You yourself have worked on the development of the first French “closed hybrid loop” (Diabeloop) reimbursed since September 2021 and yet the latest technologies arriving on the market to treat diabetes seem to amaze you. Why ?
We are in the culmination of twenty years of medical research on diabetes. We had more or less efficient tools. But to have perfectly reliable systems, it took us twenty years. There, we arrived at phenomenal computing power. With the integration of increasingly sophisticated artificial intelligence, we are reaching levels of performance never seen before. Today, if we put ten diabetologists around the patient 24 hours a day, we wouldn’t do as well as the machines. »
Is this called the “artificial pancreas”?
“Yes, we arrived at something that was a bit of a dream and which has become a reality. Today, we have two devices reimbursed in France (that of the American group Medtronic and that of Diabeloop), a third will arrive and, by the end of 2024, we will have five. Then, we have insulin pumps and implantable artificial pancreas already present in the United States, not yet in France. We are really in a phase of technological acceleration. »
How does this medical device work?
“The hybrid closed loop allows diabetic patients on insulin, mainly type 1, to benefit from a system that couples a biochemical sensor placed on the skin, which continuously measures the glucose level, a pump system that diffuses permanent insulin and artificial intelligence. The pump will thus deliver insulin according to what the sensor tells it via the AI. We no longer have a blood glucose reading at your fingertips. And this allows the patient to almost no longer think about adjusting his insulin doses during the day, except when he eats and when he practices physical activity. In fact, in these two cases, it is necessary to announce it to the artificial intelligence. This technology will quickly become established in toddlers, from 0 to 4 years old, affected by type 1 diabetes.”
Has the closed loop lifted all the constraints for diabetics on insulin?
“Measuring blood sugar has always been considered by patients as the most restrictive obligation. We asked for a measure between four and six times a day. However, today, the sensor produces 288 values per day. Depending on the sensors, there is a measurement every five to ten minutes. The patient constantly knows his sugar level. »
Apart from the comfort that the artificial pancreas provides, what is the health benefit for diabetics?
“We are changing a dogma inscribed since we treat patients with insulin. Since 1922, when we try to balance diabetes, we increase the risk of hypoglycaemia. There, with artificial intelligence, we reduce the time spent in hyperglycemia and hypoglycemia to increase the time spent in normoglycemia. We stay in the middle of the road. To evaluate the evolution of a patient, we refer to the time he spends between 0.70 g/l and 1.80 g/l of sugar in the blood. We are very happy when he spends 70% of his day in this range. With the artificial pancreas, we have patients who are 90-95%. However, we know that the glycemic balance is good over time and makes it possible to develop fewer severe complications. »
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