New dual-hormone artificial pancreas leads to better blood sugar control in type 1 diabetes

The rapid insulin-alone artificial pancreas improves blood sugar control in type 1 diabetes but daytime control remains suboptimal. Researchers have proposed two novel dual-hormone artificial pancreas systems to overcome this problem.

Researchers from McGill University's Faculty of Medicine have developed a novel dual-hormone artificial pancreas system that improves blood sugar control compared with a rapid insulin-alone artificial pancreas. The findings of the research have appeared in Diabetes Care.

Dr Ahmad Haidar and his research team have combined pramlintide with insulin as part of an automated insulin delivery system. The researchers proposed a dual-hormone approach in order to build on current findings from insulin-only artificial pancreas trials. Dr Haidar and his team also tested a rapid system and a regular system.

Pramlintide is a synthetic form of the hormone amylin. This hormone works to reduce post-meal blood sugar levels by inhibiting the action of the glucose-raising hormone glucagon.

The researchers conducted a randomized crossover trial comparing a rapid insulin-alone artificial pancreas with rapid insulin-and-pramlintide and with regular insulin-and-pramlintide artificial pancreas systems in adults with type 1 diabetes. The participants were assigned to the interventions in random order during three 24-h inpatient visits. Each visit was preceded by an outpatient hormonal open-loop run-in period of 10–14 days. The dual-hormone artificial pancreas delivered pramlintide in a basal-bolus manner, using a novel dosing algorithm, with a fixed ratio relative to insulin. The primary outcome was a time in the range of 3.9–10.0 mmol/L.

The investigators found that those on both insulin and pramlintide reported a high level of satisfaction and better quality of life. Pramlintide slowed down meal absorption, giving insulin more time to work. As a result, patients using the combination of hormones experienced a significant improvement in the time spent within the target blood glucose range.

They concluded: "Compared with the rapid insulin-alone artificial pancreas system, the rapid insulin-and-pramlintide system increased the time in a range from 74% to 84%, whereas the regular insulin-and-pramlintide system did not change the time in range."A novel rapid insulin-and-pramlintide artificial pancreas leads to better blood sugar control compared with a rapid insulin-alone artificial pancreas.

For further reference log on to:https://doi.org/10.2337/dc19-1922