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Artificial pancreas ‘safe and effective’ for type 1 diabetes, concludes study

System can boost normal blood glucose time by almost 2.5 hours

Caroline White

Thursday, 19 April 2018

An artificial pancreas seems to better control blood glucose in people with type 1 diabetes than standard treatment, finds a review of the available evidence* published in The BMJ today.

The system can provide almost two and a half extra hours of normal blood glucose levels a day, while cutting the duration of high peaks and troughs, the findings show.

Further research is needed to verify the findings, but, say the researchers, these results lend weight to the view that “artificial pancreas systems are a safe and effective treatment approach for people with type 1 diabetes”.

The artificial pancreas measures blood glucose using a continuous glucose monitor (CGM) and transmits this information to an insulin pump which then calculates and releases the required amount of insulin into the body.

The researchers reviewed the results of 41 randomised controlled trials involving over 1,000 people with type 1 diabetes, that compared artificial pancreas systems with other types of insulin-based treatment, including insulin pump therapy.

The artificial pancreas was associated with almost two and a half additional hours of normal blood glucose compared with other types of treatment when used overnight and over 24 hours.

The duration of high blood glucose was cut by around two hours and that of low blood glucose by 20 minutes compared with other types of therapy.

Further analyses to test the strength of the associations for different devices and in different settings were consistent, suggesting that the results stand up.

As such, the researchers say that their review provides a valid and up to date overview on the use of artificial pancreas systems for type 1 diabetes. But they point out that most trials were at high or unclear risk of bias, included small numbers of people and didn’t last long, so the findings should be interpreted with caution.

And a comprehensive assessment of cost-effectiveness is needed before artificial pancreas systems could be used in clinical practice, they suggest.

They also recommend that future research should “explore artificial pancreas use in relevant groups of people with type 2 diabetes” and that “the effect of artificial pancreas use on quality of life and on reducing patient burden should be further explored.”

In a linked editorial,** Professor Norman Waugh of the University of Warwick and colleagues, argue that closed loop systems have much to offer, “but we need better evidence to convince policymakers faced with increasing demands and scarce resources.”

* Bkiari E, Kitsios K, Thabit H,et al. Artificial pancreas therapy for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ 2018;361:k1310

** Waugh N, Adler A, Craigie I. Closed loop systems in type 1 diabetes. BMJ 2018;361:k1613

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