Data support artificial pancreas for type 1 diabetes, but better evidence needed
medwireNews: Analysis of the research to date comparing artificial pancreas treatment with other insulin systems supports its ability to significantly improve glycemic control in patients with type 1 diabetes, while reducing the burden of hypoglycemia.
Apostolos Tsapas (Aristotle University of Thessaloniki, Greece) and colleagues’ systematic review and meta-analysis of 40 randomized controlled trials, involving 1027 participants and 44 comparisons, showed that using an artificial pancreas was associated with almost 2.5 additional hours spent in near normoglycemia (3.9 to 10 mmol/L) over a 24-hour period, compared with other single and dual insulin hormone systems. This equated to an average 9.62% difference in time spent in normoglycemia in favor of the artificial pancreas over the 24-hour period.
This benefit was mainly due to the artificial system’s effect overnight, during which it was associated with patients spending about 15.5% more time, on average, in near normoglycemia, compared with other treatments. And this remained consistent when the artificial pancreas was used only overnight (14.25% difference) or over a 24-hour period (16.44% difference).
The artificial pancreas system also reduced the time spent in hyperglycemia and hypoglycemia, by about 2 hours and 20 minutes, respectively, compared with other treatments.
“Results were robust for single and dual hormone systems, and were consistent in all sensitivity analyses performed—including an analysis restricted to trials under normal living conditions without remote monitoring, supporting the convenience and ease of use of artificial pancreas systems,” the team points out in The BMJ.
The favorable effect of the artificial pancreas was associated with a relative mean reduction in blood glucose levels of 0.48 mmol/L. which the researchers say is “consistent with the HbA1c reduction of about 0.3% recorded in trials with duration of more than eight weeks per intervention.”
They conclude that the results “reflect the progress made over recent decades of extensive research and development in artificial pancreas use.”
However, in a related editorial Norman Waugh (University of Warwick, UK) and colleagues argue that more information is still needed, calling the overall evidence base for the current analysis “weak.”
They highlight that many of the trials were of low quality and short duration, citing in particular that 30 out of the 41 studies lasted for only 7 days. The editorialists also point out that severe hypoglycemia was too infrequent for meaningful comparisons.
Waugh and colleagues believe that longer and larger trials are needed to compare these systems with self-management using continuous glucose monitoring in adults and children. They recommend that v n addition to hypoglycemia and blood glucose variability, look at the effects on diabetic complications, quality of life (including the parents of diabetic children), and cost-effectiveness.
“Closed loop systems have much to offer, but we need better evidence to convince policy makers faced with increasing demands and scarce resources,” they conclude.
By Lucy Piper
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