Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 5 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
6 days ago
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.

Artificial pancreas bests smart insulin pump for glycaemic control in T1D

Pearl Toh
09 Dec 2019

Use of a closed-loop system, also known as artificial pancreas, led to better glycaemic control in terms of more time spent in the target glycaemic range than a sensor-augmented insulin pump in patients with type 1 diabetes (T1D), according to the iDCL* study.

“It is clear that patients would appreciate wearing devices that require minimal interaction, leading to a more carefree lifestyle,” wrote Dr Daniela Bruttomesso from the University of Padua, Padua, Italy in a linked editorial. [N Engl J Med 2019;381:1774-1775]

The new closed-loop system, according to the investigators, relies on “an algorithm with a dedicated hypoglycaemia safety module, automated correction boluses, and overnight intensification of basal insulin delivery designed to consistently target near-normal glycaemia each morning.”

More time in target range

Patients receiving the closed-loop system spent significantly more time within the target glucose range (70–180 mg/dL), which improved from 61 percent to 71 percent, compared with the control group using a sensor-augmented pump who saw their time within target range unchanged (59 percent) during the 6 months study. This translates to a 11-percentage points greater time within target range with the closed-loop system vs the control pump (p<0.001). [N Engl J Med 2019;381:1707-1716]

“[The 11-percentage points difference is] an advantage that amounted to 2.6 hours per day … less time in hyperglycaemia [2.4 hours less/day] and hypoglycaemia [13 minutes less/day],” explained the researchers.

“Beneficial glycaemic effects associated with the closed-loop system were seen during both daytime and nighttime and were particularly prominent in the second half of the night,” they observed. “[Furthermore,] the glycaemic benefits associated with closed-loop control were seen in the first month of the trial and were sustained over the entire 6 months.”

The results were consistent across a wide range of patients with different age and regardless of whether they were insulin-pump or injection insulin users.    

Bruttomesso commended the results as “impressive and clinically relevant,” since a recent study has shown that each 10 percent less time spent in the target glucose range was associated with 64 percent increased risk of retinopathy development/progression and 40 percent increased risk of microalbuminuria. [Diabetes Care 2019;42:400-405]

The multicentre study randomized 168 T1D patients aged 14–71 years (mean age 33 years) to receive closed-loop system or a sensor-augmented pump in a 2:1 ratio.

Main secondary outcomes including the percentage of time having glucose level >180 mg/dL, glycated haemoglobin level, mean glucose level, and percentage of time that the glucose level was <70 mg/dL or <54 mg/dL were all significantly different between the two groups, in favour of the closed-loop system.

Specifically, the percentage difference between treatments was -0.88 percent (p<0.001) for time spent having glucose level <70 mg/dL and -0.33 percent (p=0.001) for glycated haemoglobin levels, both favouring the closed-system.

For the closed-loop group, the system was reported to be in closed-loop mode 90 percent of the time during the 6 months.

There were more adverse events (AEs) in the closed-loop group compared with the control group, mainly due to hyperglycaemia with ketosis resulting from pump infusion set failure.

A big step forward

“The closed-loop system is becoming a mature technology ready for practical use, but there are a variety of barriers to a fully automated closed-loop system,” said Bruttomesso. “Whether closed-loop systems can be used in higher-risk patients, such as those with impaired awareness of hypoglycaemia, also remains a pressing issue.”

“We are not there yet, but the trial by Brown et al. offers an almost fingerstick-free option, providing a big step toward a brighter future for patients.”

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 5 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
6 days ago
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.