Otago Researchers Lead Revolution in Type 1 Diabetes Care

At the University of Otago, paediatric endocrinologists Professors Ben Wheeler and Martin de Bock are at the forefront of a transformative shift in managing type 1 diabetes (T1D), an autoimmune condition where the body's immune system attacks insulin-producing beta cells in the pancreas. Their work on hybrid closed-loop (HCL) systems, often called artificial pancreases, promises what they term 'diabetes freedom' – a life where constant manual insulin dosing and blood sugar monitoring fade into the background.

In New Zealand, around 26,000 people live with T1D, which makes up about one in ten diabetes cases. Without optimal management, it shortens life expectancy by up to 20 years, with even greater impacts on Māori and Pacific communities. Traditional treatments rely on multiple daily insulin injections or pumps, frequent finger-prick tests or continuous glucose monitors (CGMs), and vigilant carbohydrate counting – a relentless burden, especially for children and youth.

Professors Wheeler (Dunedin School of Medicine) and de Bock (Christchurch campus) received the Health Research Council's (HRC) prestigious Beaven Medal in October 2025 – the first joint award – for their decade-long efforts. Their research has accelerated global adoption of automated insulin delivery (AID) technologies, reducing daily management by up to 70 percent and paving the way for 90-95 percent relief with emerging systems.

A Patient's Story: Freedom Through Innovation

Eleven-year-old Rosie Barton from Dunedin embodies the impact. Previously tethered to a traditional insulin pump with tubes that complicated swimming and play, Rosie now uses a patch-like, tubeless device trialled at Otago. This next-generation AID integrates a CGM sensor, insulin reservoir, and smart algorithm, automatically adjusting doses based on real-time glucose levels.

Her mother, Lisa Barton, calls it a 'game-changer.' 'Rosie can swim without worrying about disconnections or water damage. It's simplified our lives dramatically,' she shares. Stories like Rosie's highlight how Otago's trials are not just academic – they're reshaping childhoods affected by T1D.

Understanding Type 1 Diabetes and Its Challenges in New Zealand

Type 1 diabetes occurs when the immune system destroys pancreatic beta cells, halting natural insulin production essential for glucose uptake into cells for energy. Patients must mimic the pancreas externally: injecting insulin to cover basal needs (constant low-level supply) and boluses (meals/exercise). Hypoglycemia (low blood sugar) risks seizures or coma; hyperglycemia leads to long-term complications like heart disease, kidney failure, and neuropathy.

In Aotearoa New Zealand, T1D diagnosis peaks in childhood, with youth facing unique hurdles: erratic growth hormones, active lifestyles, and adolescent rebellion against regimens. Māori and Pacific youth experience worse outcomes due to access barriers, with life expectancy losses amplified. Otago's Edgar Diabetes and Obesity Research (EDOR) Centre addresses this through targeted paediatric studies.

How Hybrid Closed-Loop Systems Work: Step-by-Step

HCL systems – the core of Otago's revolution – form an 'artificial pancreas.' Here's the process:

• Sensing: A CGM measures interstitial glucose every 5 minutes via a small sensor under the skin.
• Computing: A smartphone app or pump runs an algorithm predicting glucose trends 30-60 minutes ahead, factoring activity, meals, and history.
• Acting: The pump delivers precise insulin micro-doses automatically, intervening only for user-confirmed boluses if needed.
• Learning: Systems adapt over time, reducing user input.

Professor Wheeler likens it to a 'self-driving Tesla': sensors (cameras), engine (pump), and AI brain. Tubeless versions like Rosie's eliminate visible tubes, enhancing discretion and activity freedom.

Groundbreaking Trials: Evidence from Otago Studies

Professor Wheeler's landmark randomised controlled trial (RCT), published in NEJM Evidence, involved 80 young people with suboptimal control. Over 13 weeks, HCL users spent 8.4 more hours per day in target glucose ranges (3.9-10 mmol/L) versus standard care, with halved hypoglycemia fear – the largest gains in any youth RCT.

Professor de Bock evaluated tubeless pumps and advanced algorithms, influencing European approvals and global standards. Their combined 12+ years of publications have fast-tracked safer, more effective tech. Ongoing EDOR projects like ACCESS-AID accelerate equitable rollout nationwide.

Photo by Alexandre Lecocq on Unsplash

Recognition and Global Influence

The Beaven Medal underscores Otago's impact. As the HRC notes, their interventions have 'transformed type 1 diabetes care' regionally and worldwide. De Bock's tubeless pump data spurred faster regulatory nods; Wheeler's trials set benchmarks for youth AID. This positions University of Otago as a leader in diabetes technology research, fostering collaborations and attracting talent.

Addressing Equity: A New Care Model for All Kiwis

Despite promise, AID access lags: only 15-20 percent of T1D patients use it now. Pharmac's funding expansion could boost to 80-90 percent, overwhelming systems (12,000-15,000 new users yearly). Otago secured a $1.4 million HRC grant for innovative training: remote monitoring, fly-in-fly-out clinics for rural Taranaki, and prioritising underserved Māori/Pacific groups.

This model ensures equity, tackling disparities where ethnic minorities face higher complication rates due to socioeconomic barriers.

Challenges in Scaling AID Nationwide

Training thousands requires paradigm shifts: from clinic visits to app-guided self-management. Health systems must scale educator teams, address tech literacy, and monitor long-term adherence. Otago's ACCESS-AID study tests protocols for safe, rapid onboarding, blending online manuals with hands-on support.

• Benefits: 70 percent burden reduction, better glycaemic control.
• Risks: Sensor inaccuracies, over-reliance; mitigated by algorithms and education.

Future Horizons: Towards Full Automation

Professors envision the 'Holy Grail': fully automated AID needing zero decisions – wear it, and it emulates a healthy pancreas. Advances like bi-hormonal (insulin+glucagon) pumps and implantable sensors loom. While biological cures (stem cell beta cells) progress globally, Otago focuses on immediate tech solutions, influencing international guidelines.

With NZ's high T1D youth incidence, Otago's work could add healthy years, easing $1 billion+ annual diabetes costs.

Otago's Broader Diabetes Ecosystem

EDOR's portfolio spans T1D trials (Co-Pilot, OPTIMISE) to obesity links. Collaborations with Diabetes New Zealand and international bodies amplify reach. Student opportunities abound, training future researchers in this vital field.

Photo by Duskfall Crew on Unsplash

Expert Insights and Stakeholder Perspectives

'We've focused where challenges are greatest,' says Wheeler. De Bock adds, 'Each tech generation reduces burden further – it's transformative.'

Stakeholders like patient advocates praise equity focus; clinicians note workflow shifts. Globally, Otago's data shapes FDA/EMA decisions.

Implications for Higher Education and Research Careers

Otago exemplifies how university research drives health innovation. Amid NZ's research funding debates, successes like Beaven Medal highlight ROI. Aspiring academics find opportunities in EDOR's clinical trials, algorithm development, and equity studies – bolstering NZ's higher ed reputation in biomedicine.