People with type 1 diabetes who used a bionic pancreas instead of manually monitoring glucose using fingerstick tests and delivering insulin using a pump were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs. The full report of the findings, funded by the National Institutes of Health, can be found online June 15 in the New England Journal of Medicine. 
 
 The researchers - at Boston University and Massachusetts General Hospital - say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type 1 diabetes walk an endless tightrope. Because their pancreas doesn't make the hormone insulin, their blood glucose levels can veer dangerously high and low. Several times a day they must use fingerstick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump. 
 
 In two scenarios, the researchers tested a bihormonal bionic pancreas, which uses a removable tiny sensor located in a thin needle inserted under the skin that automatically monitors real time glucose levels in tissue fluid and provides insulin and its counteracting hormone, glucagon, via two automatic pumps. In one scenario, 20 adults wore this device combination and carried a cell phone-sized wireless monitor around Boston for five days, unrestricted in their activities. In the other, 32 youth wore the device combination for five days at a camp for children with type 1 diabetes. Both groups were also monitored for five days wearing their own conventional pumps that deliver insulin. 
 
 "The bionic pancreas system reduced the average blood glucose to levels that have been shown to dramatically reduce the risk of diabetic complications," said co-first author Steven Russell, M.D., Ph.D., assistant professor of medicine at Massachusetts General Hospital. "This is tremendously difficult with currently available technology, and so most people with diabetes are unable to achieve these levels." 
 
 The researchers found about 37 percent fewer interventions for low blood glucose (hypoglycemia) and a more than twofold reduction in the time in hypoglycemia in adults using the bionic pancreas than with the manual pump. For adolescents using the bionic pancreas, results showed more than a twofold reduction in the need for interventions for hypoglycemia. As well, both groups had significant improvements in glucose levels with the bionic pancreas, particularly during the night. 
 
 "The performance of our system in both adults and adolescents exceeded our expectations under very challenging real-world conditions," said Ed Damiano, Ph.D., the paper's senior author, an associate professor of biomedical engineering at Boston University and the parent of a son with type 1 diabetes. 
 
 "A cure is always the end goal," he said. "As that goal remains elusive, a truly automated technology, which can consistently and relentlessly keep people healthy and safe from harm of hypoglycemia, would lift an enormous emotional and practical burden from the shoulders of people with type 1 diabetes, including my child and so many others." 
 
 Just as a thermostat helps control a home's temperature, the normal pancreas senses blood glucose levels and adjusts the hormones that control it. People with type 1 diabetes, whose pancreas produces little or no insulin, have been using the equivalent of a manual thermostat, needing constant checking and adjustment. A bionic pancreas - like the one used in these studies - would function more like an automated thermostat, automatically monitoring blood glucose and delivering insulin or glucagon when needed to keep glucose within the normal range. As well, these bionic pancreas devices could be monitored remotely by the patient's medical provider or parent. 
 
 "With promising results such as these, we plan to support larger multicenter trials of the artificial pancreas in the near future," said Guillermo Arreaza-Rubín, M.D., the project officer for artificial pancreas studies funded by the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Within the next few years, we hope these technologies will go beyond experimental trials and be available to benefit more people with type 1 diabetes." 
 
 "The landmark Diabetes Control and Complications study - also funded by NIDDK - has long shown that maintaining as normal a blood glucose level as possible early on can stave off complications, including heart, kidney and eye diseases, decades later," said NIDDK Director Griffin P. Rodgers, M.D. "By funding research on the artificial pancreas, we aim to help people with type 1 diabetes maintain healthy blood glucose levels, prevent painful and costly complications, and lead freer, healthier lives." 
 
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 Among other funding sources, this research was supported by NIDDK grants R01DK085633 and R01DK097657, and was made possible by the Special Statutory Funding Program for Type 1 Diabetes Research. The program was established by Congress for research to prevent and cure type 1 diabetes. 
 
 The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit http://www. niddk. nih. gov/ . 
 
 About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www. nih. gov . 
 
