Dual hormone closed-loop insulin/glucagon delivery has been successfully used in in- and out-patient clinical setting with a reduction in hypoglycemia and improvement in time in range of glucose concentration. However, the main goal of the dual hormone closed-loop systems complete prevention of hypoglycemia has not been achieved. In the latest published studies with dual hormone closed-loop systems the amount of intervention with oral carbohydrates is still almost half of the amount in the control arm. Several physiologic and technical barriers preclude complete elimination of hypoglycemia with the dual closed-loop systems. The glucagon action is physiologically less potent at high insulin concentrations in the blood, which is exactly when its action is most needed in the dual hormone insulin delivery. Additionally, its subcutaneous application may not always be successful due to various technical reasons. Finally, partial protection from hypoglycemia with the use of dual hormone closed-loop systems may reduce the attentiveness of its users to the remaining alarms requiring rescue carbohydrate ingestions. On the other hand, an increasing amount of published data on single hormone closed loop systems demonstrates its safety and efficacy, and most importantly feasibility of its routine day-to-day use. Hybrid single hormone closed-loop systems seem more efficient in clinical studies as pre-meal boluses reduce post-prandial hyperglycemia. However, in every-day routine full single hormone closed-loop system may become the option of choice.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology