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Hope in the Making

Friday, 14 September 2012

By creating an artificial pancreas, Dr Roman Hovorka and his team hope to improve the wellbeing of children with Type 1 diabetes. Luke Turton reports on this Freemason-funded medical breakthrough

At Addenbrooke’s Hospital in Cambridge, Dr Roman Hovorka sits on a bed. In his hands he holds a small black device about the size of a DVD box. If it performs as Hovorka hopes, it will help children with Type 1 diabetes to sleep through the night, calm the nerves of their anxious parents and reduce the likelihood of the long-term complications that can come from low blood glucose such as blindness.

The black box in Hovorka’s hand is a computational device that wirelessly connects a tiny glucose sensor sitting just under the skin with a pager-sized pump that delivers insulin into the body through a catheter. Together they can do the job of a healthy pancreas.

In 2007, The Freemasons’ Grand Charity donated £50,000 to diabetes charity JDRF to help fund research commissioned by the University of Cambridge into an artificial pancreas for children that would take place at the Wellcome Trust Clinical Research Facilities at Addenbrooke’s Hospital. It could be used overnight to monitor blood glucose levels and administer insulin automatically. Five years later, Hovorka and his colleagues are at the testing phase with technology that has the potential to bring relief to not just the 29,000 children in the UK with Type 1 diabetes but to young sufferers worldwide.

Type 1 diabetes can occur at any age, but is most commonly diagnosed during childhood. With this type of diabetes, the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. People with Type 1 diabetes must therefore carefully monitor their glucose levels every day and inject insulin. Children are a particularly vulnerable group: they do not necessarily understand the seriousness of their condition or comprehend that if they do not keep a tight control over their glucose levels they may begin to see the early signs of complications in their late teens or early 20s.

The artificial pancreas has the potential to help protect these children by automating what was previously a manual process. The computational device receives data from the glucose sensor that it processes in order to advise how much insulin is needed, which the pump can then automatically deliver. Hovorka describes the artificial pancreas as ‘closing the loop’, with the devices able to talk to each other without the need for human intervention.

‘Closing the loop is an old idea. A group in Canada and Germany came up with it in 1979. There was even a commercial device about the size of a fridge that cost $50,000. For around 20 years, people tried to make it smaller and implant it into the body but it never worked,’ explains Hovorka, who is a mathematician by training. ‘Then in early 2000, Medtronic came up with a sensor that could sit outside the body and monitor the glucose on the skin. When I saw the data, the current levels of treatment and control, it clicked that if we combine the devices we can improve the lives of those with the condition, as well as those of their carers.’

Hovorka is keen to emphasise that the artificial pancreas is an interim measure, what he terms a bridge to cure, but that it can nevertheless be a crucial component in the management of Type 1 diabetes for the short to medium term: ‘Biological research could provide the final cure but I believe that’s 20 to 30 years away. In the meantime, closing the loop is low-hanging fruit. We can make the devices smaller, we can do things like combining the sensor and pump – we are not aiming for perfection but for gradual improvement.’

A trustee of The Freemasons’ Grand Charity, Dr Charles Akle, sat on the committee that decided to fund the research. He echoes Hovorka’s point about why the artificial pancreas is so valuable. ‘People think that medical advances happen in huge leaps, but it’s not the case – sometimes you jump a couple of steps with incremental improvements,’ he says, adding, ‘I’m a Freemason and what makes me tick is the philanthropy. Because I have a clinical and research background, I was asked if I could sit on the committee to look at all these applications for worthy causes. The decision process is always difficult, but it is made easier when we are certain that projects have the potential to succeed – which we felt this did from the beginning.’

After the Daily Mail reported on the Cambridge team’s work in June this year, Hovorka received an email from a family who had a child with Type 1 diabetes. ‘They were two doctors and they explained how their child was missing school because of chronic fatigue syndrome,’ he explains. ‘People can see that this technology is in reasonable shape and can revolutionise the way Type 1 diabetes is managed, so there’s been enormous interest from families.’

Over the last five years, research nurse Janet Allen has been diligently recruiting children to come and try out the artificial pancreas in a special hospital ward at the Wellcome Trust Clinical Research Facilities. ‘We started off by signing up 12 children between five and 18 who had Type 1 diabetes. There had been a lot of media attention about the research so they were easy to sign up. We compared controlling glucose with a computer in a hospital to how they managed the condition at home and the first pilot study results were very encouraging.’

Janet describes the dawning realisation by parents when they first see the tight control that the artificial pancreas is able to achieve. ‘Hypoglycemia is the real fear. It’s where the glucose drops suddenly and tends to happen more frequently overnight. That’s the reason parents are so nervous with their kids ­– they don’t sleep at night and are up two or three times checking their child’s glucose levels. With the artificial pancreas doing this automatically, the parents in our focus group said half their worries were gone.’

With the trials moving on from overnight stays for the children to 24-hour tests and then 36-hour, Janet is full of admiration for the resilience of both the children and their parents. ‘They’ve been so patient and positive. We need to insert a tube into the child called a canula to take blood samples, but they understand that’s part of the study. When they see the results, they’re so happy and I’ve sometimes felt very sad to turn the computer off because after one hour you see the glucose go sky high when it’s been in a steady state during the night.’

The next stage of testing for the artificial pancreas sees the devices being used overnight in children’s homes. While the hope is that the technology will function in exactly the same way, a whole host of new factors come into play once the test subject steps out of a hospital ward and into the real world. ‘Once people think that the system can work, they can get a little bit careless with the treatment,’ says Hovorka. ‘It’s about finding which group will benefit the most. We also have to justify the artificial pancreas on an economic basis, weighing up the benefits against costs. The big push is then how we take this to market – we can do only so much and then the commercialisation happens with big companies getting involved.’

Theodore Collins is an eight-year-old who has been part of the hospital trials. If his experiences are anything to go by, then the artificial pancreas deserves to find a global audience. ‘When I took part I was one of the youngest children and so nervous. Everyone took care of me and was extremely kind. I felt brilliant helping to achieve the artificial pancreas goal – I wanted to help all the children in the world who have Type 1 diabetes,’ he says. Asked what the artificial pancreas would mean for him, Theodore doesn’t hesitate. ‘Better blood sugars all day, freedom to be a child doing any sport and no worries throughout the night. My mum and dad can finally relax and not wake up. More importantly, it would mean having a normal life again.’


Healthier for Longer

For more than four decades JDRF has been searching for new ways to treat Type 1 diabetes. ‘It’s run by people with Type 1 diabetes for people with Type 1 diabetes. We get no government funding so committed individuals give us what they can afford, as well as foundations and trusts such as The Freemasons’ Grand Charity. Getting ideas out of the laboratory and into the clinic is crucial to JDRF – enabling that first transition from Petri dishes, to animals, to humans. Roman Hovorka had some great ideas in simulation and our funding allowed him to trial them in the real world,’ says JDRF’s Head of Research Communication, Rachel Connor.

‘We are not just pursuing the artificial pancreas, we also want to cure Type 1 and prevent it – JDRF put $170 million into lots of different types of research last year,’ she adds. ‘A cure would allow people to make their own insulin but this would involve a restoration of the cells that produce insulin as well as stopping the destruction of these cells. While the artificial pancreas is not a cure, it could have a transformative function in keeping people healthier for longer. I’d like to say that in three years we’ll have first generation machines being used outside of a clinical setting, but there’s a lot to do.’

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