Bionic pancreas in children and adults with type 1 diabetes

Abstract

Journal of Paediatrics and Child HealthEarly View Heads UpFree Access Bionic pancreas in children and adults with type 1 diabetes First published: 08 May 2023 https://doi.org/10.1111/jpc.16426 edited by Craig Mellis ([email protected]) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Unlike currently available semi-automated insulin delivery systems, which require individualised settings and carbohydrate counting, bionic pancreas allows for automated insulin delivery based on body weight and ‘meal announcements’. The Bionic Pancreas Research Group randomised 326 persons with type 1 diabetes aged 6–79 years to insulin-only bionic pancreas treatment (n = 219) or standard care with any insulin-delivery method and unblinded continuous glucose monitoring (n = 107).1 After 13 weeks, the bionic pancreas group saw an HbA1c improving from 7.9% at baseline to 7.3% at follow-up, while standard-treatment group saw no change. Additionally, in the bionic pancreas group, mean sensor glucose improved and time in range (TIR) increased by 11% (Fig. 1). These effects were greater in participants with higher HbA1c and on multiple daily injections or non-automated pump systems. There was no difference in hypoglycaemia (sensor glucose <3 mmol/L). A high rate of adverse events occurred in the bionic pancreas group: hyperglycaemia occurred in 95 participants, predominantly due to infusion-set failures. However, such adverse events were not reported in the standard-treatment group. Of the bionic pancreas group, 19 participants stopped using the intervention prior to completion of the study and two children required additional insulin glargine for hyperglycaemia despite maximal insulin delivery based on the device algorithm. Fig. 1Open in figure viewerPowerPoint (a) Median glucose level over 24 h. Solid circles indicate the hourly median values of the participants' mean glucose levels, and shaded regions indicate the interquartile range; dashed curves indicate the 10th and 90th percentiles. (b) Cumulative distribution plot of the percentage of sensor glucose level in range (3.9–10 mmol/L). (), Standard care; (), bionic pancreas. In conclusion, insulin-only bionic pancreas resulted in lower HbA1c, improved TIR and lower mean sensor glucose level than standard care without increased hypoglycaemia. Further development and optimisation of insulin sets and the insulin delivery algorithm (especially for children) would reduce the risk of adverse events seen in this trial. Reference 1 Bionic Pancreas Research Group et al. Multicenter, randomized trial of a bionic pancreas in type 1 diabetes. N. Engl. J. Med. 2022; 387: 1161– 72. Reviewers: Lara E. Graves, [email protected], The Children's Hospital at Westmead, Sydney; Jessica Sandy, [email protected], The Children's Hospital at Westmead, Sydney Early ViewOnline Version of Record before inclusion in an issue FiguresReferencesRelatedInformation