Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Abstract

AimTo evaluate the efficacy and safety of a dual‐hormone artificial pancreas (DH) in type 1 diabetes.Material and MethodsPubMed, Embase, the Cochrane Library and ClinicalTrials.gov were searched for studies published up to February 16, 2022. We included randomized controlled trials that compared DH with single­hormone artificial pancreas (SH), continuous subcutaneous insulin infusion (CSII) or sensor‐augmented pumps (SAP), and predictive low glucose suspend systems (PLGS) in type 1 diabetes. The primary outcome was percent time in target (3.9‐10 mmol/L [70‐180 mg/dL]). Data were summarized as mean differences (MDs) or risk differences (RDs).ResultsA total of 17 randomized crossover trials (438 participants) were included. There were nine trials of DH versus SH, 13 trials of DH versus SAP/CSII, and two trials of DH versus PLGS. For time in target, DH showed no significant difference in time in target compared with SH (MD 2.69%, 95% confidence interval [CI] −0.38 to 5.76) but resulted in 16.05% (95% CI 12.06 to 20.05) and 6.89% (95% CI 2.63 to 11.14) more time in target range compared with SAP/CSII and PLGS, respectively. DH slightly reduced time in hypoglycaemia (MD −1.20%, 95% CI −1.85 to −0.56) but increased the risk of gastrointestinal symptoms (RD 0.18, 95% CI 0.08 to 0.27) compared with SH.ConclusionsThe results of this study suggest that DH has a comparable effect on time in target compared with SH, but is associated with a longer time in target range compared with SAP/CSII and PLGS. The DH slightly reduced time in hypoglycaemia but may increase the risk of gastrointestinal symptoms compared with the SH. PROSPERO registration number: CRD42022314015.