Most Read Articles
Rachel Soon, 03 Apr 2019

The Malaysian Community Pharmacy Guild (MCPG) has submitted a seven-point proposal for comprehensively including community pharmacists (CPs) in the national healthcare system.

14 May 2019
At the recent GLYCEMIC GUARDIANS™ dinner symposium, three eminent speakers spoke on theindispensable role of medical nutrition therapy (MNT) in improving outcomes for patients with type2 diabetes (T2D).
Rachel Soon, 24 Apr 2019

With recent recalls of losartan-containing products contaminated by potentially carcinogenic nitrosamines, MIMS speaks to the Malaysian National Pharmaceutical Regulatory Agency (NPRA) for more details.

Rachel Soon, Yesterday

Many patient-facing healthcare professionals are supported by colleagues in the back room who make sure they stay well-supplied. For its May-June 2019 issue, MIMS Pharmacist speaks to Choong Kin Hoe, former logistics pharmacist at Hospital Kuala Lumpur (HKL), about what goes on in the store pharmacy.

Dual-hormone artificial pancreas beats insulin-alone system in glycaemic control in small study

Pearl Toh
10 Jul 2018
A dual-hormone artificial pancreas (DAP) with a rapid delivery of insulin and pramlintide in a fixed ratio improves glycaemic control and reduces glucose variability in adults with type 1 diabetes (T1D) compared with first-generation artificial pancreas delivering insulin alone, according to a study presented at ADA 2018.

“Post-meal [glycaemic] control remains a challenge [with insulin-only artificial pancreas] … This study shows that the first-generation, insulin-only artificial pancreas can be improved by delivering other hormones along with insulin, which will hopefully encourage the development of insulin-plus-pramlintide coformulations,” said lead author Dr Ahmad Haidar of McGill University in Montreal, Canada.

Pramlintide is a synthetic analogue of amylin — a hormone that helps regulate blood glucose levels but is completely absent in people with T1D. Besides insulin analogues, pramlintide represents the only FDA-approved drug known to reduce blood glucose levels in T1D patients.   

In the crossover study, twelve adults (mean age 43 years) with T1D were randomized to any one of the three systems: a DAP delivering rapid insulin and pramlintide, DAP delivering regular insulin (Humulin R) and amylin (DAP-R), and a rapid insulin-alone artificial pancreas for 24 hours before crossing over to another system for another 24 hours. During each 24-hour period, the participants had three meals plus one bedtime snack. [ADA 2018, 210-OR]

Compared with the insulin-alone system, DAP significantly improved the duration of time spent in target range of 3.9–10.0 mmol/L, from 71 percent to 85 percent of the 24-hour study period (p=0.03).

There was also less glucose variability with DAP vs the insulin-alone system (25 percent vs 34 percent; p=0.01), without an increased risk of hypoglycaemia.

Furthermore, mean glucose level during daytime was lower with DAP than the insulin-alone system (7.8 vs 9.1 mmol/L; p=0.02).

In terms of adverse events, two participants using DAP reported moderate nausea while none were reported while using the insulin-alone system.

“We were expecting some benefits with the insulin-plus-pramlintide artificial pancreas, yet we were impressed by both the extent of improvements and the lack of side effects, considering these benefits were achieved without increasing the risk of dangerous low-glucose levels,” said Haidar.

Time spent in target range during overnight period was similar between the DAP and the insulin-alone groups (77 percent vs 71 percent; p=0.47).

On the other hand, the DAP-R system did not confer additional benefits over the insulin-alone system during the daytime or overnight study periods.

“Longer and larger studies in free-living outpatient settings are warranted,” said Haidar, who noted the small number of study subjects in the current comparison.

 

   

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Pharmacist - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Rachel Soon, 03 Apr 2019

The Malaysian Community Pharmacy Guild (MCPG) has submitted a seven-point proposal for comprehensively including community pharmacists (CPs) in the national healthcare system.

14 May 2019
At the recent GLYCEMIC GUARDIANS™ dinner symposium, three eminent speakers spoke on theindispensable role of medical nutrition therapy (MNT) in improving outcomes for patients with type2 diabetes (T2D).
Rachel Soon, 24 Apr 2019

With recent recalls of losartan-containing products contaminated by potentially carcinogenic nitrosamines, MIMS speaks to the Malaysian National Pharmaceutical Regulatory Agency (NPRA) for more details.

Rachel Soon, Yesterday

Many patient-facing healthcare professionals are supported by colleagues in the back room who make sure they stay well-supplied. For its May-June 2019 issue, MIMS Pharmacist speaks to Choong Kin Hoe, former logistics pharmacist at Hospital Kuala Lumpur (HKL), about what goes on in the store pharmacy.