JDC Gems

1. Artificial pancreas to achieve glycemic targets for people with Type 1 diabetes

     Artificial pancreas is devised to release insulin in response to changes in the blood glucose level similar to the way our pancreas functions. It is considered as a possible treatment option for people with Type 1 and Type 2 diabetes. Among the three main artificial pancreas systems, Closed-loop insulin delivery or Closed loop artificial pancreas is the most widely tested systems for the automated insulin delivery.

      In a recent 6-month randomized, multicenter trial conducted by the International Diabetes Closed Loop (iDCL) Trial research group, it was observed that automated insulin delivery systems such as the artificial pancreas may improve glycemic outcomes in patients with type 1 diabetes. The selected 168 patients were within the age group 14 to 71 years with type 1 diabetes and with an A1c of 5.4 to 10.6%. They were assigned in a 2:1 ratio to receive treatment with a closed-loop system and a sensor-augmented pump. The primary outcome was the percentage of time that the blood glucose level stays within the target range of 70 to 180 mg/dL (3.9 to 10.0 mmol/L), as measured by continuous glucose monitoring.

      The trial results also reveals that patients who had used closed loop spent more time in target glucose level compared to those who had used augmented pump. The trial also showed an increase in the time spent in target range by closed loop group from 61±17% at baseline to 71±12% during the 6 months and remained without any change from 59±14% in the augmented pump group. The results with regard to the main secondary outcomes which are the percentage of time that the glucose level was >180 mg/dL, mean glucose level, glycated hemoglobin level, and percentage of time that the glucose level was <70 mg/dL or <54 mg/dL (3.0 mmol/L) were also are found to be in favor of closed loop system.

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