Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Abstract

Aim: To evaluate the efficacy and safety of a dual-hormone artificial pancreas (DH) in type 1 diabetes.Material and Methods: PubMed, Embase, the Cochrane Library and ClinicalTrials.gov were searched for studies published up to February 16, 2022. We included randomized controlled trials that compared DH with single-hormone artificial pancreas (SH), continuous subcutaneous insulin infusion (CSII) or sensor-augmented pumps (SAP), and predictive low glucose suspend systems (PLGS) in type 1 diabetes. The primary outcome was percent time in target (3.9-10 mmol/L [70-180 mg/dL]). Data were summarized as mean differences (MDs) or risk differences (RDs).Results: A total of 17 randomized crossover trials (438 participants) were included.There were nine trials of DH versus SH, 13 trials of DH versus SAP/CSII, and two trials of DH versus PLGS. For time in target, DH showed no significant difference in time in target compared with SH (MD 2.69%, 95% confidence interval [CI] À0.38 to 5.76) but resulted in 16.05% (95% CI 12.06 to 20.05) and 6.89% (95% CI 2.63 to 11.14) more time in target range compared with SAP/CSII and PLGS, respectively. DH slightly reduced time in hypoglycaemia (MD À1.20%, 95% CI À1.85 to À0.56) but increased the risk of gastrointestinal symptoms (RD 0.18, 95% CI 0.08 to 0.27) compared with SH. Conclusions:The results of this study suggest that DH has a comparable effect on time in target compared with SH, but is associated with a longer time in target range compared with SAP/CSII and PLGS. The DH slightly reduced time in hypoglycaemia but may increase the risk of gastrointestinal symptoms compared with the SH.

The efficacy of glucose‐responsive insulin and glucagon delivery on exercise‐induced hypoglycaemia among adults with type 1 diabetes mellitus: A meta‐analysis of randomized controlled trials

“…A previous meta‐analysis showed that artificial pancreas systems significantly improved glycaemic control among patients with T1DM, and DH‐APSs outperformed SH‐APSs 11 . In contrast, our meta‐analysis focused on exercise‐related glycaemic control.…”

“…A previous meta-analysis showed that artificial pancreas systems significantly improved glycaemic control among patients with T1DM, and DH-APSs outperformed SH-APSs. 11 In contrast, our metaanalysis focused on exercise-related glycaemic control. LOPEH can even occur up to 24 h after exercise but has not been attributed adequate importance, leading to 'death in bed' syndrome.…”

Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters

“…This is especially pertinent in diabetes care, where the development of e.g. novel pharmacological agents (such as GLP-1 (glucose-like peptide 1) receptor agonists1 2 and sodium-glucose cotransporter-2 (SGLT2) inhibitors1 2) and technological innovations (such as flash glucose monitoring,3–6 smart insulin pens6 7 and pumps6 and the artificial pancreas8 9) are rapidly changing the field. To form sensible plans of care that respond well to and advance the situation of the individual patient, that is, to make care fit, patients and clinicians must collaborate to determine what to do, work often referred to as shared decision-making (SDM) 10–13.…”

Dual hormone fully closed loop in type 1 diabetes: a randomised trial in the Netherlands – study protocol

“…These systems use insulin only and still require carbohydrate counting for administering mealtime insulin boluses. In contrast, the newly developed dual hormone fully closed loops (DHFCLs) provide a balanced infusion of not only insulin but also glucagon mimicking physiological conditions 4–7. The user does not have to provide any meal or correction boluses as the DHFCL reactively adapts the insulin and glucagon infusion 5.…”