Fully Closed-Loop Insulin Delivery in Patients Undergoing Pancreatic Surgery.

Area of Science:

• Endocrinology
• Surgical Metabolism
• Diabetes Technology

Background:

• Pancreatic surgery significantly impacts glucose regulation due to the pancreas's central role.
• Effective perioperative glucose management is crucial for patients undergoing pancreatic resection.
• High variability in insulin needs presents a challenge in this patient population.

Purpose of the Study:

• To evaluate the efficacy of subcutaneous (SC) fully closed-loop (FCL) insulin therapy (CamAPS HX) compared to usual care (UC) for perioperative glucose control.
• To assess glucose control metrics, including time in target range and hypoglycemia risk, in patients undergoing pancreatic surgery.

Main Methods:

• Post hoc subgroup analysis of a randomized controlled trial.
• Comparison of SC FCL (CamAPS HX) versus UC insulin therapy.
• Utilized continuous glucose monitoring (CGM) to assess glycemic control (time in range 5.6-10.0 mmol/L).

Main Results:

• FCL therapy significantly improved time in the target glucose range (77.7% ± 4.6%) compared to UC (41.1% ± 19.5%).
• The mean difference in time in target range was 36.6% (95% CI 18.5-54.8).
• No increased risk of hypoglycemia was observed with FCL therapy.

Conclusions:

• An adaptive SC FCL system effectively managed the fluctuating insulin requirements in patients post-pancreatic surgery.
• FCL insulin therapy offers a promising approach for optimizing perioperative glycemic control in this complex surgical group.