medwireNews: Results of a randomized crossover trial show that closed-loop insulin delivery offers significantly improved glycemic control even in patients who are well controlled when self-monitoring their glucose levels.
The 29 participating type 1 diabetes patients were familiar with diabetes management devices; all were insulin pump users and five also used continuous glucose monitoring and six used flash glucose monitoring. With the help of this technology, all had achieved glycated hemoglobin levels below 7.5%.
Yet their glycemic control further improved during the 4-week period in which they used a closed-loop system day and night at home, report Roman Hovorka (University of Cambridge, UK) and co-researchers in The Lancet Diabetes & Endocrinology.
The time spent with glucose levels above 10.0 mmol/L was 20.4%, compared with 27.4% during 4 weeks using an insulin pump as normal, and the time spent below 3.9 mmol/L was 2.9% versus 5.3%, resulting in a 10.5 percentage point improvement in the time spent within target range (76.2 vs 65.6%).
“Thus, in adults who are actively engaged with self-management, closed-loop insulin delivery might provide additional benefits, justifying its use in this particular population,” says the team.
Closed-loop control delivered significant improvements both in daytime hours and during the night, increasing the time spent within target range by a respective 8.1 and 17.2 percentage points.
The closed-loop and control periods occurred in a randomly assigned order after a 2–4-week run-in, with a 2–4-week washout period between the two. The closed-loop system required participants to count carbohydrates and calculate pre-meal boluses, but 69% of participants still felt it reduced the time they spent managing their diabetes.
In an accompanying commentary, J Hans DeVries (University of Amsterdam, the Netherlands) notes that although the study “extends the evidence base to patients with well controlled diabetes, other groups such as patients with impaired awareness of hypoglycaemia, an important problem in the management of type 1 diabetes, have not been studied so far.”
And he adds that patients with poorly controlled diabetes require further study, given the variable definitions of poor glycemic control used by researchers.
Nonetheless, he hails the recent US Food and Drug Administration approval of an artificial pancreas system, saying that its “eagerly awaited” entry into the market “will be a milestone in the treatment of type 1 diabetes.”
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