A new study published last week in the New England Journal of Medicine found that for hospitalized patients with type 2 diabetes who were receiving noncritical care, the use of an automated, closed-loop insulin delivery system (an artificial pancreas) to deliver basal insulin resulted in better glycemic control than standard insulin therapy injected under the skin.
With increasing evidence that an artificial pancreas can improve glucose control in patients with type 1 diabetes, investigators had sought to see if it could also help patients with type 2 diabetes.
The study also found the improved glucose control in patients with type 2 diabetes was achieved without increasing the risk of hypoglycemia. One of the major limiting factors in achieving improved glucose control is the increase in hypoglycemic events.
Conducted by researchers at the University of Cambridge and Manchester University in the United Kingdom, along with the University of Bern in Switzerland, the study was published to coincide with a presentation at the American Diabetes Association’s 78th Scientific Sessions in Orlando, Florida.
It was notable as most studies of automated closed-loop insulin delivery systems include patients with type 1 diabetes, said Sri Prakash Mokshagundam, MD, an endocrinologist and diabetes specialist with University of Louisville Physicians. It also focused on hospitalized patients, where most studies have focused on outpatients who were already on insulin, he said. About 25 percent of hospitalized individuals have diabetes.
In the study, patients who were not already on a pump or sensor to control their diabetes prior to admission were placed on the system upon admission to the hospital. Mokshagundam said that using the technology in an inpatient setting has certain advantages, such as less burden on nursing staff as they try to manually adjust insulin doses. Meal-time insulin delivery still has to be planned by the health care team.
He said that while the technology helps in the acute setting, procedures need to be developed to transition it from acute to chronic care after patients leave the hospital.
He noted there also are some hurdles at this time to implementing the technology in the United States, as the technology used in the study has not yet been approved by the U.S. Food and Drug Administration for inpatient use here. A slightly different type of system has been approved for outpatient use, which uses a different algorithm to calculate the dose.
“The study that shows that this can be done, but we are still a ways off before this becomes routine practice,” Mokshagundam said. “There is some refinement needed.”
