ARTIFICIAL
PANCREAS
The artificial pancreas is a technology in development to help people with diabetes automatically
control their blood glucose level by providing
the substitute endocrine
functionality of a healthy pancreas.
Jonathan Kearns
John Merrigan
Johannes Simon Schork
ARTIFICIAL PANCREAS
Introduction
1. Function of the pancreas:
a. Anatomical overview
b. Physiology overview:
Endocrine and Exocrine gland
2. Pancreas failure:
Overview + Facts
3. Diabetes:
a. Type 1 + Type 2
b. Statistics and Reasons
c. Current treatments
4.
Approaches to an Artificial Pancreas:
a. Bioengineering
b. Gene therapy
c. Medical equipment
5.
Future Treatments for Pancreas Failure:
Design concept “Pancreum”
2011 DiabetesMine Design Challenge Winner
(Threshold Concepts)
Conclusions & References
1. Function of the pancreas
Anatomical overview
The pancreas arises in the fourth week of fetal life.
It is a dual-function glandular organ in the
digestive system and endocrine system.
It is a thin elliptic organ and lies within the
retroperitoneum in the upper abdomen.
In the adult, it is 16 - 20 cm long, 3 - 4 cm wide and
weighs 70 - 100 g.
Retroperitoneum
The gland can be divided into three main areas:
- The head
- The body
- The tail
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1. Function of the pancreas
Physiological overview
Exocrine Pancreas
Pancreatic juice
Endocrine Pancreas
Hormones
a | Cross anatomy of the pancreas. b | The exocrine pancreas. c | A single
acinus. d | A pancreatic islet embedded in exocrine tissue (islets of Langerhans).
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1. Function of the pancreas
Physiological overview
α cells secrete
glucagon: increases
glucose in blood.
(15-20% of total islet
cells)
β cells secrete
insulin: decreases
glucose in blood.
(65-80%)
Δ cells secrete
somatostin:
regulates or stops
α+β cells.
(3-10%)
PP cells secrete
pancreatic polypeptide:
self-regulates pancreatic
secretion activities.
(3-5%)
Pancreatic juice
containing digestive enzymes that
assist the absorption of nutrients and
the digestion in the small intestine
PANCREAS
The pancreas is both:
1. Endocrine gland, producing several
important hormones (including Insulin, Glucagon,
Somatostatin, pancreatic Polypeptite)
2. Digestive organ, secreting pancreatic juice
containing digestive enzymes.
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CASE 1
CASE 2
LOW BLOOD
GLUCOSE
HIGH BLOOD
GLUCOSE
1. Function of the pancreas
Insulin + Glucogen
PANCREAS
GLUCAGON
Released by alpha
cells of pancreas
INSULIN
Released by beta cells
of pancreas
LIVER
Releases glucose
into blood
FAT CELLS
Take in glucose from
blood
ACHIEVE
Normal blood glucose
levels
α cells secrete
glucagon: increases
glucose in blood.
β cells secrete
insulin: decreases
glucose in blood.
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2. Pancreas failure
a. Statistics
Cancers
Diabetes
Cardiovascular disease
Digestive diseases
Chronic respiratory
diseases
Other noncommunicable
diseases
Figure: Proportion of global NCD deaths under the age of 70, by
cause of death, 2008. (NCD Report, WHO)
Diabetes:
Type 1 DM results from the body’s failure to produce
insulin.
Type 2 DM results from insulin resistance, a
condition in which cells fail to use insulin properly.
Pancreatitis:
A condition in which the pancreas becomes inflamed.
Gallstones and alcohol are the two most common
causes for the pancreatitis.
Pancreatic cancers:
Particularly cancer of the exocrine pancreas, remain
one of the most deadly cancers, and the mortality
rate is very high.
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Diabetes Cancer Pancreatitis
is the leading cause of kidney failure,
nontraumatic lower-limb amputations,
and new cases of blindness among
adults in the US. Diabetes is a major
cause of heart disease and stroke and
is the seventh leading cause of death in
the US.
Pancreatic cancer has a 98%
mortality rate, the highest of any
cancer. Pancreatic cancer is
the 4th leading cause of cancer
death in the United States.
Acute pancreatitis hospitalizations cost more than $2
billion annually, and certain population groups (blacks
and older patients) have disproportionately high
hospitalization rates.
