• Researchers at the Bionics Institute are developing a new medical device that activates the body’s natural processes to treat type 2 diabetes.
• Despite advancements in new medicines, many people experience poorly controlled type 2 diabetes and medication side effects.
• The aim of our research is to develop a drug-free treatment that stimulates the pancreas when blood sugar levels are too high.

What is type 2 diabetes?

Diabetes is a chronic, progressive condition that affects over 415 million people worldwide.

Around 90% of this number suffer from type 2 diabetes, which is associated with lifestyle and genetic factors. Type 2 diabetes initially leads to insulin resistance, followed by not enough insulin being produced by the pancreas.

Insulin is a hormone produced by the pancreas that is critical to maintain blood sugar levels in a normal, healthy range. People with diabetes experience high blood sugar levels, which can eventually damage their body’s organs, causing eye disease, stroke, heart attacks and death.

The issue with controlling blood sugar in type 2 diabetes

Despite advancements in drug therapies, type 2 diabetes is poorly controlled in many people, who are unable to keep their blood sugar levels within a healthy range.

It is also a huge burden on the economy with the total costs of treating people diagnosed with diabetes estimated to be USD $623 billion globally.

In addition, common treatments are often inconvenient to administer and can cause unpleasant side effects.

It is therefore important that alternative treatments are developed to help people keep blood sugar in a healthy range and improve long-term health outcomes for people with type 2 diabetes.

Treating type 2 diabetes with electrical stimulation

Electrical medical devices can be used to alter the activity of nerves to treat a wide range of diseases that don’t respond to drug treatments.

At the core of this ‘electric medicine’ research lies the vagus nerve, which has been harnessed extensively to treat epilepsy and depression.

Recently, researchers at the Bionics Institute invented a vagus nerve stimulation device to treat inflammatory bowel disease that is now being adapted to treat type 2 diabetes.

Harnessing the vagus nerve

The vagus nerve, which runs from the brain to the gut, with branches to the heart, lungs, liver and pancreas, controls many processes in the body.

Bionics Institute researchers have found a way to stimulate a specific part of the vagus nerve using a complex electrical medical device that activates the release of hormones to lower blood sugar levels.

The beauty of this device is that it kick-starts the body’s natural mechanisms, which means there are fewer side effects than with drug treatments.

Working towards an implant with a remote control

This new and incredibly innovative device, currently in the early stages of development at the Bionics Institute, will eventually be implanted into people with uncontrolled type 2 diabetes using key-hole surgery.

The aim is to connect the device with a remote control that can be used to switch on stimulation after eating, control blood sugar levels and improve overall health of people with type 2 diabetes.

Next steps for Bionics Institute researchers

The vagus nerve stimulation device that has been developed to treat inflammatory bowel disease has passed safety tests for use in humans and will be moving into clinical trials in 2021.

As the type 2 diabetes device uses similar technology, this approval for use in clinical trials will accelerate its development.

Our next steps are to consolidate preclinical data and start planning for a clinical trial, in collaboration with our clinical collaborators.

BI researchers: Associate Professor James Fallon (PI), Dr Joel Villalobos, Dr Sophie Payne, Dr Tomoko Hyakumura

External researchers: Associate Professor Sof Andrikopoulos (Austin Health), Professor John Prins (University of Melbourne)

Clinical collaborators: Professor Richard J. MacIsaac (St Vincent’s Hospital), Associate Professor Glenn Ward (St Vincent’s Hospital)

More information for researchers

Bionic medicine is emerging as a promising alternative treatment for chronic diseases as it aims to rapidly adapt to the patient’s fluctuating condition to provide real-time, patient-specific therapy.

Furthermore, it offers a reduction in side effects and long-term costs (Vitale and Litt, 2018), and could provide a fully internal, automated system with a high medical adherence and minimal interference to the patient’s activities during the day (Payne et al., 2019a; Alliance for Advancing Bioelectronic, 2020; Cho et al., 2020; Guemes Gonzalez et al., 2020).

Electrical modulation of the vagus nerve to lower high glucose levels to improve glycaemic control has been the focus of research (Malbert, 2018; Guemes Gonzalez et al., 2020) as this autonomic nerve is involved in the regulation of food intake, glucose metabolism and homeostasis and influences the overall dynamics of insulin secretion (Travagli and Browning, 2011; Waise et al., 2018).

We have developed a unique stimulation strategy that allows selective activation of efferent (motor) vagal fibres, while also inhibiting afferent pathways to the brain. We have demonstrated that this ‘efferent vagus nerve stimulation’ strategy is safe and efficacious at lowering glycaemia over a short period-of-time in a preclinical model of type 2 diabetes.

Future studies are investigating an optimal stimulation strategy that leads to the long-term reduction of glycaemia and improve in diabetic symptoms.

Publications

Payne et al., 2020 Physiol Rep. https://doi.org/10.14814/phy2.14479
Payne et al., 2018 Nat Rev: Gastrol & Hep https://doi.org/10.1038/s41575-018-0078-6