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Perioperative Fully Closed-Loop Insulin Delivery in Patients Undergoing Elective Surgery: An Open-Label, Randomized

David Herzig1, Simon Suhner1, Jonathan Roos1

  • 1Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, Switzerland.

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Summary

Fully closed-loop insulin delivery significantly improved glucose control in patients undergoing surgery. This advanced system enhanced time in target glucose range without increasing hypoglycemia risk.

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Surgical Care

Background:

  • Perioperative glucose management is complex for patients requiring insulin.
  • Maintaining optimal glycemic control during surgery is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy of fully closed-loop subcutaneous insulin delivery for glycemic control in insulin-requiring patients undergoing elective surgery.
  • To compare closed-loop insulin delivery with standard insulin therapy in this surgical population.

Main Methods:

  • A single-center, open-label, randomized controlled trial was conducted.
  • Patients with non-type 1 diabetes undergoing elective surgery were randomized to either closed-loop insulin delivery or standard care.
  • The primary endpoint was the proportion of time sensor glucose remained within the target range (5.6-10.0 mmol/L).

Main Results:

  • The closed-loop group spent significantly more time in the target glucose range (76.7%) compared to the control group (54.7%).
  • The mean difference in time within the target range was 22.0 percentage points (P < 0.001).
  • No severe hypoglycemia or hyperglycemia with ketonemia occurred in either group.

Conclusions:

  • Fully closed-loop subcutaneous insulin delivery effectively improves glycemic control in patients undergoing mixed elective surgery.
  • This technology offers a safe alternative, showing no increased risk of hypoglycemia compared to standard insulin therapy.