Fully closed-loop insulin therapy safe, effective in diabetes patients requiring dialysis: Study

Published On 2021-10-23 04:30 GMT   |   Update On 2021-10-23 06:52 GMT

UK: A new study in the journal Nature Medicine has reported that fully closed-loop insulin therapy improved glucose control and reduced hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis. 

Management of diabetes in this population is challenging for both patients and healthcare professionals as it poses severe complications of the kidney and heart. Closed-loop systems are increasingly being applied for the management of type 1 diabetes. However, the use of this technology in people with type 2 diabetes is limited to the inpatient setting including those on hemodialysis.

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Charlotte K. Boughton, Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK, and colleagues, therefore, aimed to evaluate the safety and efficacy of fully closed-loop insulin therapy compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis.

The study was an open-label, multinational, two-center, randomized crossover trial, 26 adults with type 2 diabetes requiring dialysis (17 men, 9 women, average age 68 ± 11 years (mean ± s.d.), diabetes duration of 20 ± 10 years) underwent two 20-day periods of unrestricted living, comparing the Cambridge fully closed-loop system using faster insulin aspart ('closed-loop) with standard insulin therapy and a masked continuous glucose monitor ('control') in random order. The primary endpoint was a time in target glucose range (5.6–10.0 mmol l−1).

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 A total of 13 participants received closed-loop first and thirteen received control therapy first.

The results of the study were

• The proportion of time in target glucose range (5.6–10.0 mmol l−1; primary endpoint) was 52.8 ± 12.5% with closed-loop versus 37.7 ± 20.5% with control; mean difference, 15.1 percentage points.

• Mean glucose was lower with closed-loop than control (10.1 ± 1.3 versus 11.6 ± 2.8 mmol l−1). Time in hypoglycemia (<3.9 mmol l−1) was reduced with closed-loop versus control (median (IQR) 0.1 versus 0.2).

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Boughton and team concluded that "Fully closed-loop improved glucose control and reduced hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis." They also stated that no severe hypoglycemia events occurred during the control period, whereas one severe hypoglycemic event occurred during the closed-loop period, but not during closed-loop operation.

For further information: https://doi.org/10.1038/s41591-021-01453-z

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Article Source : Nature Medicine

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