 NIH...Turning Discovery Into Health ||||| A portable artificial pancreas built with a modified iPhone successfully regulated blood sugar levels in a trial with people who have Type 1 diabetes, researchers reported Sunday. 
 
 Type 1 diabetes, which usually starts in childhood or young adulthood, is a chronic condition in which the pancreas produces little or no insulin, the hormone that lowers blood sugar levels. Insulin works in conjunction with glucagon, a hormone that raises blood sugar. Together, they keep blood sugar in a healthy range. 
 
 Currently about one-third of people with Type 1 diabetes rely on insulin pumps to regulate blood sugar. They eliminate the need for injections and can be programmed to mimic the natural release of insulin by dispensing small doses regularly. 
 
 But these pumps do not automatically adjust to the patient’s variable insulin needs, and they do not dispense glucagon. The new device, described in a report in The New England Journal of Medicine, dispenses both hormones, and it does so with little intervention from the patient. 
 
 “The data address some of the most difficult problems in diabetes management,” said Dr. Kevan Herold, director of the Yale Diabetes Center, who was not involved in the study. “I’d say that the effects are quite significant and noteworthy.” 
 
 Dr. Fredric E. Wondisford, director of the diabetes institute at Johns Hopkins, also found the results encouraging. “To me, it’s a clear advance,” he said. But he cautioned that the effectiveness and practicality of the device had still not been tested in large numbers of patients over long periods of time. He also raised the issue of cost and insurance coverage. 
 
 Treatment of Type 1 diabetes is complicated. Patients not using pumps need two or more insulin injections a day, and all have to monitor blood sugar several times a day by pricking their skin and testing their blood. 
 
 Maintaining safe blood sugar levels requires precise adjustments, especially to prevent hypoglycemia, or extremely low blood sugar. Hypoglycemia can occur quickly, without the patient’s awareness, and can be a life-threatening emergency. 
 
 For patients with adequate treatment, elevated blood sugar is usually not an emergency, but can cause vascular damage over time that can lead to eye problems and amputations. 
 
 The artificial pancreas is the latest version of a device that researchers have been refining for several years. The system consists of an iPhone 4S with an attached glucose monitoring device, two pumps, and reservoirs for insulin and glucagon. 
 
 A sensor implanted under the skin on one side of the patient’s abdomen measures the glucose in the fluid between the cells, which corresponds closely to blood glucose levels. The sensor delivers the reading to the smartphone, and the phone’s software calculates a dose of insulin and glucagon every five minutes. 
 
 The medicine is then pumped through thin tubes to two tiny infusion points embedded just under the skin on the other side of the patient’s abdomen. 
 
 The phone also has an app with which a patient can enter information immediately before eating, indicating whether the meal is breakfast, lunch or dinner, and whether the carbohydrate content will be small, large or typical. The device then calculates and dispenses the proper dosages. 
 
 The device still requires a finger stick twice a day to get an accurate blood reading, which the patient enters into the phone. 
 
 The developers tested the device over five days in two groups of patients, 20 adults and 32 adolescents, comparing the results with readings obtained with conventional insulin pumps that the participants were using. 
 
 The adults in the trial each had the constant attention of a nurse, and they lived in a hotel for the five-day study. Most of the time they were free to travel around and pursue normal activities. 
 
 The adolescents, 16 boys and 16 girls, lived under supervision in a summer camp for youths with diabetes. 
 
 “We need to do a true home-use study, give people the device and send them home,” said the lead author, Dr. Steven J. Russell, an assistant professor of medicine at Massachusetts General Hospital. “Let them do whatever it is they’re going to do without supervision.” 
 
 Several authors of the new report have received payments from medical device companies and hold patents on blood sugar monitoring technology. 
 
 The artificial pancreas performed better than the conventional pump on several measures. Among the adolescents, the average number of interventions for hypoglycemia was 0.8 a day with the experimental pump, compared with 1.6 a day with the insulin pumps. Among adults, the device significantly reduced the amount of time that glucose levels fell too low. 
 
 And the artificial pancreas worked well at calculating mealtime doses without the patient having to use (often inaccurate) estimates and correct a too high or too low reading after eating. 
 
