Artificial Pancreas Improves Type 1 Blood Sugar Control

An artificial pancreas can improve blood sugar control for people with type 1 diabetes (T1D), according to a new study.

Researchers from the Aristotle University of Thessaloniki, Greece, reported Wednesday that an artificial pancreas can provide nearly 2.5 extra hours of daily normal blood glucose levels (normoglycemia). At the same time, it could also reduce time of both hyperglycemia and hypoglycemia levels.

Using a continuous glucose monitoring (CGM) device to measure blood sugar levels and transmit information to a calculating insulin pump that releases required levels of insulin into the body, the artificial pancreas has the potential to fulfill the entire duties of that of a real one in patients with diabetes.

Researchers, led by Dr. Eleni Bekiari, reviewed the results of 41 randomized controlled trials which involved an accumulated 1000-plus patients with T1D, comparing artificial pancreas systems with other insulin-based devices — including insulin pump therapy.

When used overnight and over a period of 24 hours, the artificial pancreas was associated with a near-2.5 hour increase in normoglycemia versus comparative devices, as well as an approximate 2-hour reduction in hyperglycemia. Though only slightly, it also reduced time of hypoglycemia (20 minutes) than that of other therapies.

The researchers consider the review results provide an updated overview on the use of artificial pancreas systems for T1D — albeit one that relied on trials with high or unclear risks of bias, small sample sizes and short duration, or other characteristics that indicate it should be interpreted carefully.

An accompanying essay to the study, penned by Norman Waugh, professor of Public Health Medicine and Health Technology Assessment at the University of Warwick, UK, added that the overall evidence base for the study is week. Waugh and colleagues noted multiple trials reviewed were of low quality.

“Type 1 diabetes is lifelong, but most trials are short — of 41 trials included, 30 lasted 7 days or less,” Waugh wrote. “In 16 trials, the closed loop system controlled blood glucose only overnight. Of 25 trials that evaluated closed loop systems over 24 hours, only 1 was long enough to measure glycated hemoglobin, which fell by only a clinically insignificant 0.3% (3.3 mmol/mol) after 12 weeks.”

Though closed loop systems can improve overnight T1D control, there’s still limited information as to their effect on the long-term implications of diabetes, Waugh argued. For that, longer and larger trials comparing the system to continuous glucose monitoring need to happen.

“These trials should measure HbA1c (for modelling the effects on complications), blood glucose variability, hypoglycaemia, quality of life, and cost effectiveness,” Waugh wrote.

The study authors noted that follow-up analysis should look into artificial pancreas’ effect on relevant patients with type 2 diabetes, as well as the therapy’s overall influence on patient quality of life.

Future shortcomings in clinical analysis could be avoided with more comprehensive measures set prior to a trial’s beginning.

“To ensure the clinical relevance and feasibility of this core outcome set, it is crucial that its development involves all key stakeholders, including patients, their families, clinicians, researchers, statisticians, methodologists, industry representatives, regulatory authorities, and funders,” researchers wrote.

The study, "Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis," was published online in The BMJ on Wednesday.