An artificial pancreas or closed-loop insulin delivery system has been shown to be effective at controlling glucose levels in patients with type 1 diabetes, although the effectiveness of an artificial pancreas for glucose control in patients with type 2 diabetes receiving non-critical care in hospital had yet to be established.
To determine whether an artificial pancreas could also be used in hospitals on patients with type 2 diabetes, Roman Hovorka, PhD, FMedSci, and his team of researchers conducted a clinical trial on 136 hospitalized patients with type 2 diabetes who required insulin to manage their blood glucose levels during admission.
The randomized open-label trial was conducted in two hospitals in the UK and Switzerland. 70 patients were given insulin therapy using the artificial pancreas and 66 patients received conventional subcutaneous insulin therapy. Patients were assessed based on the percentage of time that blood glucose levels were in the target range of 5.6 to 10.0 mmol/l (100 to 180 mg per deciliter) for up to 15 days or until they were discharged from hospital.
Patients who received insulin therapy through the closed-loop insulin delivery system spent 24.2% more time with their glucose levels in the target range compared to those receiving subcutaneous insulin injections. The mean level of glucose in the closed-loop group was 8.5 mmol per liter (154 mg per deciliter) and 10.4 mmol per liter (188 mg per deciliter) in those receiving standard insulin therapy. There was no significant difference between the groups in the amount of insulin delivered or the duration of hypoglycemia.
The study has shown that the use of the artificial pancreas system has potential to transform the care provided to type 2 diabetes patients in hospital. The researchers are currently using the artificial pancreas on patients receiving artificial nutrition in hospital, which can make glucose control much more difficult.
“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,” explained Dr, Hovorka.
The results of the clinical trial are detailed in the paper – Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care – which was recently published in the New England Journal of Medicine. DOI:10.1056/NEJMoa1805233