By Andy Skean
While evidence suggests that a closed-loop insulin delivery system (artificial pancreas) appears to improve glucose control in patients with type 1 diabetes, whether the same holds true in patients with type 2 diabetes who are receiving noncritical care remains unknown.
For a study published in the New England Journal of Medicine, Roman Hovorka, PhD, FMedSci, and colleagues found that an artificial pancreas helped improve blood glucose control without increasing the risk of hypoglycemia among hospital patients with type 2 diabetes in hospital.
The trial involved 136 patients who required insulin to manage blood glucose levels during their admission. Participants were randomly assigned to receive insulin therapy via the artificial pancreas or via standard insulin injections for up to 15 days (or until hospital discharge). Those using the artificial pancreas spent an average of 24.2% more time with blood glucose levels in the target range (5.6 to 10.0 mmol/l) when compared with those receiving injections. The former group also had lower average blood glucose levels (8.5 vs 10.5 mmol/l), achieved without increasing daily insulin doses or increased hypoglycemia risk.
“The study could transform the care people with type 2 diabetes receive in hospital,” says Charlotte Boughton, MD. The study team is now using the artificial pancreas for people who receive artificial nutrition in hospital, where blood glucose levels can be particularly challenging to control. “Our research opens a new era of glucose control in hospitals,” adds Dr. Hovorka. “Further research will establish the effect of improved glucose control on comorbidities, length of stay, and other clinically relevant endpoints, as well as whether certain patient groups benefit more than others.”
Bally L, Thabit H, Hartnell S, et al. Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care. N Engl J Med. 2018, June 25. [ePub ahead of print]. Available at www.nejm.org/doi/full/10.1056/NEJMoa1805233.