A new artificial pancreas system that uses advanced control algorithms to automatically monitor and regulate blood glucose levels was more effective than existing treatments at controlling blood glucose levels in people with type 1 diabetes, according to a multicenter randomized clinical trial.

The study showed that the system improved participants' blood glucose control throughout the day and overnight. Overnight glucose control is a common but serious challenge for children and adults with type 1 diabetes, since blood glucose can drop to dangerously low levels when a person is asleep. The research was published in the New England Journal of Medicine.

The artificial pancreas, also known as closed-loop control, is an "all-in-one" diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the hormone insulin when needed, using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with separate delivery of insulin by multiple daily injections or a pump.

The International Diabetes Closed-Loop (iDCL) Study involves five separate artificial pancreas clinical protocols implemented by 10 research centers, including the Icahn School of Medicine at Mount Sinai. This six-month study was the third phase in the series of trials. It was conducted with participants living their usual day-to-day lives, so the researchers could best understand how the system works in typical daily routines.

This iDCL protocol enrolled 168 participants age 14 or older with type 1 diabetes. They were randomly assigned to use either the artificial pancreas system called Control-IQ or sensor-augmented pump (SAP) therapy with a CGM and insulin pump that did not automatically adjust insulin throughout the day. Participants had contact with study staff every two to four weeks to download and review device data. No remote monitoring of the systems was done, so that the study would reflect real-world use.

The researchers found that users of the artificial pancreas system significantly increased the amount of time in which their blood glucose levels remained within the target range of 70 to 180 mg/dL by an average of 2.6 hours per day, while the time in range in the SAP group remained unchanged over six months. Artificial pancreas users also showed improvements in time spent with high and low blood glucose, hemoglobin A1c, and other measurements related to diabetes control compared to the SAP group.

The Control-IQ technology was derived from a system originally developed at the University of Virginia, Charlottesville. In this system, the insulin pump is programmed with advanced control algorithms based on a mathematical model that uses the person's glucose monitoring information to automatically adjust the insulin dose.

"This system has some unique features to help patients achieve target glucose levels while reducing the risk of hypoglycemia. It has been an exciting study both for patients and the research team," said the author. "By making management of type 1 diabetes easier and more precise by using artificial pancreas technology, the potential is tremendous to reduce the daily burden of this disease and improve long-term outcomes for our patients."

https://www.mountsinai.org/about/newsroom/2019/artificial-pancreas-system-better-controls-blood-glucose-levels-than-current-technology

https://www.nejm.org/doi/full/10.1056/NEJMoa1907863