

Management of type 1 diabetes is challenging in very young children because of a number of factors, including the high variability in levels of insulin required and in how individual children respond to treatment, plus their unpredictable eating and activity patterns. Children are particularly at risk of dangerously low blood-sugar levels (hypoglycaemia) and high blood-sugar levels (hyperglycaemia).

Previous studies have linked prolonged hyperglycaemia in children with type 1 diabetes with lower IQ scores and slower brain growth. To manage children’s glucose levels, doctors increasingly turn to devices that monitor glucose levels continuously and deliver insulin via a pump that administers it through a cannula inserted in the skin. These devices have proved successful to an extent in older children, but not in very young children. Current technology – sensor-augmented pump therapy – requires parents to review their child’s glucose levels using a monitor and then manually adjust the amount of insulin administered by the pump.

Professor Roman Hovorka, from the Wellcome-MRC Institute of Metabolic Science at the University of Cambridge, has developed an app – CamAPS FX – which, combined with a glucose monitor and insulin pump, acts as an artificial pancreas, automatically adjusting the amount of insulin it delivers based on predicted or real-time glucose levels. It is a ‘hybrid closed-loop system’, meaning that the child’s carer has to administer insulin at mealtimes, but at all other times the algorithm works by itself. Research has shown that it is safe to use and more effective at managing bloodsugar levels in children compared with other technology.

Professor Hovorka explained: “CamAPS FX makes predictions about what it thinks is likely to happen next, based on past experience. It learns how much insulin the child needs per day and how this changes at different times of the day. It then uses this to adjust insulin levels to help achieve ideal blood-sugar levels. “Other than at mealtimes, it is fully automated, so parents do not need to continually monitor their child’s blood-sugar levels.”

CamAPS FX application, insulin pump and glucose monitor. Photo credit: Julia Ware
CamAPS FX application, insulin pump and glucose monitor. Photo credit: Julia Ware

Deliver

CamAPS FX is already having an impact on the lives of children and their families. It is available through a number of NHS trusts across the UK, including Cambridge University Hospitals NHS Foundation Trust, and the team hopes it will be available even more widely. The development of this technology has been supported by Eastern AHSN (Academic Health Science Network), which is part of the wider Cambridge health ecosystem, to turn the innovator’s idea into positive health impact in the region and beyond.

Over the past three years, Sam Wright, mother to Sofia, has experienced the steep learning curve any parent of a child with type 1 diabetes has to undergo. In the first few months of Sofia’s diagnosis, finger-prick tests were a regular occurrence to understand bloodglucose levels throughout the day. Sam also had to set alarms at night so she could check her daughter’s bloodglucose levels. If Sofia’s levels were high or low, Sam would have to administer a corrective dose and then wait until her levels were moving in the right direction before going back to sleep, an exhausting process for both every night. In January 2020, Sam was introduced to the CamAPS FX app – and she hasn’t looked back since. “I have full trust in the CamAPS FX app and, for the first time since the diagnosis, I feel like I can relax,” she says. “The time Sofia spends within her target blood-glucose range has improved and it is much easier now to control her levels. It’s a complete weight off my shoulders.”

Sam says it makes sense for children of Sofia’s age to have the closed loop, because their bodies are constantly changing how they respond to insulin. It is an extremely difficult ask for a parent to manage their child’s condition without significant highs and lows, whereas the app learns and adapts instantly. It is beneficial for the child’s long-term management of the condition and enables children and their parents to sleep at night. “I would never be without the app,” says Sam. “It is something looking out for you, so you don’t have to worry. “To anyone considering it, just go for it. It is a game changer, and you won’t look back or want to be without it once you’ve had it. I completely believe it is so beneficial for both the parents and the child.”

Sofia (left) and Sam Wright. Photo credit: Phil Mynott
Sofia (left) and Sam Wright. Photo credit: Phil Mynott

Governance

Cambridge University Health Partners (CUHP) was established in 2009 as a private company limited by guarantee with charitable objects....

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