Sensor-augmented pumps with automated insulin suspension is a step closer to the artificial pancreas
A narrative review published in Journal of Diabetes Science and Technology (January 2017) by Danish Diabetes Academy PhD student Isabelle Steineck and colleagues, evaluates the available knowledge on sensor-augmented insulin pumps, in relation to hypoglycemia prevention. The review focuses on randomized trials, observational studies, and meta-analyses including non-pregnant individuals with type 1 diabetes mellitus.
HYPOGLYCEMIA IS A BARRIER FOR OPTIMAL GLYCEMIC CONTROL
“Almost 100 years after the discovery of insulin hypoglycemia is still a barrier for achieving optimal glycemic control for individuals with type 1 diabetes. If untreated, hypoglycemia can lead to seizures, unconsciousness or death”, states Isabelle Steineck. Insulin pump treatment reduces episodes of severe hypoglycemia compared with treatment with multiple daily injections. Insulin pump and a continuous glucose monitor, so called sensor-augmented pump treatment, has the potential to further limit the duration and severity of hypoglycemia as the most advanced systems can detect and act on impending and prevailing low blood glucose levels.
SENSOR-AUGMENTED PUMP REDUCES EPISODES AND SEVERITY OF HYPOGLYCEMIA
Sensor-augmented insulin pumps reduce episodes and severity of hypoglycemia but both insulin pumps and continuous glucose monitors also reduce hypoglycemia when used separately. It is unclear whether the insulin pump, the continuous glucose monitor, the accompanying training or another mechanism holds the main responsibility for the positive effects observed. Irrespectively, there is strong evidence that sensor-augmented pump treatment reduces moderate and severe episodes of hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that sensor-augmented pumps both with and without automated insulin suspension reduce the frequency of severe hypoglycemic events compared with insulin pumps without a continuous glucose monitor.
SENSOR-AUGMENTED PUMP IS A STEP CLOSER TO THE ARTIFICIAL PANCREAS
“Sensor-augmented pumps with automated insulin suspension is a step closer to the artificial pancreas, which combine insulin pumps, continuous glucose monitors, and control algorithms for insulin dosing to deliver insulin in a semi- or fully automated manner. Until these systems are ready, sensor augmented pumps available today may mitigate the physiological and psychological burden of hypoglycemia in individuals with type 1 diabetes mellitus without compromising metabolic control”, concludes Isabelle Steineck
AUTHOR AFFILIATION
Steineck I1,2, Ranjan A1,2, Nørgaard K1, Schmidt S1,2
1Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark
2Danish Diabetes Academy, Odense University Hospital, Odense, Denmark