26,9%
43,920
$ 2.2
215.000
37,390
$ 9870
1 in 71
$ 1670
The American Cancer Society’s most recent
estimates for pancreatic cancer in the United
States are for 2012 3
U.S. Department of Health and Human Services,
National Diabetes Statistics, 2011 4
Among US residents ages 65 years
and older, 26.9%/10.9 million had
diabetes in 2010.
people younger than 20 years had
diabetes, type 1 or 2, in the US.
1.9
million people ages 20 years or
older were diagnosed with diabetes
in 2010 in the US.
U.S. Department of Health and Human
Services, National Diabetes Statistics, 2011 2
people (22,090 men and 21,830
women) will be diagnosed with
pancreatic cancer.
people (18,850 men and 18,540
women) will die of pancreatic
cancer.
The lifetime risk of developing
pancreatic cancer is about 1 in 71
(1.41%). This is about the same for
men and women.
The estimated total cost for acute pancreatitis
admissions was $2.2 billion.
a mean cost per hospitalization.
a mean cost per hospital day.
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Diabetes Mellitus Defined
“Diabetes is defined as a condition in which the pancreas no longer produces enough
insulin or cells stop responding to the insulin that is produced, so that glucose in the
blood cannot be absorbed into the cells of the body”
Diabetes Types
Type 1:
Most commonly formed in childhood or adolescence. In this form of diabetes, the body produces little or no insulin.
It is characterized by a sudden onset and occurs more frequently in populations descended from Northern European
countries. This form also is called insulin-dependent diabetes because people who develop this type need to have
daily injections of insulin.
Brittle diabetics are a subgroup of Type I where patients have frequent and rapid swings of blood sugar levels between
Hyperglycaemia and hypoglycaemia . These patients may require several injections of different types of insulin
during the day to keep the blood sugar level within a fairly normal range.
Type 2:
This form of diabetes occurs most often in people who are overweight and who do not exercise, it is worth noting that
people who have migrated to Western cultures more likely to develop Type II diabetes than those who remain in their
original countries.
Type II is considered a milder form of diabetes because of its slow onset (prediabetes) and because it usually can be
.
controlled with diet and medication. The consequences of uncontrolled and untreated Type II diabetes, however, are the just
as serious as those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading
Gestural Diabetes:
Developed during pregnancy and generally resolves after the baby is delivered. This diabetic condition develops during
the second or third trimester of pregnancy in about 2% of pregnancies. Children of women with gestational diabetes are
more likely to be born prematurely, have hypoglycaemia, or have severe jaundice at birth.
Causes of Diabetes
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary and environmental factors involved.
Research has shown that some people who develop diabetes have common genetic markers.
In Type I diabetes, the immune system, is believed to be triggered by a virus or another microorganism that destroys cells in
the pancreas that produce insulin.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin
produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a
person may not know that he or she has it.
People at risk include:
Are obese (more than 20% above their ideal body weight)
Have a relative with diabetes mellitus
Belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
Have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)
Have high blood pressure (140/90 mmHg or above)
Have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or
equal to 250 mg/dL
Have had impaired glucose tolerance or impaired fasting glucose on previous testing
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Other Complications Associated
Infection/Gangrene
Diabetic Neuropathy
Atherosclerosis
Cataracts
Hemorrhage/Aneurysms
Stroke
Image: Complications of diabetes, from Damjanov (2000).
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Diabetesʼ impact on the economy
Within the report; Diabetes Expert, Advisory group first report 2008, it was highlighted the cost of the disease on the hse
through the evaluation of various professionals suited to a demographic of 500ʼ000 persons. (pay scales as of 01.09.08)
Endocrinology/diabetologist 5 practitioners per 500ʼ000;
$197,296 X 5= $986,480
Diabetes Nurse specialists, 15 employees across service domains:
$54,188 X 15= $812,820
Podiatrists x 2
$64,061 X 2= $128,122
Social Worker (visits across domains)
$52,662 X 1.5= $78,993
Dietitians x 10
$58,192 X 10 = $581,920
Ophthalmologist x 1
$94,648
GP - to be consulted
Retinopathy screening (Per HSE region) $1 million
Total managerial cost excluding screening,medication GP visits is in excess of $2,682,983 per 500,000 populace.
This also highlights the issue of the severity of care required for this disease.
