Editors' ChoiceType 1 Diabetes

Sense and Sensibility of Insulin Pumps

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Science Translational Medicine  16 Oct 2013:
Vol. 5, Issue 207, pp. 207ec171
DOI: 10.1126/scitranslmed.3007758

It’s not closet monsters that haunt people with type 1 diabetes at night. It’s low blood glucose (hypoglycemia). This condition is a constant critical side effect of insulin therapy but is especially detrimental during the night, when a sleeping patient may not be aware of a dangerous decrease in blood glucose. Repeated episodes of hypoglycemia greatly impair a patient’s quality of life and can also be fatal—hypoglycemia accounts for 4 to 10% of deaths among type 1 diabetes patients. With the introduction of continuous glucose sensors, implanted insulin pumps can be programmed to cease drug delivery automatically for up to 2 hours when the sensor has indicated that glucose has fallen below a preset threshold. The ability of a continuous glucose sensor to detect hypoglycemia and suspend insulin delivery can potentially reduce the incidence of hypoglycemic events. Early reports have suggested that this technology is safe, but data from randomized clinical trials were lacking. Now, Ly et al. report the results of a recent randomized clinical trial that was conducted in Australia and involved 95 patients with type 1 diabetes.

The trial compared the incidence of severe (seizure or coma) and moderate (an event requiring assistance for treatment) hypoglycemia in type 1 diabetes patients who were treated with either a sensor-augmented pump with low-glucose delivery-suspension technology or a standard insulin pump. After 6 months of intervention, the adjusted hypoglycemia incidence rate per 100 patient-months was 34.2 [95% confidence interval (CI), 22.0 to 53.3] for the pump-only group as compared with only 9.5 (95% CI, 5.2 to 17.4) among participants with a low-glucose automatic pump suspension. This significant decrease in the incidence of nighttime hypoglycemia by automatic suspension of the insulin delivery was not associated with impaired metabolic control or with increased risk of ketoacidosis. These results suggest that the prevention of severe hypoglycemic episodes by the sensor technology will improve the safety and quality of life of type 1 diabetes patients, at least until a complete closed-loop artificial pancreas becomes available.

T. T. Ly et al., Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: A randomized clinical trial. JAMA 310, 1240–1247 (2013). [Abstract]

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