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Richard M Bergenstal1, David C Klonoff, Satish K Garg

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The New England Journal of Medicine
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PubMed
Summary

Sensor-augmented insulin pump therapy with threshold-suspend significantly reduced nocturnal hypoglycemia in type 1 diabetes patients. This feature lowered hypoglycemic events without impacting glycated hemoglobin levels over three months.

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Area of Science:

  • Endocrinology
  • Diabetes Technology

Background:

  • Sensor-augmented insulin pumps aim to prevent hypoglycemia using a threshold-suspend feature.
  • Nocturnal hypoglycemia is a significant concern for patients with type 1 diabetes.

Purpose of the Study:

  • To evaluate the efficacy and safety of sensor-augmented insulin-pump therapy with the threshold-suspend feature in patients experiencing nocturnal hypoglycemia.
  • To compare outcomes between therapy with and without the threshold-suspend feature.

Main Methods:

  • A 3-month randomized trial involving patients with type 1 diabetes and nocturnal hypoglycemia.
  • Patients received sensor-augmented insulin-pump therapy either with or without the threshold-suspend feature.
  • Primary outcomes included changes in glycated hemoglobin and the area under the curve for nocturnal hypoglycemic events.

Main Results:

  • The threshold-suspend group showed a 37.5% lower area under the curve for nocturnal hypoglycemia compared to the control group.
  • Nocturnal hypoglycemic events were 31.8% less frequent in the threshold-suspend group.
  • Significant reductions in sensor glucose values below 70 mg/dL were observed in the threshold-suspend group, with no increase in glycated hemoglobin levels.

Conclusions:

  • Sensor-augmented insulin-pump therapy with the threshold-suspend feature effectively reduces nocturnal hypoglycemia in type 1 diabetes patients.
  • The threshold-suspend feature is safe, as evidenced by similar glycated hemoglobin levels and no cases of diabetic ketoacidosis.
  • This technology offers a valuable tool for managing nocturnal hypoglycemia in insulin-pump users.