Closed Loop System Improves Overnight Glucose Control

Insulin delivery method also reduces nocturnal hypoglycemia risk in type 1 diabetes

FRIDAY, April 15 (HealthDay News) -- In adults with type 1 diabetes, closed loop delivery of insulin (artificial pancreas) appears to improve overnight control of glucose levels and reduce the risk of nocturnal hypoglycemia, according to an article published online April 14 in BMJ.

In two sequential, open-label, randomized, controlled, crossover studies, Roman Hovorka, Ph.D., of the University of Cambridge in the United Kingdom, and colleagues compared the safety and efficacy of overnight closed loop delivery of insulin with conventional insulin pump therapy among 24 adults (10 men, 14 women) with type 1 diabetes, aged 18 to 65, who had used insulin pump therapy for at least three months. One study used a medium sized meal (60 g carbohydrate; "eating in" scenario), and the other used a large sized meal (100 g carbohydrate plus white wine; "eating out" scenario).

The investigators found that overnight closed loop delivery of insulin increased the time that plasma glucose levels were in target by a median 15 percent for the "eating in" scenario. The method increased the time that plasma glucose levels were in target by a median 28 percent for the "eating out" scenario. An analysis of pooled data revealed that the overall time plasma glucose was in target increased by a median 22 percent with closed loop delivery. This method also reduced overnight time spent hypoglycemic by a median 3 percent and eliminated plasma glucose concentrations below 3.0 mmol/L after midnight.

"Preliminary results have been promising -- the most notable improvement is in overnight control of type 1 diabetes, with improvements in safety and a reduction in nocturnal hypoglycemia being reported. These improvements result from the fine adjustment of insulin delivery provided by closed loop control overnight being superior to a generally fixed basal rate and less likely to cause hypoglycemia," writes the author of an accompanying editorial.

Smiths Medical supplied the study pumps, and Abbott Diabetes Care supplied the Freestyle Navigator devices and sensors for the "eating in" scenario. Several authors disclosed financial relationships with various pharmaceutical and medical device companies.

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