Photo Credit: iStock.com/Akarawut Lohacharoenvanich

A closed-loop glucose system improved glycemic control and reduced variability in patients undergoing major abdominal surgery with no serious adverse events.

A fully closed-loop (FCL) glucose control system resulted in significantly better glycemic control compared with usual care in patients undergoing major abdominal surgery who were expected to experience prolonged hypoglycemia, according to findings published in Annals of Surgery.

Also known as artificial pancreas systems, FCL glucose control systems adjust insulin delivery through a pump in response to continuous glucose monitoring. Such real-time adaptation to frequently changing insulin requirements in the perioperative setting could improve patient safety.

“A substantial body of literature links perioperative hyperglycemia to adverse clinical outcomes, leading to excess morbidity and mortality,” Lia Bally, MD, PhD, and colleagues wrote. “Of note, patients without preexisting diabetes seem to be particularly vulnerable and were observed to have higher hyperglycemia-associated mortality compared with patients with a known diagnosis of diabetes.”

The two-center randomized controlled trial compared usual care glucose management with subcutaneous FCL glucose management in 37 patients undergoing pancreatic (54%), liver (22%), upper gastrointestinal (19%), and lower gastrointestinal (5%) surgery. Among patients, 18 were randomly assigned to FCL and 19 to usual care glucose management.

Glucose Levels & Glycemic Variability

During hospitalization, the mean proportion of time with sensor glucose levels in the target range of 5.6 to 10.0 mmol/L was 26.4 percentage points higher in the FCL group (80.1% ± 10.0%) compared with the usual care group (53.7% ± 19.7%), according to the researchers.

Mean glucose was also significantly lower in the FCL group (7.5 ± 0.5 mmol/L) than in the usual care group (9.1 ± 2.4 mmol/L). Glycemic variability was significantly lower with FCL than usual care, while total daily insulin dose was significantly higher: 34.3 IU in the FCL group compared with 3.5 IU in the usual care group.

“This suggests a reluctance to treat hyperglycemia by the hospital care team, especially among patients who are insulin naïve despite prior evidence showing that correction of hyperglycemia is associated with improved outcomes among hospitalized patients, independent of diabetes status,” Dr. Bally and colleagues wrote.

In both groups, the time in hypoglycemia was low. There were no serious adverse events related to the study.

“Automated glucose-responsive insulin delivery is a safe and effective strategy to minimize hyperglycemia in complex surgical populations,” the researchers wrote.