Restricted artificial pancreas use may suffice

By Eleanor McDermid

Restricting use of an artificial pancreas to the evening and nighttime, with standard pump therapy the rest of the time, seems to deliver similar benefits to using one all day and night in patients with Type 1 diabetes, a study suggests.

Eric Renard (Montpellier University Hospital, France) and colleagues previously tested evening/nighttime use only, finding improved blood glucose control compared with standard pump therapy. But they were then surprised when a different study, testing all day and night artificial pancreas use, reported improvements very similar to their own, leading them to extend their study to add a period of 24-hour usage.

Twenty patients from their original trial participated. In the original randomised crossover study, the participants had maintained their blood glucose within the target range of 3.9-10.0 mmol/L for 59.7% of the time (over 24 hours) during the control standard pump therapy stage versus 63.6% during the evening/night artificial pancreas stage, which was a significant difference.

During the extension study, 24-hour pump use did improve on this, but only slightly, at 64.7%, reports the team in Diabetes Care.

There were larger improvements in blood glucose control during the daytime period (08:00-20:00), when patients had previously not used the artificial pancreas, with blood glucose control maintained for 64.9% of the time versus 61.2% in the evening/nighttime use period and 60.7% in the control period, although these were not statistically significant.

However, daytime blood glucose variability was significant improved with 24-hour over evening/nighttime artificial pancreas use, with the standard deviation of blood glucose being 3.2 versus 3.4 mmol/L.

The researchers caution that this was not a direct randomised comparison, so the results are not conclusive. Nevertheless, they suggest that the "lack of a significant difference on major glucose control outcomes" between 24-hour and evening/nighttime artificial pancreas use suggests that the latter might be the most viable initial commercial use of the artificial pancreas.

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