Is closed-loop glucose control an effective treatment for patients with type 2 diabetes with serious kidney disease?

This study looked at the use of closed-loop glucose control treatment for patients with type 2 diabetes (T2D) requiring dialysis. It found that compared to standard insulin therapy, closed-loop glucose control led to improved glucose control in these patients. 

Closed-loop glucose control is a form of insulin treatment. It involves a system that is continuously monitoring changes in blood sugar (glucose). When the blood glucose level increases, an automatic insulin-delivery system responds to these changes as they happen.

Standard insulin treatment usually involves insulin injections several times a day, at a specific time (usually mealtimes). Standard insulin treatment cannot respond to small changes in blood glucose as effectively as closed-loop glucose control.

Many patients with T2D develop kidney damage caused by uncontrolled blood glucose. Many of these patients may require dialysis to remove waste products and excess fluids from their bodies because their kidneys no longer work. In these patients, it is particularly difficult to control blood glucose.

Closed-loop glucose control is often used for type 1 diabetes. However, it is not clear if it is also safe and effective for patients with T2D, particularly in patients requiring dialysis. 

26 patients with T2D participated in this study. All patients had severe kidney disease requiring dialysis. Patients were 68 years old on average and had diabetes for an average of 20 years. Patients were separated into 2 groups and underwent two 20-day treatment regimes. One group received standard insulin treatment first, followed by closed-loop glucose treatment. The other group received closed-loop glucose treatment for 20 days followed by standard insulin treatment. 

Patients remained within their target glucose range (5.6-10 mmol/l or 100.8-180 mg/dl) for a greater amount of time when using closed-loop glucose control treatment than standard insulin treatment. On average, patients stayed in the target range 52.8% of the time when using the closed-loop system, compared to 37.7% of the time when using standard insulin treatment. 

The average glucose reading in the closed-loop glucose control group was 10.1 mmol/l (181.8mg/dl), compared to 11.6 mmol/l (208.8mg/dl) in the standard insulin treatment group. Patients also spent less time in hypoglycemia (dangerously low blood sugar) when on closed-loop treatment than when on standard insulin therapy.

This study showed that closed-loop glucose control is safe and effective for patients with T2D and advanced kidney disease. 

This study involved a small number of patients. Larger studies are needed to confirm these findings.