Real-world data confirm benefits of ‘pump-suspend’ technology in diabetes
medwireNews: Exposure to hypoglycemia deceases significantly with increasing levels of insulin suspension automation in people with type 1 diabetes, real‐world study data show.
Simona de Portu (Medtronic International Trading Sàrl, Tolochanez, Switzerland) and colleagues found that “predictive suspension of insulin adds incremental value to threshold suspend systems,” which in turn were more effective than sensor-augmented pumps alone.
They say: “[T]hat the potential benefits of pump therapy with insulin suspension technologies seen in clinical trials are generalizable to the real-world setting is clearly of great clinical relevance.”
The study included 920 people with type 1 diabetes who were using a MiniMed Paradigm Veo insulin pump or a MiniMed 640G insulin pump with SmartGuard technology (both Medtronic International Trading Sàrl, Tolochanez, Switzerland), with or without automated insulin suspension enabled, between 2016 and 2018.
After taking into account switching between sensor types, 96 participants used the system as a sensor‐augmented pump alone, 249 used it as a sensor‐integrated pump with low glucose suspend enabled, and 781 used it as a sensor‐integrated pump with predictive low glucose management enabled.
As reported in Diabetic Medicine, the median percentage of time that adults (aged 15 years and older; n=401) spent with a sensor glucose value at or below the hypoglycemic threshold of 3 mmol/L (54 mg/dL) was 0.9% in the sensor‐augmented pump group, 0.3% in the sensor‐integrated pump with low glucose suspend group, and 0.2% in the sensor‐integrated pump with predictive low glucose management. The corresponding values in children (n=519) were 0.8%, 0.3%, and 0.3%.
When the researchers compared individual data for people who switched suspension mode, they found that those who moved from the sensor-augmented system to the sensor‐integrated system with low glucose suspend (n=31) had a significant 37% reduction in the monthly rate of hypoglycemic events as well as a significantly lower median proportion of time spent in hypoglycemia after the switch (0.63 vs 0.33%).
The monthly rate of hypoglycemic events also decreased, by a significant 18%, in 139 individuals switching from the sensor‐integrated system with low glucose suspend to predictive low glucose management.
However, the greatest reductions were seen in the 55 participants who switched from the sensor‐augmented system to predictive low glucose management. In this group, the monthly rate of sensor hypoglycemic events decreased by a significant 49%, and the median percentage of time in hypoglycemia was reduced from 0.8% to 0.3%.
Similar results were seen when a cutoff of 3.9 mmol/L (70.3 mg/dL) was used for hypoglycemic events and the team also notes that the median time spent in target glucose range did not differ significantly between the three groups.
de Portu et al conclude that their study “showed that a low frequency and duration of hypoglycaemia can be achieved with insulin suspension technologies during routine use in individuals with Type 1 diabetes in the real-world setting.”
By Laura Cowen
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