So I am curious - many people are interested in seeing what the artificial pancreas can do, but are you ready to trust it with your well-being?
I wrote a short post about it on the JDCA blog:
But I wanted to get people's opinions on here as well. How do you feel about the AP, and to what degree are you ready to trust it?
I, for one, will be waiting. I've achieved fairly decent results with pumping and finger sticks. When I tried to use CGMs, even the much loved Dexcom, I got too many wacky/unreliable results. Now, I DO think that the low-glucose suspend feature is much needed, and that I would use. But I would NOT want my pump making insulin delivery decisions off a CGM at this time. The CGM would have to be far more reliable and I will be waiting to see the improvements in the CGMs before jumping onto any artificial pancreas. While I think the artificial pancreas is a great idea, the technology just isn't there yet for me to feel comfortable with it.
Some things I would like to see include more accurate glucometers, better CGMS, the low-glucose suspend system, and a wider availability of pumps to people who cannot otherwise afford them. I think research is great, but I have a hard time dumping money into something like the AP when there are SO MANY people on here who can barely afford insulin and test strips (i.e., the bare necessities for surivival when you're a type 1). We need to address that problem first.
I am not willing to trust an artificial pancreas with my knowledge of current technology. There would have to be more exact equipment (meter, CGM, etc.) and some reliable trials for me even to consider an artificial pancreas. I do not believe that an AP could control my T1 better than I can at this point in time.
I feel that this is more of a legal hurdle than one bound by the limits of technology.
The CGMs that we have today are possibly not what is the best available, but rather what needs to run it's course to gain back profits before they launch revision 2, and then 3.... As gross as that is when it's medical products, a company is in it for money, not charity and they often have several generations in development that are unknown.
If we can presume for the sake of argument that they have a superior product that reacts faster and screws up less, then yes, of course I'd trust it to automate. It's an uneasy step, but an inevitable one.
Would a pump manufacturer be prepared to launch that artificial pancreas knowing it could theoretically malfunction and empty 200 units into someone? Probably not without you signing away some serious rights.
Hmm. People raise some good points. I think that in it's current state it really will be hard for many to trust it - we just don't know that much about it or how safe it is.
Secondly, I agree that if it still falls short from making a big impact on people's lives and allowing us to live a cure-like lifestyle (having tubes and wires attached to your body, like someone suggested, would not be that cool with me either) we can't allow that to discourage us from searching for a better cure.
Like I said even if it worked and was safe its still not a cure. Its just a machine that will better regulate our levels then we could do on our own. I doubt it would ever get approval unless it proved fool proof which will be many years of testing. So if its ever available it's likely going to be safe to use. Basically with diabetes you either fix it right or you don't do anything. We already have an far from perfect therapy with risk and we don't need another. I think the most realistic thing in the future will be what Viacyte is working on. We already know islet transplants can be effective. The problem is still an endless supply of cells to treat everyone and protection against our immune systems. Viacyte is working with stemcells and may be able to offer an endless supply. Otherwise the cells must come from pigs. There are a few company's working with different ways of protecting the cells and eventually I believe they will get it done. I just think the big problem will be the cost of treatment. If we could only be so lucky and have to shoot up with the BCG vaccination a few times a year to keep it at bay that would be the godsend.
I would definitely NOT be interested in a AP. If it is successful and accurately functions for at least 5 years, then I might consider it. I like to control my own insulin administration and not leave it to another "machine". That is why I don't have a pump.
^ Me too. I never had interest in the pump either. Not because of fear of it screwing up but I don't want crap hanging off my body..when I sleep, in the shower....etc. It seems like more of a hassle then its worth but to each his own. On top of that the cost of more supplies.I believe you can get the same control with shots but if you like to nosh food randomly your likely gonna be taking 6 to 8 shots a day. On a good sugar day I am usually at about 5 shots. Sometimes I take a shot for a meal and then 10 minutes later I decide I want more crap so I load it up again and eat my cake.
I was wanting a pump, but relized I just want a CGM. A pump would still be great but the $$$$. So I'm thinking of just a CGM for now
Your blog post over at the JDCA starts with a false premise. You state:
"Many people are urging the FDA to approve the artifical pancreas, which some are calling a cure for type 1 diabetes."
Are you serious? Is your hatred of the JDRF this great? Who even has an AP that is remotely ready for the market? Who are the "many"? Who is calling this "over the horizon" technology a cure? In short and respectfully, you are asking the wrong questions.
FWIW, the CNN story is filled with generalizations and lacks specifics on the differences between a LGS system and the AP concepts being tested in a clinical setting. There is a very significant difference! You would be better served analyzing the holes in the CNN story than asking your current question.
IOW, how about asking, "Does the CNN Artificial Pancreas story raise false hopes (again) by suggesting a cure (NOT!) is in the near future?"
The FDA is facing legitimate criticism over the amount of time it has taken to come up with guidelines for both LGS and AP systems. There is no question that the FDA needs a mechanism to evaluate what other regulatory agencies in other countries have received from companies in order to reduce the time to market and the costs both to the manufacturers and the people living with this chronic condition (pretty huge, I think!). Note that these guidelines are DRAFT(!). This means that there will be further delay before companies can really move forward to research AND bring products to market - ARRGGHH!
In the meantime, LGS systems are available in 40+(?) countries and there are lives being regularly lost in the USA that the current LGS system might have saved. Why should USA PWDs be denied this technology? How long will those most likely to benefit have to wait, and for how many will that be too long?
Again, the next time you are poised to attack the JDRF, please ask if you are doing this for the right reasons. As PWDs, we need to focus our efforts towards moving forwards on many (every?) front, not tearing each other apart. Please join me.
Mike...there is no attack or hatred of the JDRF. The post is meant to get people to share their different opinions on the matter. While we will be discussing the results of our survey at a later time, I can tell you that they reflect the mixed opinions found in this thread too.
Most people are aware of the JDRF AP ad http://jdca2025.files.wordpress.com/2011/11/jdrf_fda_ad_nov_2011-56... which is urging the FDA to pave the way for the artificial pancreas. It has stirred up a lot of debate on other forums as well - including Children With Diabetes - though my questions are focused on what people know about the system, not from the article alone, and how they are currently feeling about it. Opinions may change when we find out more.
Stoyan, I believe that ad is urging support for Low Glucose Suspend. The ad is all about dying in one's sleep due to hypoglycemia. JDRF is well aware that current technology does not yet extend to administering insulin without human intervention, and I see no indication that they are asking the FDA to support such a system.
I would not trust an AP.
As others have said I see the following problems:
CGM: accuracy, sensor inconsistency some work well others don't, warm up period, what do you do while the sensor gets "wet"
Pump & Infusion sets & Site problems: sometimes works great other times it doesn't
Insulin: doesn't work fast enough.
I'm not even interested in the MM feature to turn off basal on low BG, this would not work for me, if I detect a low I treat with eating glucose tablets, if I also reduce my basal I always end up too high, it seems I have a 2 hour lag in basal adjustment.
It's a nice concept but definately not nearly ready for prime time.