©Shutterstock

Closed-loop systems, whereby continuous glucose sensing works in tandem with an insulin pump, can be used to improve glycaemic control in patients with type 1 diabetes mellitus. In this randomised trial, Bally et al. compared the use of standard subcutaneous insulin regimes (control group, n=66) with the use of closed-loop technology (experimental group, n=70) in non-critical adult hospital in-patients with type 2 diabetes.

The two groups had similar values for body mass index, glycated haemoglobin and daily insulin requirement before the trial. Patients’ food intake and activity were unrestricted for the duration of the study (either 15 days or until discharge from hospital).

Closed-loop patients spent significantly more time than the control group with glucose levels in the target range of 5.6–10mmol/l (mean 65.8% of the time, compared with 41.5%). Glucose variability was significantly reduced in the closed-loop group too. There were no differences in insulin requirement or incidence of hypoglycaemia. Closed-loop patients reported high levels of satisfaction with both their glycaemic control and the technology.

The authors propose that closed-loop systems could improve the safety of in-patient diabetes care, without increasing demands on hospital staff.

Read the full article in New England Journal of Medicine doi:10.1056/NEJMoa1805233