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Closed-loop insulin delivery improves glucose control in noncritical care setting
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ORLANDO, Fla. — In hospitalized patients with type 2 diabetes receiving noncritical care — including dialysis and glucocorticoid therapy — use of a fully automated, closed-loop insulin-delivery system resulted in better glycemic control compared with standard insulin therapy, according to a speaker here.
In addition, improved glucose control with the closed-loop system was achieved with insulin amounts that were similar to standard therapy, without increasing hypoglycemia risk.
“Participants receiving closed-loop insulin delivery spent almost 25% more time in the ideal blood glucose range and 26% less time with blood glucose levels above the target range,” Lia Bally, MD PhD, from the department of diabetes, endocrinology, clinical nutrition and metabolism and the department of general internal medicine at Bern University Hospital, University of Bern, Switzerland, told Endocrine Today. “The closed-loop system was shown to be safe and well-accepted by the participants. It may, therefore, represent a novel approach to manage inpatient diabetes.”
The randomized, controlled, parallel-design study included 136 adults with inpatient hyperglycemia requiring subcutaneous insulin therapy, selected from medical and surgical noncritical care wards at two acute hospitals in Switzerland and the United Kingdom. Bally and colleagues randomly assigned patients to receive insulin via a fully automated, closed-loop system (n = 70; mean age, 68 years; mean HbA1c, 7.8%; mean BMI, 32.7 kg/m²) or to receive conventional insulin therapy as per local practice with masked continuous glucose monitoring (n = 66; mean age, 67 years; mean HbA1c, 8%; mean BMI, 32.3 kg/m²) for up to 15 days. The patients consumed self-selected hospital meals. Primary endpoint was the percentage of time spent in the target glucose range (5.6-10 mmol/L) for up to 15 days or hospital discharge.
Mean percentage of time spent in the target glucose range was 65.8% for the closed-loop group vs. 41.5% for the conventional-therapy group. Values above the target range were observed in 23.6% of the closed-loop group vs. 49.5% of the conventional-therapy group, Bally said. Mean glucose levels were 154 mg/dL in the closed-loop group vs. 188 mg/dL in the conventional-therapy group. There were no between-group differences for time spent in hypoglycemia (P = .8) or amount of insulin delivered (P = .5), Bally said.
In an intention-to-treat analysis, the proportion of time when sensor-measured glucose was in target range was higher in the closed-loop group vs. the conventional-therapy group (P < .001). Patients assigned closed-loop therapy spent less time above the target glucose range vs. those assigned conventional therapy (P < .001).
No severe hypoglycemia or serious adverse events occurred in either group.
Study co-author Hood Thabit, MD, PhD, consultant diabetologist and honorary senior lecturer at the Manchester Diabetes Centre, Manchester Royal Infirmary, told Endocrine Today that these findings demonstrate that glucose control can be more effectively and safely managed with a fully automated, closed-loop system in this population.
“It is possible to automatically control glucose levels and potentially reduce work-load burden using the closed-loop system, even in those conventionally thought to be the most challenging to manage from a glycemic point of view,” Thabit said.
Bally said further research is needed to understand the wider benefits of improved glucose control during hospitalization.
The findings were simultaneously published in The New England Journal of Medicine. – by Regina Schaffer
References:
Bally L, et al. 350-OR. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Bally L, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1805233.
Disclosures: Bally and Thabit report no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.