Use of an artificial pancreas at diabetes camps
Attempts to improve blood glucose control in type 1 diabetes have led to the use of technology such as insulin pumps and glucose sensors, or both (sensor augmented pump) but they have not eliminated the risk of nocturnal hypoglycaemia. It has been estimated that three quarters of hypoglycaemic seizures in children occur during the night. Fully automated artificial pancreas systems use computer controlled algorithms to link glucose sensors with insulin pumps to control insulin delivery. Such devices have improved blood glucose control in hospital trials and have reduced the risk of nocturnal hypoglycaemia. New researchers in Israel, Slovenia and Germany (Moshe Phillips and colleagues. New England Journal of Medicine 2013;368:824–33) have used the artificial pancreas system at a youth diabetes camp in each of these countries.
The study included a total of 56 patients aged 10–18 years who had had type 1 diabetes for at least a year, had used an insulin pump for at least 3 months, had a glycated haemoglobin level of 7–10%, and a body mass index of <97 percentile for age. Patients were treated on two consecutive nights with randomisation to artificial pancreas on the first night and sensor augmented insulin pump (control) on the second night or visa versa. Median individual overnight blood glucose concentrations were 7.0 mmol/L (artificial pancreas nights) vs. 7.8 mmol/L (control nights). The number of nocturnal episodes of blood glucose <3.5 mmol/L for at least 10 minutes was 7 (artificial pancreas nights) vs. 22 (control nights), a significant difference. Periods of blood glucose <3.3 mmol/L were also significantly shorter on nights using the artificial pancreas. The median time with blood glucose>7.8 mmol/L was 146 minutes vs. 234 minutes and the median time with blood glucose 4.4–6.6 mmol/L was 3.9 hours vs. 2.2 hours. Patients aged 10–18 years at diabetes camps had better blood glucose control and less nocturnal hypoglycaemia with the artificial pancreas than with the sensor augmented insulin pump.