BMJ: Use
of an artificial pancreas is associated with better control of blood
sugar levels for people with type 1 diabetes compared with standard
treatment, finds a review of the available evidence published by The BMJ today. The
findings show that artificial pancreas treatment provides almost two
and a half extra hours of normal blood glucose levels (normoglycaemia) a
day, while reducing time in both high (hyperglycaemia) and low
(hypoglycaemia) blood glucose levels. While
further research is needed to verify the findings, the researchers say
these results support the view that “artificial pancreas systems are a
safe and effective treatment approach for people with type 1 diabetes.”
The
artificial pancreas is a system that measures blood sugar levels using a
continuous glucose monitor (CGM) and transmits this information to an
insulin pump that calculates and releases the required amount of insulin
into the body, just as the pancreas does in people without diabetes.
Lead
researcher, Eleni Bekiari at Aristotle University of Thessaloniki,
Greece and the team set out to investigate the effectiveness and safety
of artificial pancreas systems in people with type 1 diabetes.
They
reviewed the results of 41 randomised controlled trials involving over
1000 people with type 1 diabetes, that compared artificial pancreas
systems with other types of insulin based treatment, including insulin
pump therapy.
They
found that the artificial pancreas was associated with almost two and a
half additional hours in normoglycaemia compared with other types of
treatment when used overnight and over a 24 hour period.
Use
of the artificial pancreas also reduced time spent in hyperglycaemia by
approximately two hours – and in hypoglycaemia (20 minutes less) –
compared to 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
are robust.
As
such, the authors say that their review provides a valid and up to date
overview on the use of artificial pancreas systems for type 1 diabetes.
However, they point out that most trials were at high or unclear risk
of bias, had a small sample size and short duration, and therefore
should be interpreted with caution.
Furthermore,
they suggest more should be done to assess cost-effectiveness “to
support adoption of artificial pancreas systems in clinical practice.”
The
authors also recommend that future research should “explore artificial
pancreas use in relevant groups of people with type 2 diabetes” and say
“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 at 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.”
Editorial: Closed loop systems in type 1 diabetes
Journal: The BMJ