Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis

Lia Bally; Philipp Gubler; Hood Thabit; Sara Hartnell; Yue Ruan; Malgorzata E Wilinska; Mark L Evans; Mariam Semmo; Bruno Vogt; Anthony P Coll; Christoph Stettler; Roman Hovorka

doi:10.1016/j.kint.2019.03.006

Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis

Kidney Int. 2019 Sep;96(3):593-596. doi: 10.1016/j.kint.2019.03.006. Epub 2019 Mar 20.

Authors

Lia Bally¹, Philipp Gubler², Hood Thabit³, Sara Hartnell⁴, Yue Ruan⁵, Malgorzata E Wilinska⁶, Mark L Evans⁷, Mariam Semmo⁸, Bruno Vogt⁸, Anthony P Coll⁷, Christoph Stettler², Roman Hovorka⁹

Affiliations

¹ Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
² Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Manchester University Hospitals NHS Foundation, Manchester Academic Health Science Centre, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁴ Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
⁶ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Department of Paediatrics, University of Cambridge, Cambridge, UK.
⁷ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁸ Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁹ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Department of Paediatrics, University of Cambridge, Cambridge, UK. Electronic address: rh347@cam.ac.uk.

PMID: 31133457
DOI: 10.1016/j.kint.2019.03.006

Abstract

Inpatient diabetes management of those on hemodialysis poses a major challenge. In a post hoc analysis of a randomized controlled clinical trial, we compared the efficacy of fully automated closed-loop insulin delivery vs. usual care in patients undergoing hemodialysis while in hospital. Compared to control patients receiving conventional subcutaneous insulin therapy, those patients receiving closed-loop insulin delivery significantly increased the proportion of time when a continuous glucose monitor was in the target range of 5.6-10.0 mmol/l by 37.6 percent without increasing the risk of hypoglycemia. Thus, closed-loop insulin delivery offers a novel way to achieve effective and safe glucose control in this vulnerable patient population.

Trial registration: ClinicalTrials.gov NCT01774565.

Keywords: artificial pancreas; closed-loop insulin delivery; glucose control; hemodialysis.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Blood Glucose / analysis
Blood Glucose / drug effects
Diabetes Mellitus, Type 2 / blood
Diabetes Mellitus, Type 2 / complications
Diabetes Mellitus, Type 2 / diagnosis
Diabetes Mellitus, Type 2 / drug therapy*
Drug Therapy, Computer-Assisted / instrumentation
Drug Therapy, Computer-Assisted / methods
Female
Hospitalization
Humans
Hypoglycemic Agents / administration & dosage*
Infusion Pumps, Implantable
Insulin Aspart / administration & dosage
Insulin Infusion Systems*
Insulin Lispro / administration & dosage
Kidney Failure, Chronic / complications
Kidney Failure, Chronic / therapy*
Male
Middle Aged
Monitoring, Physiologic / instrumentation
Monitoring, Physiologic / methods
Renal Dialysis / adverse effects*
Treatment Outcome

Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis

Authors

Affiliations

Abstract

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