medwireNews: A dual-hormone artificial pancreas may reduce the risk of night-time hypoglycaemia in adolescents with Type 1 diabetes, research suggests.

The 3.1% reduction in median time spent in hypoglycaemia, versus an insulin-only artificial pancreas, was no longer statistically significant after correction for multiple comparisons.

However, the study was conducted in closely supervised children, aged an average of 13.3 years, who were attending a diabetes camp. Even when using a conventional insulin pump, the 33 children spent only a median 3.4% of their time with a glucose concentration lower than 4.0 mmol/L during the night, whereas night-time hypoglycaemia is reportedly common in real-world settings, and a barrier to intensive insulin treatment.

The median time spent in hypoglycaemia was 3.1% when the children were using a single-hormone artificial pancreas, and 0.0% when using the dual-hormone system, over periods of three consecutive nights.

“Whether it is justifiable to add glucagon to the artificial pancreas is a challenging question to answer and needs further research”, write Ahmad Haidar (McGill University, Montreal, Quebec, Canada) and co-researchers in The Lancet Diabetes & Endocrinology.

They suggest that a dual-hormone artificial pancreas might be best used in specific groups, such as patients with hypoglycaemia unawareness and physically active patients.

The team also notes that dual-hormone systems are more complicated and require an additional catheter. “To predict future adherence to dual-hormone therapy, we should assess, from patients’ perspectives, whether the clinical benefits outweigh the increased complexity.”

The study participants spent more time in their target blood glucose range of 4.0–8.0 mmol/L when using the dual-hormone pancreas, at 63%, compared with 55% for the single-hormone pancreas and 29% for conventional insulin pump therapy.

The incidences of both hypo- and hyperglycaemia decreased during the course of the night when patients were using either of the artificial pancreas systems, whereas hypoglycaemic episodes continued throughout the night when they were using a conventional insulin pump and the incidence of hyperglycaemia gradually increased.

In a commentary accompanying the study, Jessica Castle (Oregon Health & Science University, Portland, USA) stresses the importance of continued development of dual-hormone systems, saying “Until a truly ultra-rapid insulin is available, an insulin-only system will be suboptimal, particularly in situations where insulin needs drop rapidly, such as during exercise.”

She says that the “true test” of the weaknesses of insulin-only systems and the potential need for glucagon will come only when artificial pancreas systems are used commercially, beyond research populations.

By Eleanor McDermid, Senior medwireNews Reporter

Lancet Diabetes Endocrinol 2015; Advance online publication

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