Closed-loop insulin delivery improves blood sugar control in type 1 diabetes

A study presented at this year’s annual meeting of the European Association for the Study of Diabetes has shown that hybrid day-night closed-loop insulin delivery systems are more effective at controlling blood sugar levels in type 1 diabetes than sensor-augmented pump therapy.

By Magic mineImage Credit: Magic mine / Shutterstock

With sensor-augmented pump therapy, an insulin pump is combined with a continuous glucose monitoring sensor that sends readings to the patient who is then responsible for administering their insulin doses.

Closed-loop insulin delivery systems, on the other hand, combine this monitoring with an insulin pump and an algorithm that enables automatic insulin delivery.

Hybrid closed-loop systems combine automated delivery with insulin delivery initiated by the patient. The first of these systems was introduced into clinical practice in 2017 following a safety trial.

For the study, 86 patients with type 1 diabetes (aged six years and older) treated with insulin pump therapy and who had sub-optimal blood glucose control, were randomly assigned to receive either sensor-augmented pump therapy (control group) or the hybrid closed-loop therapy over a 12 -week period.

The participants underwent training on the insulin pump and glucose monitoring during a 4-week run-in period.

As reported in The Lancet, glucose levels were within the target range of 3.9 to 10.0mmol/L for a significantly greater proportion of time in the closed-loop group compared with the control group, at 65% versus 54%.

In the closed-loop group, the HbA1c level fell from 8.3% to 8.0% after training and to 7.4% after the study.

The corresponding figures in the control group were 8.2%, 7.8%, and 7.7%. This difference in reduction was a significant 0.36%.

The median amount of time spent in a hypoglycemic state (glucose below 3.9mmol/L) was 12 minutes lower in the closed-loop group versus control group and the time spent in a hyperglycemic state (above 10.0mmol/L) was 2 hours and 24 minutes lower.

Overall, the proportion of time spent in the hypo-or hyperglycemic state in the closed-loop group was a median of 3.5% at baseline and 2.6% after the study.

The corresponding figures for the controls were 3.3% and 3.9%.

The authors conclude that, compared with sensor-augmented pump therapy, the use of day-and night-hybrid closed-loop insulin delivery improves glycemic control in people with type 1 diabetes and reduces their risk of hypoglycemia.

Results from our study together with those from previous studies support the adoption of closed-loop technology in clinical practice across all age groups."

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