Projected Figures
Within the report; A systematic approach to forecasting population prevalence on the island of Ireland
N
orthern Ireland
Northern
Scenario
P
Population
opulation C
2005
1
2010
2015
Republic of Ireland
ases
Prevalence
Population
C
ases
Prevalence
1,230,947
,230,947
67,063
5.4%
2,981,300
141,063 4
.7%
1
1,287,592
,287,592
70,066
5.4%
3,222,976
153,538 4
.8%
1
1,355,852
,355,852
75,466
5.6%
3,466,961
173,917 5
.0%
Table Illustrates the population prevalence of adult diabetes Type 1 and 2 combined.
Additional research is required into the prevalence amongst children (0 - 19years) as the current PBS model is
taken from the UK model hense estimates are not as accurate as they should be.
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Additional Information
All documentation is sourced through the HSE website; www.hse.ie/eng/services/Publications/topics/Diabetes
Review of Diabetes Structured Education 2009
Guidelines for the management of Pre-gestational and Gestational Diabetes Mellitus from Pre-conception to the
Postnatal period
Framework for the Development of a Diabetic Retinopathy Screening Programme
Diabetes Expert Advisory Group First Report
A Practical Guide to Integrated Type II Diabetes Care
Selfcare Guide for People with Diabetes
4. Approaches to an
Artificial Pancreas
Medical equipment
Bioengineering
Gene therapy
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4. Approaches to an
Artificial Pancreas
Medical equipment
Using an insulin pump under closed loop control using real-time data from a continuous blood glucose sensor.
The Insulin pump is an alternative to multiple daily injections of insulin by insulin syringe or an insulin pen.
Insulin Pump System Contains:
The pump (including controls, processing module, and batteries)
A disposable reservoir for insulin (inside the pump)
a disposable infusion set, including a cannula for insertion under the skin and a tubing system to interface the
insulin reservoir to the cannula.
Continuous
Glucose Sensor
Control
Algorithm
Insulin
Pump
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4. Approaches to an
Artificial Pancreas
Bioengineering
The development of a bio-artificial pancreas consisting of a biocompatible sheet of encapsulated beta cells.
When surgically implanted, the islet sheet will behave as the endocrine pancreas delivering endocrine hormones in
response to glucose and will be viable for years.
Islet sheet research is pressing forward with large animal studies at the present, with plans for human clinical trials
within a few years.
........
......................
..........
Weave of synthetic fibers
(Adds strenght to fabric)
Encapsulated islet cells
(Protect against autoimmune distruction)
........
........
Cluster of islet cells
(Produce insulin, amylin & glucagon)
Biocompatible outer layer
(Implant will survive without a fibrotic response)
Semi-permeable material
(Allows diffusion of glucose, cell nutrients & endocrine hormones)
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4. Approaches to an
Gene therapy
Artificial Pancreas
The therapeutic infection of a diabetic person by a genetically engineered virus which causes a DNA change of
intestinal cells to become insulin-producing cells.
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5. Future Treatments for
Pancreas Failure
Pancreum Genesis Concept
The Pancreum Genesis closed loop (automated insulin + CGM +
glucagon) system concept by Gil DePaula.
It’s a wearable artificial pancreas system can manage and effectively
regulate the glucose level with limited (or without) input from the
user.
The system has 5 components:
The PDA (Personal Diabetes Analyzer),
the CoreMD,
the GlucoWedge continuous glucose monitor,
the BetaWedge insulin pump
and the AlphaWedge glucagon pump..
In addition, an ultra intelligent algorithm that resides in the PDA
provides safe and reliable adjustments to the insulin and glucagon
delivery. If research proves necessary, other substances such as
cortisol or adrenaline could replace glucagon in the AlphaWedge.
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5. Future Treatments for
Pancreas Failure
Fraunhofer (IMS) Biosensor
Tiny biosensor could mean an end to daily finger sticks for diabetics.
Provides a non-invasive way to measure blood glucose levels and can transmit its readings wirelessly to a
mobile device.
The tiny biosensor can calculate a person’s glucose levels from tears or sweat.
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...thank you
References:
Current Surgical Diagnosis and Treatment, 11th Ed 2003: Lawrence W. Way, Gerard M. Doherty
By McGraw-Hill/Appleton & Lange
http://www.ncbi.nlm.nih.gov/pubmed/18090234
http://www.endocrineweb.com/conditions/diabetes/normal-regulation-blood-glucose
[1] http://diabetes.niddk.nih.gov/dm/pubs/statistics
[2] http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-key-statistics
[3] pancreasfoundation.org/Docs/patient_info/PancreaticDisease.pdf
www.HSE.ie
www.pancreum.com
Jonathan Kearns
John Merrigan
Johannes Simon Schork