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Artificial pancreas systems offer better glucose control than standard therapy
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Better overnight glucose control was found with single- and dual-hormone artificial pancreas systems compared with conventional therapy, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
The dual-hormone system, however, did not increase overnight time-in-target glucose levels, although the effect of lowering hypoglycemic risk cannot be dismissed, the researchers wrote.
Bruce A. Perkins, MD, MPH, FRCP(C), of the University of Toronto, and colleagues evaluated 28 participants with type 1 diabetes (21 adults; seven adolescents) to compare the efficacy of the dual-hormone (insulin and glucagon) artificial pancreas, single-hormone (insulin alone) artificial pancreas and conventional insulin pump therapy. All three interventions were applied over a night after exercise and another night after a high-carbohydrate/high-fat meal.
Compared with conventional therapy, which had a median percentage of time-in-target glucose range of 47%, the single- (76%) and dual-hormone (81%) artificial pancreas systems had higher percentages of time-in-target glucose range (P < .001 for both). No difference was found for time-in-target between the single- and dual-hormone therapies.
The median percentage of time of sensor glucose readings at less than 4 mmol/L was lower in the single- (P = .004) and dual-hormone (P < .001) therapies compared with conventional therapy.
During conventional therapy, there were 14 hypoglycemic events compared with six during the single-hormone therapy (P = .06) and three during the dual-hormone therapy (P = .02).
“In this head-to-head at-home comparison of the efficacy of single- and dual-hormone artificial pancreas configurations on overnight glycemic controls in patients with type 1 diabetes, both configurations improved the amount of time spent in target glycemic range and improved other measures of hyper- and hypoglycemic exposure when compared to conventional insulin pump therapy in the setting of stimuli designed to increase overnight glycemic excursions,” the researchers wrote.
However, the results did not show a significant advantage of the dual-hormone approach compared with the single-hormone approach, according to the researchers. – by Amber Cox
Disclosure: Perkins reports speaker honoraria from GlaxoSmithKline Canada, Johnson and Johnson, Medtronic, Novo Nordisk, Roche and Sanofi; research grants from Boehringer Ingelheim and Medtronic; and consulting for Neurometrix. Please see the full study for a list of all other authors’ relevant financial disclosures.
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