 Much more work needs to be done before the device can be marketed, Dr. Russell said. The senior author, Edward R. Damiano, an associate professor of biomechanical engineering at Boston University, has a 15-year-old son with Type 1 diabetes. He said he was determined to get the new device working and approved in time for his son to go off to college carrying one. ||||| An artificial pancreas developed by Boston researchers shows considerable promise to dramatically change the treatment of type 1 diabetes, potentially enabling 2 million Americans to eat what they want without counting carbohydrates or calculating insulin injections, researchers announced Sunday. 
 
 Investigators from Massachusetts General Hospital and Boston University developed the experimental device, which consists of an automated pump that releases the hormones insulin and glucagon and a glucose monitoring system controlled by an iPhone app. 
 
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 “We encouraged them to eat whatever they wanted while they wore the bionic pancreas,” said Dr. Steven Russell, an endocrinologist at Massachusetts General Hospital who led the study. “They went on a diabetes vacation, eating ice cream, candy bars, and other things they normally wouldn’t eat — like taking out a new sports car and seeing what it can do.” 
 
 In a new study published online in the New England Journal of Medicine, the researchers found that 52 adults and teens who used the mobile system for five days had healthier blood sugar levels compared to when they used standard treatments that required them to check their own blood sugar levels and determine how much insulin to inject via a pump device. 
 
 “This is not a cure,” said study coauthor Edward Damiano, an associate professor of biomedical engineering at Boston University who holds a patent on the software that makes the automatic dosing decisions. “It’s taking diabetes management to its ultimate potential and unburdens people with type 1 diabetes from thinking about all the things that go into managing diabetes every day of their lives.” 
 
 Damiano, whose 15-year-old son developed type 1 diabetes during his first year of life, said he wakes up two to three times a night to check his son’s blood sugar to prevent it from falling to a dangerously low level, called hypoglycemia, which can cause seizures, a coma, and sometimes even death. Having an automated device, which is expected to become available by 2017 after more testing and upgrades, would save Damiano and other parents from having to wake up in the middle of the night to avoid medical emergencies, he said. 
 
 Children with type 1 diabetes are eight times more likely to die from severe hypoglycemia at night — called dead in bed syndrome — than in a car accident. 
 
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 Diabetes experts who were not involved in the study cautioned that automated devices need far more rigorous testing to determine if they’ll be safe enough to become widespread. 
 
 “Quite a few things need to be addressed,” added Dr. David Harlan, chief of the diabetes division at the UMass Memorial Medical Center in Worcester. “The chances of the pump failing with two difference hormone infusions are great and it doesn’t remove constant diligence from lives of people with diabetes.” 
 
 The rate of type 1 diabetes — in which the body’s immune cells attack and destroy a healthy insulin-producing pancreas — has, for unknown reasons, been surging over the past few decades, with nearly 16,000 children under age 18 now diagnosed with the condition every year. (Type 2 diabetes, by comparison, is a more common condition, and tends to occur well into adulthood and has far more explainable causes, such as genetics, obesity, and a lack of exercise.) 
 
 In the new study, all of the study participants were closely monitored — adults were accompanied by nurses round-the-clock and the teens were in a summer camp for those with type 1 diabetes — to ensure that their blood sugar levels wouldn’t rise too high or fall too low, which could cause seizures or other complications. 
 
 The research found that adult patients with type 1 diabetes who used the experimental device had lower blood sugar levels overall than the control group while also spending 67 percent less time in a state of hypoglycemia. 
 
 Children who used the device experienced a 50 percent reduction in carbohydrate use to treat hypoglycemia, though they did not experience a significant difference in their blood sugar measurements. That’s likely because children who participated in the study were closely monitored even when they used their usual treatments, said Russell. 
 
 He and his colleagues presented their results Sunday evening at the American Diabetes Association meeting in San Francisco. 
 
