medwireNews: Switching to a predictive low-glucose suspend (PLGS) insulin delivery system significantly reduces hypoglycemia risk in people with diabetes in clinical practice, research shows.
The study included an average 65 days of data from 8123 users of the Tandem Basal-IQ PLGS system, which suspends basal insulin delivery if predicted glucose levels within the next 30 minutes are less than 80 mg/dL or current levels are below 70 mg/dL. The users were aged between 6 and 90 years and they kept the PLGS system enabled 98% of the time.
A subgroup of 1371 experienced diabetes technology users had continuous glucose monitoring data for at least 21 days prior to initiating use of the PLGS system. Among these users, the average time spent with blood glucose levels below 70 mg/dL fell from 3.00% to 1.76%, with the reduction evident from the first day of use.
Among the other 3563 users, the average time in hypoglycemia was 1.74%, report Eliah Aronoff-Spencer (University of California, San Diego, USA) and colleagues in Diabetes Technology & Therapeutics.
The number of hypoglycemic events per day in the experienced subgroup fell from 0.11 to 0.03, the same level as achieved by the new users subgroup, meaning that “patients using PLGS experienced on average one hypoglycemic event every 30 days instead of one event every 9 days.”
In the experienced users, corrected mean glucose levels fell slightly but significantly following the introduction of PLGS, as did their total daily dose of insulin.
By contrast, the new users exhibited a “counterintuitive” average 4 mg/dL increase in glucose levels during 9 weeks of PLGS use, along with a median 1.26 U increase in total daily insulin dose, mainly driven by a linear increase in basal insulin dose.
The researchers speculate that these increases may arise from changes in user behavior as they get to know and trust the automated insulin delivery system. They believe that as the PLGS system reduces users’ fear of hypoglycemia they may start to increase their basal insulin to promote glycemic control.
However, the perceived reduced need for caution may also cause “a release in dietary discretion,” explaining the increased glucose levels.
“Recent research has also shown that for patients and caregivers, experiencing reduced hypoglycemia leads to increased confidence and trust in the technology, increased flexibility around mealtimes, and reduced diabetes distress,” write the researchers.
“The observed low rate of patient-cancelled insulin suspensions supports this view, and more research is needed to verify this effect.”
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Diabetes Technol Ther 2019; doi:10.1089/dia.2019.0190