Hypoglycaemia incidence and recovery during home use of hybrid closed-loop insulin delivery in adults with type 1 diabetes

Diabetes Obes Metab. 2018 Aug;20(8):2004-2008. doi: 10.1111/dom.13304. Epub 2018 Apr 16.

Abstract

Glucose excursion was assessed prior to and post hypoglycaemia to increase understanding of hypoglycaemia incidence and recovery during hybrid closed-loop insulin delivery. We retrospectively analysed data from 60 adults with type 1 diabetes who received, in a crossover randomized design, day-and-night hybrid closed-loop insulin delivery and insulin pump therapy, the latter with or without real-time continuous glucose monitoring. Over 4-week study periods, we identified hypoglycaemic episodes, defined as sensor glucose <3.0 mmol/L, and analysed sensor glucose relative to the onset of hypoglycaemia. We identified 377 hypoglycaemic episodes during hybrid closed-loop intervention vs 662 during control intervention (P < .001), with a predominant reduction of nocturnal hypoglycaemia. The slope of sensor glucose prior to hypoglycaemia was steeper during closed-loop intervention than during control intervention (P < .01), while insulin delivery was reduced (P < .01). During both day and night, participants recovered from hypoglycaemia faster when treated by closed-loop intervention. At 120 minutes post hypoglycaemia, sensor glucose levels were higher during closed-loop intervention compared to the control period (P < .05). In conclusion, closed-loop intervention reduces the risk of hypoglycaemia, particularly overnight, with swift recovery from hypoglycaemia leading to higher 2-hour post-hypoglycaemia glucose levels.

Keywords: CSII; continuous glucose monitoring (CGM); glycaemic control; hypoglycaemia; insulin delivery; type 1 diabetes.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Blood Glucose / analysis
  • Blood Glucose Self-Monitoring
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / therapy*
  • Female
  • Humans
  • Hyperglycemia / prevention & control
  • Hypoglycemia / epidemiology
  • Hypoglycemia / etiology
  • Hypoglycemia / prevention & control*
  • Hypoglycemia / therapy
  • Incidence
  • Insulin Infusion Systems / adverse effects
  • Male
  • Middle Aged
  • Monitoring, Ambulatory
  • Pancreas, Artificial / adverse effects*
  • Retrospective Studies
  • Risk
  • Self-Management*
  • Time Factors

Substances

  • Blood Glucose