 “The initial proof of concept is very strong,” said Dr. Guillermo Arreaza-Rubin, a director at the National Institute of Diabetes and Digestive and Kidney Diseases which funded the trial. “Parents of children with type 1 live in permanent fear and maybe this device can free them from that burden and increase the quality of life of those with this disease.” 
 
 A few other groups of researchers presented findings on similar automated devices at the diabetes conference, he said, which, like the device developed in Boston, are also about three or four years away from widespread use. 
 
 Christopher Herndon, 13, a study participant who tried the bionic pancreas last summer while at Camp Joslin in Charlton, said for the first time in his life he “felt steady the whole day” rather than shaky when his blood sugar levels dropped too low and “really talkative” when it was too high. 
 
 Despite using an insulin pump and continuous glucose monitoring device, which many diabetes experts consider to be gold standard therapies, the Newburyport teen said he has never been able to achieve the kind of blood sugar control that he had while using the bionic pancreas. 
 
 While his mother, Christina, often wakes him at 2 a.m. to have some juice if his blood sugar drops too low, he was never woken by his counselors at the camp during the five days he used the device. 
 
 Mark Lorenz for The Globe Christopher Herndon said he has never been able to achieve the kind of blood sugar control that he had while using the bionic pancreas. 
 
 Colby Clarizia, another study participant, said he consumed three blueberry muffins for breakfast while wearing the artificial pancreas and was surprised to see how well the device worked. The 21-year-old from Amesbury also found it easy to use. 
 
 “Instead of measuring every carb in a glass of milk or serving of rice, I just had to input whether I was going to eat a large meal or small one,” he said. 
 
 Such a device, he added, would make it far easier for him to eat in restaurants where carbohydrate counts aren’t posted on menus. 
 
 The bionic pancreas automatically monitors blood sugar using a wireless glucose monitoring system that sends a signal every five minutes to an iPhone adapted with software. The iPhone app determines how much insulin to dispense — to make high blood sugar levels decrease — and how much of the hormone glucagon to dispense to make blood sugar levels rise; it also learns over time how to adjust the release of the two hormones based on input from the monitoring system. 
 
 Harlan plans to test the device in conjunction with Russell’s team in a large multicenter study launching this week that will have less rigorous monitoring. Participants will need to stay within an hour’s drive of the study site but won’t need to be accompanied by a health professional wherever they go. 
 
 “I think it’s an important step forward, but it’s going to be quite challenging to see whether this device can function safely and effectively without close supervision,” said Dr. Howard Wolpert, director of the institute for technology translation at the Joslin Diabetes Center in Boston, who reviewed the paper before publication. “An analogy I would present is that they climbed a flight of stairs but now the next stage will be like climbing a hill or even a mountain.”
– While you were using your iPhone to browse Facebook and read Newser, a group of researchers was modifying an iPhone 4S to be used as a portable artificial pancreas—and in a recent trial, the device successfully regulated the blood sugar levels of people with Type 1 diabetes. About a third of people with Type 1 diabetes, which is typically diagnosed in childhood, use an insulin pump to regulate their blood sugar rather than giving themselves insulin injections. But unlike those pumps, the bionic pancreas adjusts both insulin and glucagon, a hormone that works with insulin to regulate blood sugar, automatically, the New York Times reports. It performed better than a regular pump for both adults and adolescents, according to the press release. The device is comprised of more than just the iPhone: The patient has a sensor implanted under the skin near the abdomen, which sends readings of blood glucose levels to the attached phone. The phone then calculates and sends the correct dosage of insulin and glucagon through attached pumps and tubes every five minutes. Patients can also enter information about meals before they eat, and the phone will calculate and deliver the correct dose. Twice-daily finger pricks are still required, with the blood sugar readings entered into the phone. Adult participants had about 37% fewer incidents during which low blood glucose levels required intervention—incidents that can be dangerous in the moment as well as cause health complications down the line—and the device could even allow patients to eat what they want, the Boston Globe notes. (During the trial, participants "went on a diabetes vacation, eating ice cream, candy bars, and other things they normally wouldn’t eat," explains the lead researcher.) It could be available by 2017, but larger trials are the next step.