Meta-analysis supports artificial pancreas superiority over pumps
medwireNews: Artificial pancreas systems increase time in blood glucose target range by nearly 3 hours per day compared with conventional pump therapy in outpatients with type 1 diabetes, meta-analysis data show.
“If improvement in time in target is associated with change in HbA1c [glycated hemoglobin], we expect that use of artificial pancreas systems would reduce HbA1c by a minimum of 0.3%,” Alanna Weisman (University of Toronto, Ontario, Canada) and co-researchers remark.
They add: “Our results also suggest additional benefits beyond HbA1c reduction, such as reduction of hypoglycaemia and lessened burden of disease selfmanagement.”
The findings arose from a systematic review and meta-analysis of 24 randomized controlled trials comparing closed-loop artificial pancreas systems with conventional pump therapy in 585 adults and children with type 1 diabetes undergoing treatment in an outpatient setting.
The researchers report that patients receiving conventional pump therapy, be that either continuous subcutaneous insulin infusion (CSII) with blinded continuous glucose monitoring (CGM) or unblinded sensor-augmented pump therapy, spent an average 58.2% of time in target glucose range (3.9–10.0 mmol/L or 3.9–8.0 mmol/L, depending on the study).
By comparison, the time in target range was a significant 12.6% higher with insulin only or insulin plus glucagon artificial pancreas systems, which equated to an increase of 172 minutes per 24 hours.
Weisman and team note that there was high statistical heterogeneity (I2=84%) among the studies, with effect sizes ranging from a mean difference of –6.3% to 26.7%.
The researchers also found that time in target range was significantly greater with dual-hormone artificial pancreas systems compared with single-hormone systems, with mean differences of 19.5% and 11.1%, respectively, compared with conventional pump therapy.
However, they caution that six of seven comparisons compared dual-hormone systems with CSII plus blinded CGM, whereas 21 of 22 single-hormone comparisons had unblinded sensor-augmented pumps as the comparator, which they say prevents additional analysis examining the effect of the comparator therapy on outcomes.
An analysis of 21 comparisons with 463 participants revealed that time spent in hypoglycemia (<3.9 mmol/L) was reduced by 2.5% with artificial pancreas systems, from a weighted mean of 4.9% with conventional pump therapy, which is equivalent to 35 minutes per day.
But the researchers highlight the fact that such a reduction only occurred in studies with remote monitoring, with no significant reduction in hypoglycemia observed in studies without remote monitoring.
The also found that insulin dose did not change according to the type of treatment used.
“Our results show that closedloop technology is feasible and beneficial in a variety of clinical settings and as such it is likely artificial pancreas systems will transform the management of type 1 diabetes in the near future,” Weisman et al conclude in The Lancet Diabetes and Endocrinology.
By Laura Cowen
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