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October 29, 2019
Artificial pancreas improves type 1 diabetes management
At a Glance
- An artificial pancreas system improved blood glucose control throughout the day and overnight for people with type 1 diabetes.
- This technology may help reduce the daily burden of managing diabetes and lessen complications from the disease.
Diabetes is a disease that happens when your blood glucose, or blood sugar, is too high. Glucose is the body’s main source of energy. Insulin, a hormone made by the pancreas, tells the body’s cells to take in glucose. If you have type 1 diabetes, your body doesn’t make insulin, and glucose builds up in your blood. Over time, high levels of blood glucose can cause serious health problems.
People with diabetes must test their blood glucose regularly with a fingerstick or use a continuous glucose monitor. They take insulin when needed by giving themselves injections or using an insulin pump. Researchers have developed all-in-one diabetes management systems. These “artificial pancreas” systems track blood glucose levels using a continuous glucose monitor, calculate when insulin is needed, and automatically deliver it using an insulin pump. Artificial pancreas systems don’t entirely eliminate the need for patient input, but substantially reduce the level of effort.
To test the efficacy and safety of an artificial pancreas, a team led by Drs. Sue A. Brown and Boris Kovatchev at the University of Virginia and Dr. Roy W. Beck at the Jaeb Center for Health Research carried out a six-month study of the Control-IQ technology system from Tandem Diabetes Care. They enrolled 168 people with type 1 diabetes. The study was funded by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Results were published online on October 16, 2019, in the New England Journal of Medicine.
Participants were randomly assigned to use either the Control-IQ artificial pancreas or sensor-augmented pump (SAP) therapy. SAP uses a continuous glucose monitor and insulin pump, but still requires frequent input and decisions from the user about when and how much insulin to administer. The Control-IQ system uses advanced computer algorithms to automatically adjust insulin doses based on glucose levels.
People who used the artificial pancreas system showed a significant increase in the amount of time their blood glucose levels stayed in the target range of 70 to 180 mg/dL—from 61% at start of the study to 71%. This translated to an additional 2.6 hours per day in range. In contrast, the control group remained unchanged at 59%. Artificial pancreas users also showed improvements in time spent with high and low blood glucose and other measurements related to diabetes control.
No severe low blood sugar (hypoglycemia) events occurred in either group. Diabetic ketoacidosis—a life-threatening complication—occurred in one participant in the artificial pancreas group due to an issue with the insulin pump setup called pump infusion set failure.
“This artificial pancreas system has several unique features that improve glucose control beyond what is achievable using traditional methods,” says Kovatchev. “In particular, there is a special safety module dedicated to prevention of hypoglycemia, and there is gradually intensified control overnight to achieve near-normal blood sugar levels every morning.”
“Artificial pancreas technology has tremendous potential to improve the day-to-day lives of people with type 1 diabetes,” says NIDDK Director Dr. Griffin P. Rodgers. “By making management of type 1 diabetes easier and more precise, this technology could reduce the daily burden of this disease, while also potentially reducing diabetes complications including eye, nerve, and kidney diseases.”
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References: Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. Brown SA, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, Laffel LM, Levy CJ, Pinsker JE, Wadwa RP, Dassau E, Doyle FJ 3rd, Anderson SM, Church MM, Dadlani V, Ekhlaspour L, Forlenza GP, Isganaitis E, Lam DW, Kollman C, Beck RW; iDCL Trial Research Group. N Engl J Med. 2019 Oct 16. doi: 10.1056/NEJMoa1907863. [Epub ahead of print]. PMID: 31618560.
Funding: NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and University of Virginia.