Artificial pancreas in the hospital

The automated insulin pump has already shown great results in type 1 diabetes in an ambulatory setting. This study shows that it is as useful in type 2 diabetes patients treated in the hospital. Patients utilizing the “artificial pancreas” had better glycemic control, without an increased risk of hypoglycemia. I anticipate that closed-loop, automated insulin devices will become the “standard of care” for hospitalized patients with type 1 and type 2 diabetes in the future.

GT

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N E J M

Randomized, open-label

August 2018

BACKGROUND

In patients with diabetes, hospitalization can complicate the achievement of recommended glycemic targets. There is increasing evidence that a closed-loop delivery system (artificial pancreas) can improve glucose control in patients with type 1 diabetes.

We wanted to investigate whether a closed-loop system could also improve glycemic control in hospital patients with type 2 diabetes who were receiving noncritical care.

METHODS

In this randomized, open-label trial conducted on general wards in two tertiary hospitals located in the United Kingdom and Switzerland, we assigned 136 adults with type 2 diabetes who required subcutaneous insulin therapy to receive either closed-loop insulin delivery (70 patients) or conventional subcutaneous insulin therapy, according to local clinical practice (66 patients).

The primary end point was the percentage of time that the sensor glucose measurement was within the target range of 100-180 mg/dL for up to 15 days or until hospital discharge.

RESULTS

The mean percentage of time that the sensor glucose measurement was

In the target range was 66% in the closed-loop group and 42% in the control group, a difference of 24 percentage points (p<0.001);

Values above the target range were found in 24% and 50% of the patients, respectively, a difference of 26 percentage points (p<0.001).

The mean glucose level was 154 mg/dL in the closed-loop group and 188 mg/dL in the control group (p <0.001).

There was no significant between-group difference in the duration of hypoglycemia (as defined by a sensor glucose measurement of <54 mg per deciliter; P=0.80) or in the amount of insulin that was delivered (median dose, 44.4 U and 40.2 U, respectively; P=0.50).

No episode of severe hypoglycemia or clinically significant hyperglycemia with ketonemia occurred in either trial group.

CONCLUSIONS

Among inpatients with type 2 diabetes receiving hospital noncritical care, the use of an automated, closed-loop insulin-delivery system resulted in significantly better glycemic control than conventional subcutaneous insulin therapy, without a higher risk of hypoglycemia.