A closed-loop artificial pancreas system increased glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they played winter sports, study data show.
“The highest mean HbA1c occurs during adolescence and young adulthood, indicating that this age group is a prime target for improved glycemic control,” Marc D. Breton, PhD, assistant professor of research at the Center for Diabetes Technology at the University of Virginia School of Medicine, and colleagues wrote. “As such, closed-loop control technology, commonly known as the artificial pancreas, has become a focus of significant research and industrial development effort. … Glucose control, especially during intense exercise, is a particular challenge for people with [type 1 diabetes].”
The researchers performed a randomized controlled trial of 32 adolescents with type 1 diabetes who attended 5-day skiing camps in Breckenridge, Colorado, and Wintergreen, Virginia. The patients were randomly assigned to a University of Virginia-designed closed-loop control system or a remotely monitored sensor-augmented pump. Participants were “coarsely” matched by HbA1c and age, and the researchers monitored them remotely for 24 hours a day. The patients’ mean age was 13.2 years.
Patients assigned to the closed-loop control system demonstrated a greater percentage of time in range compared with the physician-monitored open-loop group (71.3% vs. 64.7%; P = .005), Breton and colleagues reported.
Overall hypoglycemia exposure (P = .001) and carbohydrate treatments (P = .007) were reduced, the researchers wrote. This held true during the daytime, with a significant effect in the participants’ levels of ability in skiing or snowboarding (P = .0001 and P = .006). However, those in the closed-loop control system group were exposed to hypoglycemia less than the remotely monitored group while skiing or snowboarding, regardless of ability (1.4% vs. 2.3% for beginners, 1.3% vs 2.3% for advanced) and received fewer carbohydrates (15.63 g vs. 18.53 g for beginners, 12.38 g vs. 16.03 g for advanced).
“Future studies of [closed-loop control systems] require longer duration, less supervision and challenges with activities in which patients engage in their lives,” Breton and colleagues wrote. – by Andy Polhamus
Disclosures: Breton reports receiving fees from Ascencia, Dexcom, The Epsilon Group, Merck, Roche and Sanofi; nonfinancial support from Novo Nordisk, Tandem and TypeZero Technologies; and patents relating to glucose monitoring.