Artificial Pancreas as an Effective and Safe Alternative in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Abstract

IntroductionInsulin injection is the main treatment in patients with type 1 diabetes mellitus (T1DM). Even though continuous glucose monitoring has significantly improved the conditions of these patients, limitations still exist. To further enhance glucose control in patients with T1DM, an artificial pancreas has been developed. We aimed to systematically compare artificial pancreas with its control group during a 24-h basis in patients with T1DM.MethodsElectronic databases were carefully searched for English publications comparing artificial pancreas with its control group. Overall daytime and nighttime glucose parameters were considered as the endpoints. Data were evaluated by means of weighted mean differences (WMDs) and 95% confidence intervals (CIs) generated by RevMan 5.3 software.ResultsA total number of 354 patients were included. Artificial pancreas significantly maintained a better mean concentration of glucose (WMD − 1.03, 95% CI − 1.32 to − 0.75; P = 0.00001). Time spent in the hypoglycemic phase was also significantly lower (WMD − 1.23, 95% CI − 1.56 to − 0.91; P = 0.00001). Daily insulin requirement also significantly favored artificial pancreas (WMD − 3.43, 95% CI − 4.27 to − 2.59; P = 0.00001). Time spent outside the euglycemic phase and hyperglycemia phase (glucose > 10.0 mmol/L) also significantly favored artificial pancreas. Also, the numbers of hypoglycemic events were not significantly different.ConclusionArtificial pancreas might be considered an effective and safe alternative to be used during a 24-h basis in patients with T1DM.