The Juvenile Diabetes Research Foundation’s announcement yesterday of a partnership with Animas Corp. and DexCom Inc. to develop a first-generation automated insulin delivery system brought to my mind a question that is often debated in diabetes circles: Would a fully automated “artificial pancreas” represent a “cure” for type 1 diabetes?
Many say no. After all, it’s a machine—two, in fact—that the user must wear at all times. Even if the “loop” is fully “closed” so that glucose control is completely automatic, the user would still have to interact with the insulin pump and the glucose sensor to replenish the insulin supply and regularly switch insertion sites, just as wearers of the current separate devices do. And of course, occlusions and malfunctions would remain possibilities.
On the other hand, consider what a fully closed-loop system would mean to type 1 diabetes patients like me. Even though I currently wear a pump and have used continuous glucose sensors, my diabetes control is far from ideal. Here’s a typical reason why: Tuesday night I had dinner with a friend. I gave myself a pre-meal insulin bolus, but in the midst of conversation I didn’t bother pushing the pump’s buttons again after eating more carbs than I had dosed for.
So of course my blood sugar was high at bedtime. I did give myself more insulin then, but not enough to fully “correct” because that could have pushed my blood sugar too low during the night, a particularly scary prospect since I live alone. Never once have I gone to bed at night without the fear that I might not wake up the next morning.
Wednesday morning I did wake up…with a high blood sugar and a lot of guilt. In my case it’s not for lack of knowledge or education or insurance coverage or access to care. It’s simply that I’m a human being, trying to live a relatively normal life despite a condition that demands constant attention.
So would an artificial pancreas be a diabetes cure? Well, Webster’s dictionary defines “cure” as “recovery or relief from a disease.” The diabetes would still be there, so it’s not really “recovery.” But a “relief?” The only problem with that definition is that it’s an enormous understatement.
—Miriam E. Tucker (@MiriamETucker on Twitter)