Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care

Bally, Lia; Thabit, Hood; Hartnell, Sara; Andereggen, Eveline; Ruan, Yue; Wilinska, Malgorzata E.; Evans, Mark; Wertli, Maria M.; Coll, Anthony P.; Stettler, Christoph; Hovorka, Roman

doi:10.1056/nejmoa1805233

Cited by 171 publications

(139 citation statements)

References 26 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

Section: Discussionmentioning

confidence: 77%

“…Bally et al recently applied artificial pancreas (AP) technology to establish euglycaemia in hospitalized patients with T2D in a general ward, that is, in a similar patient group. AP performance was comparable to that of GlucoTab with regard to mean glucose (8.5 AE 1.AE 1.2 mmol/L) 28. Time within glucose target assessed by CGM (3.9-10 mmol/L) improved continuously during the course of treatment (61.8% vs 85.2%; first vs last treatment day) while time within hypoglycaemia (1.2% vs 0.6%; first vs last treatment day) substantially decreased.These data are superior to the CGM data seen with insulin glargine U100 in a comparable setting.…”

mentioning

confidence: 77%

See 1 more Smart Citation

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aims To investigate efficacy, safety and usability of the GlucoTab system for glycaemic management using insulin glargine U300 in non‐critically ill hospitalized patients with type 2 diabetes (T2D). Materials and Methods In this open, non‐controlled single‐arm pilot study, glycaemic control at the general ward of a tertiary care hospital was guided by a mobile decision support system (GlucoTab) for basal‐bolus insulin dosing using the novel basal insulin analogue insulin glargine U300 for the first time. Glycaemic control was surveilled with capillary glucose measurements and continuous glucose monitoring (CGM). The primary endpoint was efficacy of glycaemic management, defined as the percentage of blood glucose measurements within the target range of 3.9 to 7.8 mmol/L. Results A total of 30 patients with T2D (12 female; age, 67 ± 11 years; HbA1c, 70 ± 26 mmol/mol; BMI, 31.8 ± 5.6 kg/m 2 ; length of study, 8.5 ± 4.5 days) were included. In total, 894 capillary glucose values and 49 846 data points of CGM were available, of which 56.1% of all measured capillary glucose values and 54.3% of CGM values were within the target area (3.9‐7.8 mmol/L). Overall capillary mean glucose was 8.5 ± 1.2 and 8.4 ± 1.2 mmol/L assessed by CGM. Time within glucose target improved continuously during the course of treatment, while time within hypoglycaemia (<3.9 mmol/L) decreased substantially. The GlucoTab‐suggested total daily dose was accepted by staff in 97.3% of situations. Conclusions Treatment with GlucoTab using insulin glargine U300 in hospitalized patients with T2D is effective and safe.

show abstract

Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 77%

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…These studies also highlight suboptimal glucose control in standard inpatient care: 41% time spent in the target range of 5.6-10.0 mmol/l in hospital ward settings and 73% in the critical care setting using VRIII. The comparable time-in-target values using closedloop insulin delivery were 66% and 92%, with negligible hypoglycaemia [13,14].…”

mentioning

confidence: 90%

“…Outside labour and delivery, closed-loop insulin delivery has been shown to improve time-in-target without increasing hypoglycaemia in inpatients with diabetes in critical care and hospital ward settings [13,14]. These studies also highlight suboptimal glucose control in standard inpatient care: 41% time spent in the target range of 5.6-10.0 mmol/l in hospital ward settings and 73% in the critical care setting using VRIII.…”

mentioning

confidence: 99%

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

Yamamoto

Murphy

2018

Diabet. Med.

View full text Add to dashboard Cite

In their thought-provoking commentary, Levy et al. [1] explore the possible unintended consequences of United Kingdom (UK) guideline targets on the high frequency of hypoglycaemia in people with diabetes who are hospitalized. The authors cite the National Institute for Health and Care Excellence (NICE) and the Joint British Diabetes Societies (JBDS) guidelines pertaining to inpatient, surgical and pregnancy diabetes care. These guidelines suggest using lower limits of glucose targets varying from 4.0 to 6.0 mmol/l [2-4]. Levy et al. propose a lower glucose limit of 5 mmol/l with the catchphrase 'stop at 5 and keep the inpatient alive'. This article is protected by copyright. All rights reserved.

show abstract

“…Eine erste Studie untersuchte die Anwendung eines Artificial Pancreas (bestehend aus Insulinpumpe, CGM-System und Steuerungsalgorithmus) bei Patienten mit Typ-2-Diabetes auf der Normalstation. Dabei konnte eine deutlich bessere Blutglukoseeinstellung ohne erhöhtes Hypoglykämierisiko als unter subkutaner Insulintherapie erreicht werden [73]. Kommerzielle Systeme wurden unter diesen Bedingungen bisher nicht getestet und sind in Europa zum aktuellen Zeitpunkt auch nicht verfügbar.…”

Section: Artificial Pancreas Im Krankenhausunclassified

Diabetesmanagement im Krankenhaus (Update 2019)

Mader

Brix

Aberer

et al. 2019

Wien Klin Wochenschr

View full text Add to dashboard Cite

This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.

show abstract

Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care

Cited by 171 publications

References 26 publications

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

Diabetesmanagement im Krankenhaus (Update 2019)

Contact Info

Product

Resources

About