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Evening and overnight closed-loop control versus 24/7 continuous closed-loop control for type 1 diabetes: a
Boris P Kovatchev1, Laura Kollar1, Stacey M Anderson1
1University of Virginia Center for Diabetes Technology, Charlottesville, VA USA.
The Lancet. Digital Health
|September 1, 2020
Summary
Evening-night automated closed-loop control (CLC) significantly reduced hypoglycemia in Type 1 Diabetes (T1D) patients compared to sensor-augmented pump therapy. This artificial pancreas approach achieved most benefits of 24-7 CLC, improving glycemic control.
Area of Science:
- Endocrinology
- Biomedical Engineering
- Diabetes Technology
Background:
- Automated closed-loop control (CLC), or the artificial pancreas, shows promise for Type 1 Diabetes (T1D) management.
- Previous research suggests evening-night (E-N) CLC may offer significant glycemic benefits comparable to 24-7 CLC.
Purpose of the Study:
- To directly compare the efficacy of E-N CLC versus sensor-augmented pump (SAP) therapy in adults with T1D.
- To evaluate if E-N CLC provides similar glycemic control benefits to 24-7 CLC.
Main Methods:
- A randomized crossover trial (NCT02679287) involving 80 adults with T1D.
- Participants alternated between SAP, E-N CLC, and 24-7 CLC therapy over 8-week sessions.
- Primary outcome: reduction in time spent with glucose levels <70 mg/dL (3.9 mmol/L) using continuous glucose monitoring (CGM).
Main Results:
- E-N CLC significantly reduced time <70 mg/dL compared to SAP (1.8% absolute difference, p<0.0001).
- HbA1c levels decreased from 7.4% to 7.1% with E-N CLC (0.3% absolute difference, p<0.0001).
- No diabetic ketoacidosis events occurred; 5 severe hypoglycemia events were linked to user-directed boluses.
Conclusions:
- Evening-night CLC demonstrates superiority over SAP therapy for T1D management.
- E-N CLC achieves a substantial portion of the glycemic benefits observed with 24-7 CLC, offering a potentially more convenient option.
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