Closed-loop insulin delivery in suboptimally controlled type 1 diabetes

Hoping for an intervention to improve glycemic management in type 1 diabetics, researchers studied the efficacy of day-and-night hybrid closed-loop insulin delivery systems. They assembled a sample population of people, all at least age 6 years, with unsatisfactory control of type 1 disease.

Hoping for an intervention to improve glycemic management in type 1 diabetics, researchers studied the efficacy of day-and-night hybrid closed-loop insulin delivery systems. They assembled a sample population of people, all at least age 6 years, with unsatisfactory control of type 1 disease. After recruiting in the United Kingdom and in the United States, the investigators eventually randomized 46 participants to receive hybrid closed-loop therapy and 40 to received sensor-augmented pump therapy over 12 weeks. The main outcome at the end of that "free living" period was the proportion of time that glucose concentration was within the target range of 3.9–10 mmol/L, which was calculated at 65% for participants in the closed-loop group and 54% for the controls. Closed-loop delivery of insulin lowered glycated hemoglobin (HbA1c) from a value of 8.3 at baseline to 7.4 at the end of the study, while A1c readings fell from 8.2 to 7.7 with sensor-augmented pump delivery. Not only did the closed-loop system improve glucose control to a greater extent, it also reduced the risk of hypoglycemia, with glucose concentrations in those patients dipping below the 3.9 mmol/L threshold less often than with the control patients.