An artificial pancreas could soon help people living with Type-2 diabetes and who also require kidney dialysis.

Tests led by the University of Cambridge and Inselspital, University Hospital of Bern, Switzerland, show that the device can help patients safely and effectively manage their blood sugar levels and reduce the risk of low blood sugar levels. Researchers had previously developed an artificial pancreas with the aim of replacing insulin injections for patients living with Type-1 diabetes. The study, published in the journal Nature Medicine, showed the artificial pancreas is powered by software in the user's smartphone that sends a signal to an insulin pump to adjust the level of insulin the patient receives.

A glucose monitor measures the patient's blood sugar levels and sends these back to the smartphone to enable it to make further adjustments. Unlike the artificial pancreas being used for type 1 diabetes, the new version is a fully closed loop system whereas patients with Type-1 diabetes need to tell their artificial pancreas that they are about to eat to allow adjustment of insulin. For example, with this new version they can leave the device to function entirely automatically. "Patients living with type 2 diabetes and kidney failure are a particularly vulnerable group and managing their condition --trying to prevent potentially dangerous highs or lows of blood sugar levels -- can be a challenge. There's a real unmet need for new approaches to help them manage their condition safely and effectively," said Dr Charlotte Boughton from the Wellcome Trust-MRC Institute of Metabolic Science at Cambridge.

The team recruited 26 patients requiring dialysis between October 2019 and November 2020. Thirteen participants were randomised to receive the artificial pancreas first and 13 to receive standard insulin therapy first. The researchers compared how long patients spent in the target blood sugar range (5.6 to 10.0mmol/L) over a 20 day period as outpatients. Mean blood sugar levels were lower with the artificial pancreas. The artificial pancreas reduced the number of time patients spent with potentially dangerously low blood sugar levels, or 'hypos'.

The team is currently trialling the artificial pancreas for outpatient use in people living with Type 2 diabetes who do not need dialysis and exploring the system in complex medical situations such as perioperative care. "The artificial pancreas has the potential to become a key feature of integrated personalised care for people with complex medical needs," said Dr Lia Bally, who co-led the study in Bern.