Hovorka R. Diabetes Care. 2014;37:1204-1211.
Overnight closed-loop insulin delivery is feasible, safe and effective for adolescents to use at home while unsupervised, according to research published in Diabetes Care.
“The artificial pancreas can be safely used to improve overnight glucose control, providing a stepping stone for longer and larger clinical studies,”Roman Hovorka, PhD, of the Wellcome Trust-Medical Research Council Institute of Metabolic Science at the University of Cambridge, United Kingdom, told Endocrine Today.
Hovorka and colleagues evaluated insulin delivery directed by a closed-loop system for 3 weeks, with sensor-augmented therapy applied for another 3 weeks. The order of interventions was random. Closed loop was applied continuously for a minimum of 4 hours on 269 nights (80%). Sensor data were collected for at least 4 hours on 282 control nights (84%). The primary endpoint was the time when adjusted sensor glucose registered 3.9 mmol/L to 8 mmol/L during the night, specifically between 11 p.m. and 7 a.m.
With closed loop, time spent with glucose in target rose, on average, 15% (interquartile range, –9 to 43; P<.001) and overnight glucose dropped, on average, 14 mg/dL (standard deviation, 58; P<.001).
Time spent with glucose <70 mg/dL was low in both groups, but nights with glucose <63mg/dL for at least 20 minutes occurred less frequently with closed loop (10% vs. 17%; P=.01).
Overall 24-hour glucose decreased, on average, 9 mg/dL (standard deviation, 41; P=.006) during closed loop, even with an average total daily insulin dose reduction of 2.3 units (interquartile range, –4.7 to 9.3, P=.009).
The strength of the study is the integration of closed loop into routines, including weekdays, weekends and holidays, as well as eating and sleeping, according to the researchers.
“Without supervision, adolescents with type 1 diabetes started and stopped closed loop by their own volition over multiple nights and without real-time monitoring or redundant sensor, which will accelerate cost-effective transition into routine clinical care,” the researchers wrote.
The study’s findings could carry clinical implications for the not-too-distant future, Hovorka said in an interview. “The artificial pancreas is likely to become an important treatment option in the next decade.”
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