Introduction
“Type 1 diabetes (T1D) is a chronic autoimmune disease in which the body produces only a negligible amount of insulin, therefore, patients require daily administration of exogenous insulin” (Turksoy et al., 2017). People with T1D have been forced to monitor their own survival by needing to calculate how much insulin they must take and what kind of food they can consume without becoming hypoglycemic or hyperglycemic. Diabetes has become the 7th main cause of death that affects 1.25 million American adults, but still does not have a cure (American Diabetes Association, 2018). This life-threatening disease, that requires a great reliance on the patients themselves, is being introduced to a new form of treatment known as the artificial pancreas. The artificial pancreas is a system that uses complex technology and sensors in order to perform the calculations previously done by the patients themselves. The articles “Scents And Sensibility: A Molecular Logic Of Olfactory Perception” by Richard Axel, as well as “Extra Sensory Perception,” by Gershon Dublon and Joseph Paradiso, demonstrate a consistent theme of “advancement” through the continuation of working with certain health aspects to alter and improve their effects and uses in society. Similarly, the artificial pancreas is currently being put into action to advance the treatment methods for Type 1 Diabetics. In addition, in “Extra Sensory Perception,” this concept is expanded as the authors, make a “safe bet that wearable devices will dominate the next wave of computing,” and through the new innovation of the artificial pancreas, this statement has become a reality (Dublon & Paradiso, 2014). The idea of using sensors to improve health as discussed in this article, is displayed through the artificial pancreas because it requires a continuous glucose monitoring (CGM) sensor, “a tiny electrode inserted under the skin to measure glucose levels in tissue fluid” (Medtronic MiniMed, 2018). The CGM sensor then transmits the information to a monitoring and display device that the patient wears around their waist. These components make up the artificial pancreas as it measures and distributes how much insulin a patient needs based on an algorithm the device uses after receiving information from the sensor (Voelker, 2016). Such evaluation raises the question: should the artificial pancreas be used when treating patients with T1D? Ultimately, an analysis through a health, economic, and historical perspective will demonstrate the favorability of doing so due to the benefits it can provide in the lives of Type 1 Diabetics.
Health
The artificial pancreas has proven itself to provide many benefits for patients with T1D, including the fact that it monitor’s an individual's glucose levels 24 hours a day, as well as its ability to prevent hypoglycemia or ketoacidosis, two diseases that are quite common in diabetic patients. One of the main advantages of the artificial pancreas is that it is always active. As stated by Susan Scutti, a medical researcher and reporter for CNN health and Medical Daily, “The system measures a patient's glucose levels every five minutes and either administers or withholds insulin as needed, helping patients maintain glucose levels within the normal range the majority of the time” (Scutti, 2016). Due to the fact that patients with T1D must regularly monitor their blood-sugar levels and inject insulin when needed, this innovation proves to be extremely favorable because they no longer have to worry as much about the fact that failure to carefully monitor themselves could lead to a coma. In addition, as demonstrated by Peters and Haidar, researchers from the division of endocrinology and metabolism, “the artificial pancreas was sufficient for maintenance of euglycemia (normal concentration of glucose in your bodies) in the overnight period,” so the patient no longer has to be concerned about their blood sugar while they are sleeping (Peters & Haidar, 2018). In contrast, patients who do not use this device are commonly required to perform the “middle of the night check,” a tedious, yet necessary, task that disrupts their sleep.
Moreover, the artificial pancreas’s consistency has established positive results as shown through multiple trials, such as a joint study conducted by several doctors from the International Diabetes Center, Barbara Davis Center for Diabetes, and Stanford University. Through the duration of this trial, patients who used the device had improved control of their diabetes as seen through better A1C levels (person's average levels of blood glucose), and less glucose variability (Bergenstal et al., 2016). In fact, the artificial pancreas was successful 87.2% of the time during the study and in “Over 12 ,389 patient-days, no episodes of hypoglycemia or ketoacidosis were observed” (Bergenstal et al., 2016). In addition, the artificial pancreas gives people the freedom to live without as many restraints that most diabetic patients must endure. For example, performing any strenuous activities, such as exercising, may cause adverse effects on diabetic patients because as they exercise, they are using the glucose in their bloodstream and can eventually become hypoglycemic. Nevertheless, as made evident by researchers from the Center for Biomedical Research in Diabetes Network and Associated Metabolic Diseases, the artificial pancreas was successful in preventing the occurrence of hypoglycemic events related with exercise (Bertachi, Beneyto, Ramkissoon, & Vehí, 2018).
Nonetheless, some patients displayed their concern of the artificial pancreas potentially having technological issues that could induce a few negative side effects such as the possibility of the glucose monitor not showing completely accurate results. However, this worry can easily be put to rest due to the fact that in many trials such as the same trial mentioned above, no adverse effects were caused by issues pertaining to the software, hardware or sensor of the artificial pancreas itself (Bergenstal et al., 2016). Due to fact that the health benefits provided by the artificial pancreas outweigh the unlikely potential side effect, this treatment proves to be an effective resource when viewed through a health perspective.
