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Advances in health and medicine.
Marjorie Bekaert Thomas
Advances in health and medicine.
Diabetes Channel
Reported January 29, 2013

Improving Glucose Levels in Type 1 Diabetes


(Ivanhoe Newswire) -- Patients with type 1 diabetes have a hard time controlling their glucose levels because tight glucose control increases the incidence of hypoglycemia.   Insulin pump treatment is available, but hypoglycemia still occurs.  Now, new research shows that a dual-hormone artificial pancreas system improved the control of glucose levels and reduced the risk of hypoglycemia compared with conventional pump treatment.  
"Hypoglycemia is feared by most patients and remains the most common adverse effect of insulin therapy,” Ahmad Haidar, Institut de Recherches Cliniques de Montréal and McGill University was quoted as saying.
The dual-hormone artificial pancreas delivers insulin and glucagon through infusion pumps based on continuous glucose sensor readings as guided by an intelligent dosing algorithm.  The infusion pumps and glucose sensors are already on the market; however, the intelligent algorithm is new.
The trial investigated 15 patients with type 1 diabetes who have been using an insulin pump for at least 3 months.  They were admitted for two 15 hour experiments, where their glucose levels were controlled in one visit using the artificial pancreas system and the other with the conventional pump treatment.  Each visit the patients exercised on a stationary bike, ate an evening meal and bedtime snack, and stayed in the facility until the next morning. 
"The dual-hormone artificial pancreas improved glucose control and reduced the risk of hypoglycemia in our 15 participants, as compared with continuous subcutaneous insulin infusion.  Rates of hypoglycemia were reduced, with no increased risk of hyperglycemia,” study authors were quoted as saying.  
With the artificial pancreas system, patients’ glucose levels were in the target zone 71% of the time as compared to 57% with the conventional pump treatment.  Also the new treatment resulted in a 20-fold reduction in the number of night-time glucose measurements in the low glucose level range.
"Closed-loop delivery systems have the potential to substantially improve the management of diabetes and the safety of patients. These systems will probably be introduced gradually to clinical practice, with early generations focusing on overnight glucose control and using insulin alone," study authors explained.
"Although this study is neither the first nor the longest investigation using a dual-hormone artificial pancreas, it is the first to compare such an apparatus to conventional intensive therapy in a randomized design. Treatment with the artificial pancreas increased the amount of time patients spent in the target range of blood glucose levels and decreased hypoglycemia. Thus, Haidar and colleagues show that low doses of glucagon administered under the control of a computer algorithm can act as a counter-regulatory hormone, preventing glucose levels from falling too low,” Drs. David Nathan and Steven Russell at Massachusetts General Hospital, Harvard Medical School, was quoted as saying.
SOURCE:  Canadian Medical Association Journal, January 2013


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