Can the artificial pancreas improve control of glucose levels without increasing insulin doses?

This study investigated the effectiveness and safety of the artificial pancreas (APs) in people with type 1 diabetes (T1D). It was determined that APs improve control of glucose levels, without increasing the insulin dose. 

A traditional insulin pump is a small device that continuously delivers insulin, without the need for multiple daily injections. Sensor augmented pumps (SAPs) are traditional insulin pumps that also have a continuous glucose monitoring (CGM) system. CGMs measure glucose levels throughout the day by placing a sensor in the fat just under the skin. This gives the patient up-to-date information about their glucose levels.

APs use information from a CGM system to automatically control the release of insulin from a pump. This is similar to how the pancreas changes the amount of insulin it releases when blood glucose levels change. Single-hormone APs release just insulin (lowers glucose levels). Dual-hormone APs release insulin and glucagon (raises glucose levels), depending on the needs of the patient.

Previous studies have found that APs improve glucose control in inpatient settings (where the patient stays in a hospital during the study). Whether this occurs in outpatient settings (patient is not in hospital) is less certain.

This study examined 24 studies that compared APs to traditional insulin pumps or SAPs in outpatient settings. 585 children and adults with T1D participated in these studies.

Participants who used APs spent 12.59% more time at desired glucose levels than those who did not. The effect was greater for dual-hormone APs than single-hormone APs. However, there were large differences between individual studies.

The amount of time spent in hypoglycemia (dangerously low blood glucose) was 2.45% lower with APs. This was equivalent to 35 minutes less spent in hypoglycemia each day.

Insulin dose was unchanged when participants used APs, compared to traditional insulin pumps and SAPs.

The study concluded that APs improved control of glucose levels, without increasing the need for insulin. 

There were large differences between many of the individual studies examined by the researchers.