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ORLANDO, Florida – Inpatients with type 2 diabetes receiving non-critical care – including dialysis and corticosteroid therapy – the use of an insulin delivery system in closed loop allowed better glycemic control compared to standard insulin here.
In addition, better glucose control with the closed-loop system has been achieved with amounts of insulin similar to standard therapy, without increasing the risk of hypoglycemia.
"Participants receiving closed-loop insulin injection spent nearly 25% more time in the ideal glucose range and 26% less time with blood glucose levels above the target range." Lia Bally, MD PhD, of the Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism and the Department of General Internal Medicine of Bern University Hospital, University of Bern, Switzerland. Endocrine today. "The closed-loop system has proven to be safe and well accepted by the participants, so it may represent a new approach to managing inpatient diabetes."
The randomized, controlled and parallel study included 136 adults with hyperglycemia requiring subcutaneous insulin therapy, selected from the non-critical medical and surgical care services of two acute care hospitals in Switzerland and the United Kingdom. United. Bally and colleagues randomly assigned patients to receive insulin via a fully automated closed-loop system (n = 70, mean age 68 years, mean HbA1c: 7.8%, mean BMI: 32.7 kg / m²) or to receive conventional insulin therapy according to local practice with continuous monitoring of masked glucose (n = 66, mean age: 67 years, mean HbA1c: 8%, mean BMI: 32.3 kg / m).²) until 15 days. Patients consumed self-selected hospital meals. The primary endpoint was the percentage of time spent in the target blood glucose range (5.6 to 10 mmol / L) for a period of up to 15 days or discharge from the hospital .
The mean percentage of time spent in the target glucose range was 65.8% for the closed-loop group versus 41.5% for the conventional treatment group. Values greater than the target range were observed in 23.6% of cases in the closed-loop group versus 49.5% in the conventional treatment group, Bally said. Mean glucose levels were 154 mg / dL in the closed-loop group versus 188 mg / dL in the conventional treatment group. There was no difference between groups for time spent in hypoglycemia (P = .8) or the amount of insulin administered (P = .5), said Bally.
In an intention-to-treat analysis, the proportion of time in which the glucose measured by the sensor was in the target range was higher in the closed-loop group than in the conventional treatment group (P < .001). Patients who received closed-loop therapy spent less time above the target blood glucose range than those who received conventional therapy (P < .001).
No severe hypoglycemia or serious adverse events occurred in both groups.
Co-author of the study Hood Thabit, MD, PhD, consultant diabetologist and honorary lecturer at the Manchester Diabetes Center, Manchester Royal Infirmary, said Endocrine today that these results demonstrate that blood glucose control can be managed more effectively and safely through a fully automated closed-loop system in this population.
"It is possible to automatically control glucose levels and potentially reduce the workload by using the closed-loop system, even in those traditionally considered the most difficult to manage from a glycemic point of view," he said. Thabit.
Bally said that further research is needed to understand the broader benefits of improving blood glucose control during hospitalization.
The results were published simultaneously in the New England Journal of Medicine. – by Regina Schaffer
The references:
Bally L, et al. 350-OR. Presented at: 78th Scientific Sessions of the American Diabetes Association; June 22-26, 2018; Orlando, Florida.
Bally L, et al. N Engl J Med. 2018; doi: 10.1056 / NEJMoa1805233.
Disclosures Bally and Thabit do not report any relevant financial information. Please consult the study for the relevant financial information of other authors.
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