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Artificial pancreas safe, effective for type 2 diabetes in inpatient setting
Patients with type 2 diabetes using insulin who were hospitalized for noncritical complications spent more time in the target glucose range when assigned to an artificial pancreas vs. conventional insulin therapy, according to recent study findings.
In an open-label, parallel-group, randomized controlled trial, Hood Thabit, MD, PhD, of the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge, and colleagues analyzed data from 40 adult patients with type 2 diabetes receiving insulin therapy, recruited from general wards at Addenbrooke’s Hospital in Cambridge, United Kingdom. Researchers randomly assigned patients to closed-loop insulin delivery (n = 20), using a model-predictive control algorithm to direct subcutaneous delivery of a rapid-acting insulin analogue without mealtime insulin boluses, or conventional insulin therapy (n = 20). The primary outcome was time spent in the target glucose range (5.6 mmol/L-10 mmol/L) during the 72-hour study period. Patients were enrolled between February 2015 and March 2016; reasons for admission to the hospital included infected foot ulcer (n = 30), ischemic diabetic foot (n = 4), congestive cardiac failure (n = 4) and urinary tract infection (n = 2).
Researchers found that more patients in the artificial pancreas group spent time in the target glucose concentration range vs. those assigned to conventional insulin therapy (59.8% vs. 38.1%; P = .0004). There were no episodes of severe hypoglycemia or hyperglycemia with ketonemia in either group. One patient experienced gastrointestinal bleeding unrelated to the study.
The researchers noted that the study is limited by its short duration and a predominance of patients with foot ulcers, who were approached due to an expected longer stay in the hospital. In addition, the artificial pancreas group also received daily basal insulin glargine (Sanofi) as a precaution to mitigate against potential ketonemia in the event of prolonged pump disconnection.
“In spite of available guidelines and consensu s regarding inpatient hyperglyc emia management, implementation of glucose control management in hospitalized type 2 diabetes patients remains challenging and suboptimal, with the inherent risk of hypo- and hyperglycemia st ill prevalent in many hospitals,” Thabit told Endocrine Today. “ An automated closed-loop insulin delivery (artificial pancreas) system may help improve glucose-related outcomes and reduce the workload burden of healthcare professionals in hospital managing this challenging inpatient population. ”– by Regina Schaffer
Disclosure: Thabit reports no relevant financial disclosures. Please see the full study for a list of the other authors’ relevant financial disclosures.