Show simple item record

dc.contributor.authorBally, Lia
dc.contributor.authorThabit, Hood
dc.contributor.authorHartnell, Sara
dc.contributor.authorAndereggen, Eveline
dc.contributor.authorRuan, Yue
dc.contributor.authorWilinska, Gosia
dc.contributor.authorEvans, Mark
dc.contributor.authorWertli, Maria M
dc.contributor.authorColl, Anthony
dc.contributor.authorStettler, Christoph
dc.contributor.authorHovorka, Roman
dc.date.accessioned2018-09-20T12:02:56Z
dc.date.available2018-09-20T12:02:56Z
dc.date.issued2018-08-09
dc.identifier.issn0028-4793
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/280428
dc.description.abstractBACKGROUND: In patients with diabetes, hospitalization can complicate the achievement of recommended glycemic targets. There is increasing evidence that a closed-loop delivery system (artificial pancreas) can improve glucose control in patients with type 1 diabetes. We wanted to investigate whether a closed-loop system could also improve glycemic control in patients with type 2 diabetes who were receiving noncritical care. METHODS: In this randomized, open-label trial conducted on general wards in two tertiary hospitals located in the United Kingdom and Switzerland, we assigned 136 adults with type 2 diabetes who required subcutaneous insulin therapy to receive either closed-loop insulin delivery (70 patients) or conventional subcutaneous insulin therapy, according to local clinical practice (66 patients). The primary end point was the percentage of time that the sensor glucose measurement was within the target range of 100 to 180 mg per deciliter (5.6 to 10.0 mmol per liter) for up to 15 days or until hospital discharge. RESULTS: The mean (±SD) percentage of time that the sensor glucose measurement was in the target range was 65.8±16.8% in the closed-loop group and 41.5±16.9% in the control group, a difference of 24.3±2.9 percentage points (95% confidence interval [CI], 18.6 to 30.0; P<0.001); values above the target range were found in 23.6±16.6% and 49.5±22.8% of the patients, respectively, a difference of 25.9±3.4 percentage points (95% CI, 19.2 to 32.7; P<0.001). The mean glucose level was 154 mg per deciliter (8.5 mmol per liter) in the closed-loop group and 188 mg per deciliter (10.4 mmol per liter) in the control group (P<0.001). There was no significant between-group difference in the duration of hypoglycemia (as defined by a sensor glucose measurement of <54 mg per deciliter; P=0.80) or in the amount of insulin that was delivered (median dose, 44.4 U and 40.2 U, respectively; P=0.50). No episode of severe hypoglycemia or clinically significant hyperglycemia with ketonemia occurred in either trial group. CONCLUSIONS: Among inpatients with type 2 diabetes receiving noncritical care, the use of an automated, closed-loop insulin-delivery system resulted in significantly better glycemic control than conventional subcutaneous insulin therapy, without a higher risk of hypoglycemia. (Funded by Diabetes UK and others; ClinicalTrials.gov number, NCT01774565 .).
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherMassachusetts Medical Society
dc.subjectHumans
dc.subjectDiabetes Mellitus, Type 2
dc.subjectInsulin
dc.subjectBlood Glucose
dc.subjectHypoglycemic Agents
dc.subjectInsulin Infusion Systems
dc.subjectHospitalization
dc.subjectPancreas, Artificial
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectInfusions, Subcutaneous
dc.titleClosed-Loop Insulin Delivery for Glycemic Control in Noncritical Care.
dc.typeArticle
prism.endingPage556
prism.issueIdentifier6
prism.publicationDate2018
prism.publicationNameN Engl J Med
prism.startingPage547
prism.volume379
dc.identifier.doi10.17863/CAM.27799
dcterms.dateAccepted2018-05-21
rioxxterms.versionofrecord10.1056/NEJMoa1805233
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-08
dc.contributor.orcidWilinska, Gosia [0000-0003-2739-1753]
dc.contributor.orcidEvans, Mark [0000-0001-8122-8987]
dc.contributor.orcidColl, Anthony [0000-0003-2594-7463]
dc.contributor.orcidHovorka, Roman [0000-0003-2901-461X]
dc.identifier.eissn1533-4406
rioxxterms.typeJournal Article/Review
pubs.funder-project-idWellcome Trust (100574/Z/12/Z)
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (146281)
pubs.funder-project-idMedical Research Council (MC_PC_12012)
pubs.funder-project-idDiabetes UK (14/0004878)
cam.orpheus.successThu Jan 30 10:54:33 GMT 2020 - The item has an open VoR version.
rioxxterms.freetoread.startdate2100-01-01


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record