Diabetes Patients on Dialysis See Better Sugar Control With
Adults with type 2 diabetes and end-stage renal disease requiring dialysis benefitted from an artificial pancreas in a small, randomized crossover trial.

Researchers evaluated the safety and efficacy of fully closed-loop insulin therapy compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis. In an open-label, multinational, two-center, randomized crossover trial, 26 adults with type 2 diabetes requiring dialysis (17 men, 9 women, average age 68±11 years (mean±s.d.), diabetes duration of 20±10 years) underwent two 20-day periods of unrestricted living, comparing the Cambridge fully closed-loop system using faster insulin aspart (‘closed-loop’) with standard insulin therapy and a masked continuous glucose monitor (‘control’) in random order.

The primary endpoint was time in target glucose range (5.6–10.0 mmol per litre). Thirteen participants received closed-loop first and thirteen received control therapy first. The proportion of time in target glucose range (5.6–10.0 mmol per litre; primary endpoint) was 52.8±12.5% with closed-loop versus 37.7±20.5% with control; mean difference, 15.1 percentage points. Mean glucose was lower with closed-loop than control (10.1±1.3 versus 11.6±2.8 mmol per litre). Time in hypoglycemia (less than 3.9 mmol per litre) was reduced with closed-loop versus control (median 0.1 versus 0.2).

No severe hypoglycemia events occurred during the control period, whereas one severe hypoglycemic event occurred during the closed-loop period, but not during closed-loop operation. Fully closed-loop improved glucose control and reduced hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis.

Source: https://www.nature.com/articles/s41591-021-01453-z
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