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Artificial pancreas improved overnight control of diabetes in adults
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Data from two randomized trials suggest that an artificial pancreas may improve overnight blood glucose control and reduce the risk for nocturnal hypoglycemia in adults with type 1 diabetes.
Previous studies have demonstrated the efficacy of an artificial pancreas in children and adolescents, but the effects of such a system remained unknown in adult populations. Researchers at the University of Cambridge conducted two small studies to compare the safety and efficacy of overnight closed-loop insulin delivery with conventional insulin pump therapy in 24 adults with type 1 diabetes. Participants were aged 18 to 65 years and had used insulin pump therapy for at least 3 months.
In the first study, half of participants were monitored twice overnight after consuming a medium-sized meal (60 g carbohydrates) at 7 p.m. They were randomly assigned to an artificial pancreas or conventional insulin pump therapy and then, on a night 1 to 3 weeks later, they used the other delivery method, according to a press release. In the second study, the other 12 participants were monitored twice overnight after consuming a larger meal (100 g carbohydrates) accompanied by alcohol at 8:30 p.m. They were also assigned to one of the two insulin delivery methods.
During overnight-loop insulin delivery, the time spent with blood glucose levels in the target range increased by up to 28%. Closed-loop delivery also lowered glucose variability overnight and significantly reduced the time spent hyperglycemic, according to the release.
The researchers said their findings provide further evidence that overnight closed-loop delivery can operate safely, effectively and consistently across different age groups, insulin sensitivities and lifestyle conditions. In addition, an artificial pancreas may allow more flexible lifestyles and improved glycemic control for people with type 1 diabetes in the future.
In an accompanying editorial, Boris Kovatchev, PhD, of the University of Virginia, said closed-loop control shows promise in a research setting. However, further development and system miniaturization is needed in practice to improve the health and lives of people with type 1 diabetes.
For more information:
- Hovorka R. BMJ. 2011;342:d1855.
- Kovatchev B. BMJ. 2011;342:d1911.
Disclosure: The researchers report various relevant financial disclosures. See the full study for details.