Artificial pancreas ‘improves’ inpatient type 2 diabetes control
A closed-loop insulin-delivery system resulted in “significantly better” control than conventional insulin therapy without a higher risk of hypoglycaemia in inpatients with type 2 diabetes receiving noncritical care, a study has concluded.
There is increasing evidence that a closed-loop delivery system, known as an artificial pancreas, can improve glucose control in people with type 1 diabetes.
This research, published in the New England Journal of Medicine and funded by Diabetes UK, investigated whether a closed-loop system could improve glycemic control in people with type 2 diabetes who were receiving noncritical care.
The randomised, open-label trial was conducted on general wards in two tertiary hospitals located in the UK and Switzerland. Researchers studied 136 adults with type 2 diabetes who required subcutaneous insulin therapy to receive either closed-loop insulin delivery (70 patients) or conventional subcutaneous insulin therapy, according to local clinical practice (66 patients).
The primary end point was the percentage of time that the sensor glucose measurement was within the target range of 100 to 180 mg per deciliter (5.6 to 10.0 mmol per liter) for up to 15 days or until hospital discharge.
Summarising the results, the researchers said: “The mean (±SD) percentage of time that the sensor glucose measurement was in the target range was 65.8±16.8 per cent in the closed-loop group and 41.5±16.9 per cent in the control group, a difference of 24.3±2.9 percentage points (95 per cent confidence interval [CI], 18.6 to 30.0; P<0.001); values above the target range were found in 23.6±16.6 per cent and 49.5±22.8 per cent of the patients, respectively, a difference of 25.9±3.4 percentage points (95 per cent CI, 19.2 to 32.7; P<0.001).
“The mean glucose level was 154 mg per deciliter (8.5 mmol per liter) in the closed-loop group and 188 mg per deciliter (10.4 mmol per liter) in the control group (P<0.001). There was no significant between-group difference in the duration of hypoglycemia (as defined by a sensor glucose measurement of <54 mg per deciliter; P=0.80) or in the amount of insulin that was delivered (median dose, 44.4 U and 40.2 U, respectively; P=0.50). No episode of severe hypoglycaemia or clinically significant hyperglycemia with ketonemia occurred in either trial group.”
The paper concluded: “Among inpatients with type 2 diabetes receiving noncritical care, the use of an automated, closed-loop insulin-delivery system resulted in significantly better glycemic control than conventional subcutaneous insulin therapy, without a higher risk of hypoglycaemia.”
To access the study, click here.