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Comment
. 2010 Apr 14;2(27):27ps18.
doi: 10.1126/scitranslmed.3001083.

Optimal control of blood glucose: the diabetic patient or the machine?

Larry Brown  1 , Elazer R Edelman
Affiliations
Comment

Optimal control of blood glucose: the diabetic patient or the machine?

Larry Brown et al. Sci Transl Med. .

Abstract

In this issue of Science Translational Medicine, El-Khatib et al. describe a "closed-loop" bihormonal artificial pancreas, designed to avert episodes of low blood sugar in patients with insulin-dependent diabetes. We discuss the benefits and challenges of therapy directed at tight control of blood glucose and ask whether this and similar technological breakthroughs can address as yet unanswered questions in the biology of diabetes.

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Figures

Fig. 1
Fig. 1. The pancreas' glucose regulatory pathways
Insulin secretion from the beta cells of the pancreas results in glucose uptake and gluconeogenesis by the liver, upregulation of the GLUT-4 glucose transporter in muscle, and attenuation of glucagon secretion from the islets. Glucagon secreted by the alpha cells stimulates glycogen breakdown by the liver, thereby releasing glucose in times of need. Somatostatin secreted from the delta cells attenuates both insulin and glucagon secretion. Amylin secreted by beta cells delays gastric emptying, decreases appetite, and suppresses glucagon secretion after a meal. Cells within the islets are in close proximity with one another. CREDIT: CHRIS BICKEL/SCIENCE TRANSLATIONAL MEDICINE.
Fig. 2
Fig. 2
Bi-hormonal closed-loop insulin and glucagon delivery system. Developed by El-Khatib et al. (8). Closed-loop insulin delivery is designed to maintain near normal glycemia. Intravenous glucose is measured every five minutes using the GlucoScout device, and these data are used to guide a computer-controlled algorithm that titrates the delivery of two hormones. An increase in blood glucose is countered by insulin administration. Glucagon is administered to increase blood glucose by stimulating liver breakdown of glycogen. From (8) (Supplemental Fig. 1), used by permission.
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References

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