07 Jan Dual-Hormone Artificial Pancreas Reduces Hypoglycemia Risk

MedicalResearch.com Interview with:
Ahmad Haidar PhD
Institut de Recherches Cliniques de Montreal
Montreal, QC, Canada

Medical Research: What is the background for this study? What are the main findings?

Response: We published a study in 2013 (Canadian Medical Association Journal 185.4 (2013): 297-305) where we did the first randomized trial comparing dual-hormone artificial pancreas against conventional pump therapy. We showed spectacular reduction in hypoglycemia (8-fold) with the artificial pancreas, but the first question people asked: Out of the improvement you showed, how much is due to simply closing the loop between the glucose sensor and the insulin pump, and how much is due to adding glucagon? In other words: if you just close the loop with insulin alone and use an advanced dosing algorithm, you may get a very high reduction of hypoglycemia that glucagon may not be needed (glucagon is associated with increased cost and device complexity). We were not able to answer this question with our study design.

Since then, there have been other studies by other groups either comparing single-hormone artificial pancreas vs conventional pump therapy, or comparing dual-hormone artificial pancreas vs conventional pump therapy, and most of these studies showed improvement of both artificial pancreas systems compared to conventional pump therapy. However, there has been no study comparing the three interventions to allow us to quantify the relative benefits of simply closing the loop between glucose sensor and insulin pump versus adding glucagon to the system. Quantifying the relative benefits of glucagon is important given the increased cost and device complexity of the dual-hormone artificial pancreas.

So our study compared the three interventions, and is the first study to do so.

Medical Research: What should clinicians and patients take away from your report?

Response:

– Although the single-hormone artificial pancreas reduced significantly the risk of hypoglycemia compared to conventional pump therapy, the dual-hormone artificial pancreas reduced hypoglycemia even further. This means adding glucagon to the system is associated with an increased benefits in terms of reduction of hypoglycemia.

– The single-hormone artificial pancreas seems enough for overnight hypoglycemia-free control. This is very important given that overnight hypoglycemia is very frequent and a major source of stress and anxiety for the patients and their families. Most severe hypoglycemia occur overnight.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The findings of our study should be confirmed in outpatient larger and longer studies.

Citation:

Comparison of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy for glycaemic control in patients with type 1 diabetes: an open-label randomised controlled crossover trial

• Dr Ahmad Haidar, PhD^{a, b, ,}Laurent Legault, MD^c,Virginie Messier, MSc^a,
  Tina Maria Mitre, BSc^d, Catherine Leroux, BSc^a, Rémi Rabasa-Lhoret, MD^{a, b}, ef

The Lancet Diabetes & Endocrinology
Volume 3, Issue 1, January 2015, Pages 17–26

[wysija_form id=”1″]

Last Updated on January 7, 2015 by Marie Benz MD FAAD