Economic
For many patients, the price of the artificial pancreas is a key factor in their decision to either use or reject this treatment. The artificial pancreas presents many incentives for patients due to the fact that it reduces the price of insulin and is sold at a manageable price. According to Kasia Lipska, an endocrinologist at the Yale School of Medicine, one of the main issues present for current diabetics is, “The price of insulin, the drug used in these devices, has skyrocketed in recent years” (Lipska, 2016). Patients who use insulin injections have no choice but to pay these high prices. However, when using the artificial pancreas, the insulin is covered by Medicare Part B because it is considered as “durable medical equipment,” so the patient only has to pay 20% of the full price (Medicare, n.d.). In addition, when using the artificial pancreas, the costs of needles and syringes can be avoided because neither of these are needed since all the insulin is delivered through the pump.
Moreover, the artificial pancreas itself is not quite expensive, considering the fact that it will provide patients with much more freedom and security as it is constantly measuring their glucose levels and keeping them stable. In fact, the artificial pancreas is available through Medtronic, the company that manufactures it, for only $799 and “Medtronic may even offer it for free to patients participating in an approved system access program, and most insurance plans (Kaiser, Anthem, United Healthcare, etc) cover the artificial pancreas for patients with Type 1 Diabetes” (Huynh, 2016). In addition, not only will the patients benefit by having insurance companies cover their artificial pancreas fee, but even the companies themselves are likely to have a favorable outcome. As stated by Michael O’Grady, the president of the West Health Policy Center, Priya John, a business consultant for a large health system, and Aaron Winn, a research associate at the Center for the Evaluation of Value and Risk in Health, “The modeling shows that insurers’ coverage of the cost of an artificial pancreas at a relatively early point in the life of a patient with diabetes would greatly reduce future complications of the disease and spending needed to treat such complications. Projected Medicare savings are $937 million after 25 years” (O’Grady, John, & Winn, 2012). As a result of insulin prices being reduced and most insurers being able to cover the device itself, using the artificial pancreas proves to be a wise decision from an economic view for both the patients, and the insurance companies.
Historical
Before the artificial pancreas was FDA approved in 2016, the most common alternative forms of treatment were insulin injections and pancreas transplants. As reported by Mayo Clinic, one of the top ranked hospitals in the nation, most patients with T1D take about 4-7+ injections of insulin a day and are recommended to test their blood sugar about 10 times a day (Mayo Clinic, 2018a). In contrast, when using the artificial pancreas, all insulin doses are delivered through the device, relieving the patient of the need to measure and deliver the doses themselves as well as providing much more accurate calculations; also, because the CGM sensor is constantly checking the glucose levels, the patient no longer has to check their blood sugar as frequently. In fact, the CGM sensor, “boasts a sensitivity of 93% in detecting hypoglycemia” while with the treatment that requires continuous subcutaneous insulin injection, it is almost impossible to predict the occurrence of this consequence because there is no sensor monitoring the patient’s body (Brooke & Rege, 2015).
Furthermore, Salynn Boyles, an award winning medical journalist who focuses primarily on research concerning diabetes, emphasizes how the artificial pancreas can prevent life threatening cases which generally takes place while the patient is asleep because, “sugar levels can fall to dangerously low levels during sleep, especially in people who maintain very tight control of their blood sugar with insulin during the day. Hypoglycemia can result in seizures and even sudden death” (Boyles, 2010). As described previously in the health perspective, patients who deliver insulin injections themselves are forced to either wake up in the middle of the night to check their blood sugar or risk the chance of death, both of which can be counteracted by using the artificial pancreas.
In addition, although a pancreas transplant is also a treatment option, “it is typically reserved for those with serious diabetes complications, because the side effects of a pancreas transplant are significant” (Mayo Clinic, 2018b). Side effects like infection, blood clots, and renal disease, are common, and due to the chance of the recipient’s body rejecting the pancreas, patients must also take medication to prevent rejection which presents additional side effects such as bone thinning, high cholesterol, and high blood pressure, (Sung et al., 2018) each of which could result in harming the patients more than helping them. Furthermore, the cost of a pancreas transplant procedure is about $347,000 and the ability to find a pancreas also raises an issue considering that only about 215 pancreases were donated in the United States in 2016 (Bentley, Phillips, & Hanson, 2017). The likely chance of multiple adverse effects occurring post-transplant, as well as having to pay a much higher price for the procedure than purchasing an artificial pancreas, demonstrates that the artificial pancreas proves to be the more advantageous option in treating patients with T1D. When compared to the most prominent alternative forms of treating T1D, it is clear that the artificial pancreas is a superior, safer, and cheaper as shown through its functionality, the harmful effects it prevents, and its reasonable price.
Conclusion
After deep consideration from the health, economic, and historical perspective, it is evident that the artificial pancreas should be used in treating patients with T1D due to the health benefits it provides, its economic advantages to both the patients and insurance companies, and its distinction and favorability in comparison to other prominent treatment options. The implication this treatment provides is that many more people have access to safer and more affordable treatment. Nevertheless, this treatment does have some limitations including the age restriction for some patients.
Dr. Robert Courgi, an endocrinologist at Northwell Health Hospital, discusses how the artificial pancreas cannot be used for patients 13 years old and younger, but states “The FDA cannot be faulted for beginning with older patients first. We expect improvements… as it becomes more mainstream and more data comes back, we can extend it to the younger population” (Scutti, 2016). In fact, Medtronic has recently begun studies to evaluate the safety and effectiveness of this device when used by diabetic children between the ages of 7 and 13, displaying that in the future, the age restriction should no longer be a major issue.