Primul “pancreas artificial” pentru tratamentul diabetului/The first "artificial pancreas" for diabetes treatment

Primul “pancreas artificial”, care regleaza autonom nivelul de glucoza din sange, va intra pe piata in primavara lui 2017 si promite sa schimbe radical viata persoanelor cu diabet. 
 

Biologic, insulina este produsa in organisme de pancreas. Cand acesta nu mai functioneaza corespunzator nu mai produce dozele normale de insulina si, astfel, apare diabetul zaharat. 

In cazul diabetului de tip 1, pancreasul produce putina insulina sau chiar deloc, aceasta fiind administrata prin multiplele injectii zilnice sau folosind o pompa de insulina. 
 
Administrarea cantitatii exacte de insulina de care organismul are nevoie are o importanta critica: o cantitate mare de insulina administrata duce la scaderea glucozei (zaharului) din sange, producand stari precum senzatia de foame, greata, oboseala, stari de lesin.
O cantitate prea mica de insulina inseamna multa glucoza in sange care va produce, in timp,  deteriorarea organelor. 

 

Medtronic a obtinut aprobarea FDA (Food and Drug Administration, o agentie nationala a SUA) pentru primul sistem "inteligent" care administreaza insulina cu input minim din partea utilizatorului. 
“Pancreasul artificial”, asa cum este denumit neoficial, este format (1) dintr-un senzor de glucoza situat sub piele, care masoara continuu nivelul de glicemie din sange si (2) o pompa de insulina care calculeaza cantitatea exacta de insulina de care corpul are nevoie si o administreaza printr-un cateter.

Ambele componenete ale sistemului se gaseau inainte pe piata, functionand ca device-uri separate.
Noutatea modelului MiniMed 670G vine din comunicarea dintre cele 2 componente: l
a fiecare 5 minute, senzorul  transmite nivelul de glucoza catre device.
In consecinta, device-ul (de marimea unui smartphone) pompeaza cantitatea necesara de insulina.

Singurul input din partea utlizatorului consta in introducerea manuala, inainte de fiecare masa, a cantitatii aproximative de carbohidrati din mancare. Astfel, device-ul va estima surplusul de insulina de care organismul are nevoie. 


Software-ul integrat in modelul 670G permite calcularea cu precizie a cantitatii necesare de insulina de care un organism are nevoie la un moment de timp. Aceasta precizie se datoreaza: nivelului de glucoza din sange (care este transmis la fiecare 5 minute de senzorul subcutanat) si cantitatii de carbohidrati de la o masa, introdusa manual de utilizator.

Sunt totusi mici erori care provin din exactitatea cu care utilizatorul estimeaza cantitatea de carbohidrati din mancare.


MiniMed 670G este primul sistem din lume folosit in terapia diabetului avand un nivel de automatizare foarte mare si input minim din partea utilizatorului.

Din pacate, este recomandat doar in cazurile de diabet de tip 1 si doar persoanelor peste 14 ani. Compania lucreaza la varianta dedicata copiilor intre 7 si 13.  

Folosind “pancreasul artificial”, persoanele cu diabet pot duce o viata normala fara sa isi faca griji despre nivelul de glucoza din sange din timpul somnului si fara sa aiba povara injectiilor multiple din timpul zilei. 


Pe langa avantajele evidente, sunt insa si cateva imbunatatiri care pot fi facute, una dintre ele fiind minimizarea dimensiunilor device-ului astfel incat sa fie mai usor de purtat.
O alta imbunatatire poate fi facuta reducand timpul in care insulina incepe sa isi faca efectul, dupa ce a fost injectata subcutanat (motiv pentru care utilizatorul trebuie sa estimeze cu ceva timp inainte cantitatea de carbohidrati din timpul mesei).
Scurtarea acestei perioade ar creste eficienta device-ului. 


Sistemul va fi comercializat incepand cu primavara anului viitor (2017) si are un pret estimat intre 5000 si 8000 de dolari, facandu-l inacesibil pentru multi.

Vestea buna este ca tot mai multe companii lucreaza la astfel de sisteme, cu mici diferente care constau in interfata, algoritmi sau grafica, dar cu aceeasi idee de baza. 
Ca o consecinta, acest tip de device va deveni mai accesibil in viitorul apropiat. 

EN: 

Insulin therapy is becoming easier and safer using the first “artifcial pancreas” that will be commercialized starting next spring (2017). 

 

Biologically, the pancreas is responsible for producing insulin in organisms. When the pancreas doesn’t work properly, it doesn’t produce the normal amount of insulin and in those cases, diabetes may appear.  

 

When a person suffers from type 1 diabetes, the pancreas does not produce enough insulin. This type is usually treated by multiple daily injections or the use of an insulin pump.

 


Delivering the exact amount of insulin is a critical issue: larger amounts of insulin than necessary lead to dropping of the blood sugar level, causing hunger, nausea, fatigueand fainting.  

 

Smaller amount of insulin leads to a higher blood sugar level which, in time, causes vital organs to deteriorate. 
 
 

 

Medronic has just received FDA (U.S. Food and Drug Administration, a government agency in the United States) clearance for the first, “smart” insulin pump, with minimal manual input.
 

 

This so-called “artificial pancreas”, is composed of (1) a glucose sensor placed below the skin which continuously measures the the blood sugar level and (2) an insulin calculator (calculating the necessary intake) and a pump which delivers the calculated amount of insulin through a catheter. 

 

Both components were available on the market earlier, functioning as two separate, individual devices. What is innovative about the model MiniMed 670G, is the communication between the 2 components.   
 

 

The glucose sensor transmits, every 5 minutes, the level of glucose to the calculator. The calculator then “tells” the pump (the whole device is no larger than a smartphone) exactly how much insulin to pump into the body. 
 

 

The only manual input by the user is, before each meal, the approximate amount of carbohydrates from food. 

 

This way, the device can better estimate the insulin “shot” that the organism needs. 

 

Additionally, the device is able to calculate, with a high degree of precision, the necessary intake of insulin for the user. This is based on the blood sugar level (transmitted every 5 minutes, by the sensor placed under the skin), as well as the amount of carbohydrates from food, which is manually entered by the user. 

 

There are still small deviations possible, caused by human error when estimating the amount of carbohydrates.  
 

 

MiniMed is the first system in the world with such a high level of automatization, but recommended only for type 1 diabeties for persons aged 14 or over. The company is now working on making it safe for children aged between 7 and 13. 

 

Using the “artificial pancreas”, diabetics can now have a normal life without being worried about their blood sugar level during sleep and without the burden of going through multiple, daily injections. 
 

 

Besides the obvious advantages, there are still some improvements that can be made, one of them being decreasing its size. 

 

Reducing the amount of time it takes for the insulin to reach the blood circulation from the pump (perhaps through increasing the pump pressure) is another example.

 

The device will be comercialized starting with the spring of 2017 with an estimated price between $5000 and $8000. The good news is that there are many companies developing the same kind of system with small differences in interface, graphics and algorithms, but with the same basic idea. Consequently, the accessibility of this type of device is expected to grow in the near future.