With its balanced coverage of an experimental system for managing blood glucose in type 1 diabetes, the Times demonstrates why it is often a cut above most other health media outlets. Of the three competing stories we looked at, the Times‘ was the only one to avoid the hyped-up term "artificial pancreas" in its headline. It’s also the only story to accurately portray what actually happened in this experiment; the only one to identify conflicts of interest; and the only one to offer any kind of skeptical perspective from an independent observer.
The study covered here represents a potentially important advance on the road to an automated system for managing blood sugar in patients with type 1 diabetes. By laying out the potential of such a system in sober terms and pointing out the many obstacles that still lay in its path to development and approval, the Times conveys the significance of the findings but doesn’t provide false hope.
Like its competitors, the Times did not discuss costs–an omission which perhaps is more acceptable in this story since it clearly indicated that this is not very close to being a marketable product. Nevertheless, we would have liked to have seen some mention of the financial impact. Many patients with type 1 diabetes are not using currently available pumps and sensors because of the high cost of these devices. It seems likely that this new treatment, if it ever becomes widely available, will be as expensive or more so than the current pump and sensor technology.
We applaud the Times for avoiding the term "artificial pancreas" in the headline and using it sparingly in the body of the story. The competing stories couldn’t resist it. We can understand why marketers and media relations people would favor this term because of its promotional value, but we don’t think it’s a good way to describe this technology in an objective piece of journalism. "Artificial pancreas" is misleading because we’re not really anywhere close to being able to replicate what the normal human pancreas does through artificial technology. Forgetting for a moment that the pancreas does much more than simply dispense insulin (it also produces a number of other hormones and digestive enzymes that aren’t impacted by diabetes), what’s more important is how the pancreas works in concert with the brain and other systems to regulate glucose in a very tight range. The normal human pancreas starts releasing insulin before we eat in response to complex environmental cues, whereas any artificial system would need to be told that meal is coming or react to the rise in glucose after the fact. Plus, insulin produced by the body starts acting right away, whereas insulin analogues take about 20 minutes to take effect. Put this all together and we see that the "artificial pancreas" will, for the foreseeable future, require human intervention to predict post-meal insulin needs and dosing or else patients will be at risk of post-meal blood sugar spikes. And it’s not at all clear that such a system will improve overall blood sugar management compared with existing methods. The term "artificial pancreas" conjures up a vision of totally automated glucose management and essentially a "cure" for type 1 diabetes. This is overselling what the technology can do.
The Times waited until the last 3 paragraphs of an 1,100-word story to hint that an automated system could deliver unsafe doses of insulin. It isn’t until the last sentence that we learn that the system would need to be "exquisitely reliable" in order to be safe. We feel the story should have raised these issues earlier and that it could have done more to emphasize just how difficult it will be for any device to calculate insulin requirements on the fly. Insulin dosing is affected by factors ranging from how much a person has exercised to what and how much they have eaten. It’s conceivable that technology can account for all of these variables, but there are a lot ways things could go wrong, with potentially deadly results. It’s a close call, but we don’t feel the story did enough to call attention to these issues.
In contrast to its competitors, which all led readers to believe there had been a fully automated system sensing glucose levels and dispensing insulin to the participants in this study, the Times noted that the insulin was dispensed by a nurse based on calculations made by a computer algorithm. The Times clearly indicated that the significance of this test was as a "proof of concept" that the algorithm works and is safe, not as a test of any specific device. It noted that a fully automated system combining glucose monitoring and insulin delivery was still "hypothetical."
In addition, the Times story was the only one to draw attention to the small size of this study and the fact the findings were not statistically significant for the primary outcomes. This note of caution was completely lacking from the competing coverage.
The story did not exaggerate the effects of type 1 diabetes.
The story includes quotes from interviews with one of the study investigators and another researcher, and identifies both as having ties to diabetes products manufacturers. It also quotes an analyst at an investment firm. It would have been better had they included one more source who didn’t have commercial ties to specific products.
The story describes currently available technology for glucose monitoring and insulin infusion. It describes the limitations of current approaches for managing insulin, especially during the overnight period. The story is a bit misleading in that it leaves the impression that all type 1 diabetics are currently using pumps at night. This is not actually the case. Most people are doing self monitoring of blood glucose and making judgement calls on whether and how much insulin to administer. However, the story does enough for a satisfactory in our view.
The Times did a good job of describing the system used in this study and how close it is to being commercially available. It called the system "experimental" and said that it was "not fully automated." It said that a fully automated glucose monitor/insulin delivery system was still "hypothetical" and would face regulatory hurdles before it could be marketed to the public.
The story describes the progression from skin prick glucose testing to continuous monitoring and insulin pumps. It places the new developments in this field on this continuum. There could have been more discussion of many of the recent advances that have made daytime hyper- and hypoglycemia less of a problem such as the newer short-acting insulins.
The story did not rely on any news release.