Diabetes: towards “a therapeutic revolution” thanks to the artificial pancreas

For thirty years, World Diabetes Day, organized this Monday, November 14, has raised awareness of a disease with galloping incidence, whether it is type 1, insulin-dependent, or type 2, a disease of overweight, inactivity and advancing age. In France, 4 million people live with diabetes, a chronic disease at the heart of two realities: colossal progress in care, bringing hope, and a daily life that is still difficult.

Professor Eric Renard is the head of the endocrinology-diabetology department at Montpellier University Hospital.

Professor Eric Renard, at the Montpellier University Hospital, is witness to the spectacular progress in care.

A communication from the United States last month evokes the prospect of a fully automated bionic artificial pancreas for type 1 diabetics. You have been working on the artificial pancreas for a long time, can you believe it?

It takes more than believing. The artificial pancreas is now used in routine care for diabetics type 1. In Montpellier alone, 260 people are equipped with an artificial pancreas that combines an insulin pump, a sensor that measures the glucose level continuously. The flow rate of the pump will be adapted accordingly. The systems we use are already made in the United States. The “bionic” will be quite close to ours. In France, three manufacturers are used: Medtronic, Tandem and Diabeloop, which has pump problems.

But they are not fully automated…

Patients must announce to the device when they are going to do a physical activity, or when they are going to have a meal, to activate the algorithm, because the delivery of insulin is too slow. But it is no longer necessary to prick your fingertip. For a fully automated system, we do not yet know how to take into account the complex glycemic movements. However, the system operates autonomously at night.

Are we moving towards a democratization of these devices?

Yes, it is accessible for all type 1 diabetic patients, as long as they know how to count carbohydrates and how to use the system, but there is therapeutic education in this sense, they are taught how to manage the system. many patients are candidates: in one year, 259 artificial pancreas were installed in Montpellier, there are 10,000 in France. This is the best system for type 1 diabetics, they are potentially all eligible from the age of 6 years. At the Montpellier University Hospital, we have equipped a cohort of 120 children whom we have been following for almost three years now, with satisfactory results.

Their lives are transformed…

This morning, I saw several patients in consultation, they are indeed transformed, they no longer have to worry about their basic blood sugar problem. They hardly suffer from hypoglycaemia any more, and what is spectacular is to see how much they have rediscovered a joie de vivre, a forgotten carelessness.

Is it really the most spectacular technological advance?

For type 1 diabetics, yes, it’s really a therapeutic revolution that greatly relieves patients and a priori, avoids future retinal and renal complications. We will soon start a trial of artificial pancreas in children, via pump patches, as soon as diabetes is diagnosed. They will never know the injections! At Montpellier University Hospital, we implanted the first prototype of artificial pancreas in 2002, it was a world first. And 1,750 type 1 diabetics are on insulin pumps, which were also the subject of a world first in 1981.

Are the pump problems, mentioned in recent years by patients on a Medtronic pump, solved?

Overall, yes.

New molecules against type 2 diabetes will also help you lose weight

And for type 2?

There are some who are on insulin, but for the moment, they are not put in an artificial pancreas, the device is not approved. There are a lot of innovations too, but the progress comes mainly from new drugs that take care of diabetes but also protect the kidneys, the heart… it’s a more global approach than just controlling blood sugar.

Is the search still active?

Yes, new molecules will appear and will even make it possible to lose weight, which is interesting because most type 2s are overweight. It’s very spectacular, people can lose up to ten kilos, research is very advanced. In about twenty years, things that were part of basic research have entered everyday life.

There are four million diabetics in France. Research has focused on this disease because it does a lot of damage, and it is very expensive with its complications. A lot of resources have been put into financing innovations

The question that remains, and that annoys, is the progression of the disease, whether it is type 1 or type 2…

Yes both. There is a lot to be done on the prevention of type 2 diabetes, the prevalence of which continues to increase as a result of a sedentary lifestyle and poor diet, but rather in disadvantaged social classes, even if there is a genetic determinism.

The figures for type 1 diabetes are also increasing, especially in very young children, less than 1 year old, for obscure reasons. We don’t know if there are viral factors, or environmental factors… There are people who released a type 1 after the Covid. We see that the more countries modernize, the more type 1 diabetes develops. Type 1 diabetes is most common in Scandinavian countries.

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Diabetes: towards “a therapeutic revolution” thanks to the artificial pancreas

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