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Published on: June 11, 2012
Closed-Loop Automated Insulin Delivery in Patients With Type 2 Diabetes: A Meta-Analysis of Randomised Controlled
Dua Ali1, Abdur Rafay Bilal2, S M Washaqul Arfin2
1Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Aims:
To evaluate the efficacy and safety of closed-loop automated insulin delivery (AID) systems with the conventional insulin delivery arm in adults with type 2 diabetes mellitus (T2DM).
Methods:
A systematic review and meta-analysis of 10 randomised controlled trials (n = 786; AID: 436, control: 350) was conducted per PRISMA guidelines. Data from studies were pooled using a random-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs).
Results:
AID significantly increased time in normoglycemia (WMD: +22.14%; 95% CI: 17.05, 27.23; 319 min/day; P < 0.00001) and reduced hyperglycemia (WMD: -21.04%; 95% CI: -6.23, -15.84; -303 min/day; P < 0.00001), mean glucose (WMD: -1.54 mmol/L; 95% CI: -2.37, -0.70; P = 0.0003), and HbA1c (WMD: -0.80%; 95% CI: -1.48, -0.12; P < 0.00001). Glucose SD improved significantly (WMD: -0.46; 95% CI: -0.74, -0.18; P = 0.002). No significant differences were found in hypoglycemia (WMD: -0.11%; 95% CI: -0.32, 0.09; -1.6 min/day; P = 0.28), total daily insulin (WMD: +4.80 IU; 95% CI: -1.87, 11.47; P = 0.16), or CV (WMD: -0.52%; 95% CI: -2.08, 1.04; P = 0.52). Total adverse events were higher with AID (RR: 1.61; 95% CI: 1.20, 2.17; P = 0.002), but serious adverse events (RR: 1.61; 95% CI: 0.83, 3.13; P = 0.16) and severe hypoglycemia (OR: 2.13; 95% CI: 0.22,20.83; P = 0.52) were not significantly different.
Conclusions:
Closed-loop AID significantly improves glycemic control in T2DM without increasing serious adverse events.
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