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First Clinical Trial Confirms Efficacy of Artificial Pancreas

Two configurations of an artificial pancreas were recently compared to conventional diabetes treatments in a world-first clinical trial…

Using insulin and glucagon to maintain target blood glucose levels, the devices demonstrated significantly greater glycemic control than conventional methods.
 
Researchers at the University of Montréal showed in the trial that artificial pancreases outperform conventional types of diabetes treatments. The study, the first of its kind, compared three different types of diabetes treatments, including a single-hormone artificial pancreas, a dual-hormone artificial pancreas, and a conventional insulin pump, according to a recent press release from the University of Montréal. The single-hormone system injects insulin, while the dual-hormone version injects insulin and glucagon. 
 
Dr. Rémi Rabasa-Lhoret, an endocrinologist and professor at the University of Montréal’s Department of Nutrition, said in the press release, "Our clinical trial was the first to compare these two configurations of the artificial pancreas with the conventional diabetes treatment using an insulin pump." "We wanted to determine the usefulness of glucagon in the artificial pancreas, especially to prevent hypoglycemia, which remains the major barrier to reaching glycemic targets." 
 
The primary metric that researchers studied was the percentage of times the patient spent in the target plasma glucose concentration window. They also accounted for the number of times patients experienced hypoglycemic events. During the study, conventional insulin pumps led to 52 hypoglycemic events (12 of which were symptomatic), single-hormone artificial pancreases were associated with 13 events (five of which were symptomatic), and the dual-hormone artificial pancreases were associated with nine events (none of which were symptomatic). 
 
Notably, nocturnal hypoglycemic events, which are some of the more concerning as they can lead to coma while a patient sleeps, were also greatly reduced by the artificial pancreases. Where the traditional insulin pumps led to 13 nocturnal hypoglycemic events (0 symptomatic), none of the events occurred for patients using artificial pancreases.
 
Dr. Laurent Legault, a pediatric endocrinologist at Montréal Children’s Hospital and co-author of the study, added that, "Given that low blood glucose remains very frequent during the night, the fear of severe nocturnal hypoglycemia is a major source of stress and anxiety, especially for parents with young diabetic children." "The artificial pancreas has the potential to substantially improve the management of diabetes and the quality of life for patients and their families."
 
Practice Pearls:
  • The dual-hormone artificial pancreases were associated with nine events (none of which were symptomatic) while the conventional insulin pumps led to 52 hypoglycemic events (12 of which were symptomatic)
  • The single-hormone artificial pancreases were associated with 13 events (five of which were symptomatic),
  • The artificial pancreas has the potential to substantially improve the management of diabetes
The Lancet Diabetes & Endocrinology, Early Online Publication, 27 November 2014 doi:10.1016/S2213-8587(14)70226-8. Abstract