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CheatSheet: The Bi-Hormonal Artificial Pancreas

Diabetech

CheatSheet

Note

This video explores the history, science, and future of bi-hormonal (dual-hormone) insulin pumps, which utilize both insulin and glucagon to closely mimic a healthy pancreas. Host Justin discusses key industry players like Beta Bionics and Inreda, outlines the pros and cons of these emerging automated devices, and details the technical challenges of glucagon stability and system maintenance.

Punti importanti

Bi-hormonal pumps use two hormones (insulin to lower blood sugar and glucagon to raise it) to solve both halves of the blood sugar management puzzle [1.1.2].

Current automated insulin delivery (AID) systems are mostly insulin-only, requiring human calculations for meals and exercise due to rapid-acting insulin delays (taking 15 minutes to start and 1–2 hours to peak).

Dr. Arnold Kadish developed the very first bi-hormonal pump in 1963; it was backpack-sized and administered insulin and glucose intravenously based on continuous readings.

Glucagon acts as a biological safety cushion, prompting the liver to release stored glucose when blood sugar drops. Historically, its chemical and physical instability under varying temperatures has hindered pump integration.

Beta Bionics is developing the iLet Duo (dual-hormone bionic pancreas) and partnered with Xeris Biopharma in 2024 to use a stabilized, pumpable glucagon formulation.

Inreda Diabetic (Netherlands) has developed the CE-marked Inreda AP5, a fully closed-loop bi-hormonal system currently in real-world Dutch pilot programs.

The Inreda AP5 requires two CGMs for sensor redundancy and two separate infusion sets, demanding substantial daily and weekly user maintenance.

One-year real-world trial data for the Inreda AP5 shows highly promising results: an average Time-in-Range (TIR) of 80% and a dramatic reduction of hypoglycemia (time below range) to 3-4%.