The US Food and Drug Administration has now approved the first fully automated closed-loop insulin delivery system for people with type 1 diabetes. This is a hybrid system requiring the individual to enter mealtime carbohydrates, accept bolus correction dose recommendations and calibrate the sensor with regular capillary glucose readings. The commercial product is likely to be launched in the US in 2017 and Europe in 2018.
We continue to see a steady flow of scientific papers relating to various aspects of automated insulin delivery. This leads to the question of how these products are likely to be first used in the UK. The paper by Stewart and colleagues (summarised alongside) is important, as the group studied must have one of the strongest cases for early use of this expensive technology. Pregnancy is a time when tight glucose control and avoiding hyperglycaemia is especially important. We already invest a great deal of clinical resource into achieving lower glucose values before and during pregnancy. Having said that, we accept that we will put mother and baby at increased risk of significant hypoglycaemia that may, in itself, have long-term health consequences.
The group compared an overnight closed-loop insulin delivery system with a currently available sensor-augmented pump where the individuals had to make decisions about rate of insulin delivery themselves.
In summary, the study has shown that overnight glucose control improved by a clinically significant amount using the closed-loop system. The improvement seen with the automated system lasts until about midday the following day. This was achieved without any episodes of severe hypoglycaemia in the closed-loop phase of the study.
To read the article summaries, please download the PDF
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024