Can a dual-hormone closed loop delivery systems become a “technical cure” of diabetes?
The dual hormone (insulin and glucagon) ‘‘artificial pancreas’’: Promises and challenges
Achieving tight glycaemic control without severe hypoglycaemia still is a major challenge in insulin-treated diabetes. While curative cell based and immunological therapies could theoretically provide the ideal solution for patients with diabetes, there are still many issues to be solved. Closed-loop technologies may provide a more promising alternative for the near future, although various challenges will still need to be overcome to safely avoid hypoglycaemia and still achieve good blood glucose levels in a closed-loop setting.
From a controlling perspective, a major challenge is the use of exogenous subcutaneously (s.c.) applied insulin with a rather slow onset and long duration of action, which is unable to react fast enough to the wide and highly variable range in insulin requirements under different physiological conditions. To put a physiological break on the insulin action when blood glucose tends to go low, bihormonal artificial pancreas (AP) systems are being developed which, in addition to insulin, use human pancreas hormone glucagon to counteract the effect of insulin. Glucagon leads to a rapid conversion of hepatic glycogen (the stored form of glucose) into glucose which is then released into the bloodstream. A number of academic working groups have demonstrated short-term efficacy and safety of automated insulin and glucagon delivery among people with type 1 diabetes mellitus [[i]] [[ii]] [[iii]] [[iv]]. Glucagon’s effects on reducing caloric intake and increasin Continue reading