Smartphones have gotten good enough to provide nearly continuous, closed-loop, outpatient control of blood sugar in people with diabetes, according to a recently published study.

"We showed that it is possible. Frankly, there were voices saying that it was not possible," corresponding author Boris Kovatchev, director of the University of Virginia's Center for Diabetes Technology, tells MobiHealthNews.

Kovatchev and fellow researchers from three countries first presented their findings of this attempt to make the "artificial pancreas" mobile at the American Diabetes Association's annual scientific meeting in June and had their work published in the current edition of the journal Diabetes Care. The Juvenile Diabetes Research Foundation, which funded the research along with the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases, defines the artificial pancreas as automated closed-loop control of blood glucose.

Prior to this study, artificial pancreas tests had employed laptops wired to continuous glucose monitors and insulin pumps. The paper called this "a system limiting free movement and too cumbersome to be used beyond hospital confines." 

For this experiment, researchers at UVA as well as at the the Sansum Diabetes Research Institute in Santa Barbara, Calif., University of Padova in Italy and the University of Montpellier in France built a prototype system called Diabetes Assistant (DiAs) on modified Android phones, wirelessly connected to Dexcom monitors and Insulet OmniPod insulin pumps. They monitored a total of 20 patients with type 1 diabetes for 42-hour trials in ambulatory environments.

Patients actually controlled system settings in order to replicate how they might use the technology away from clinical environments. The researchers found that this worked well enough to declare the smartphone platform "appropriate for outpatient use."

In the study, the communications system functioned properly 97.7 percent of the time. "This exceeded the predetermined primary end point of 80 percent system functionality," the international team reported. "In retrospect, this goal may have been conservative, but before this study it was generally unclear whether a smart phone can run closed-loop control, and there was no experience to guide the choice of this goal," they added.

Kovatchev, who has been working on the artificial pancreas since 2007, said UVA is talking to a few companies about commercializing the technology, though development continues. "The technology will have to improve to get there," said Kovatchev, whom the UVA Patent Foundation named inventor of the year for 2011 for his work on the JDRF Artificial Pancreas Project. That means assuring a stable connection and longer battery life, as well as advancements in the apps that control the system, according to the Virginia professor of psychiatry and neurobehavioral sciences.

"Combined with real-time remote monitoring, this system opens the possibility for large pivotal trials that will establish the artificial pancreas as a viable mainstream treatment strategy in type 1 diabetes," the paper said.

The researchers ran their trial with an experimental, proprietary wireless connection that required phones to be within 5 inches of the medical equipment. Kovatchev said this technology has since been abandoned in favor of Bluetooth low energy, which has a range of about 30 feet.

Since the research was presented at ADA meeting, the team began trials on diabetic children at summer camp. "That is expected to conclude this month," Kovatchev said.