Use of sensor‐integrated pump therapy to reduce hypoglycaemia in people with Type 1 diabetes: a real‐world study in the UK. Issue 9 (30th June 2019)

• Record Type: Journal Article
• Authors: Choudhary, P.; de Portu, S.; Arrieta, A.; Castañeda, J.; Campbell, F. M.
• Is Part Of: Diabetic medicine. Volume 36:Issue 9(2019)
• Page Start: 1100
• Page End: 1108
• Publication Date: 2019-06-30
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14043
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To assess the efficacy of insulin pumps with automated insulin suspension systems in a real‐world setting. Methods: We analysed anonymized data uploaded to CareLink ™ by people ( n =920) with Type 1 diabetes using the MiniMed Paradigm Veo system and the MiniMed 640G system (Medtronic International Trading Sàrl, Tolochanez, Switzerland) with SmartGuard technology, with or without automated insulin suspension enabled, between February 2016 and June 2018. Users with ≥15 days of sensor data and ≥70% sensor‐wear time were classified as sensor‐augmented pump alone, sensor‐integrated pump with low glucose suspend enabled or sensor‐integrated pump with predictive low glucose management enabled. Results: The median (25 th –75 th percentile) system use was 161 (58–348) days. The median time spent with sensor glucose values ≤3 mmol/l was 0.8 (0.3–1.7)% in the sensor‐augmented pump group, 0.3 (0.1–0.7)% in the sensor‐integrated pump with low glucose suspend group, and 0.3 (0.1–0.5)% in the sensor‐integrated pump with predictive low glucose management group. In individuals switching from sensor‐augmented pump to sensor‐integrated pump with low glucose suspend ( n =31), there were significant reductions in the monthly rate of hypoglycaemic events <3 mmol/l (rate ratio 0.63, 95% CI 0.45–0.89; P =0.009) and in the percentage of time with glucose values ≤3 mmol/l [sensor‐augmented pump: 0.63% (95% CI 0.34–1.29), sensor‐integrated pump with low glucose suspend: 0.33% (95% CI 0.16–0.64); P =0.001]. The monthly rate of hypoglycaemic events decreased further in individuals ( n =139) switching from sensor‐integrated pump with low glucose suspend to sensor‐integrated pump with predictive low glucose management [rate ratio 0.82 (95% CI 0.69–0.98); P <0.0274]. Similar results were seen for events <3.9 mmol/l. There was no difference in median time spent in target glucose range. Conclusion: Real‐world UK data show that increasing automation of insulin suspension reduces hypoglycaemia exposure in people with Type 1 diabetes. What's new?: Insulin pumps that automatically suspend insulin delivery based on actual or predicted low glucose levels reduce nocturnal and overall hypoglycaemia in randomized controlled trials, but even with these devices some people continue to struggle with nocturnal hypoglycaemia. This is one of the first real‐world studies to assess the effectiveness of automated insulin suspension systems. Both daytime and nocturnal hypoglycaemia were reduced to low levels. Automated insulin suspension in response to hypoglycaemia can reduce the burden of hypoglycaemia in real‐world clinical practice. These reductions in hypoglycaemia are achieved with no loss of mean glucose control. Predictive suspension of insulin adds incremental value to threshold suspend systems.