In 2018, the National Library of Medicine (PubMed) included 132 publications in the artificial pancreas (AP) field, and in the first 6 months of 2019, new 80 papers were published. This continues a trend of over 100 scientific publications per year since 2015 and confirms the growing prominence of the AP for the treatment of diabetes. This presentation recounts briefly the technologies enabling the AP, including continuous glucose monitoring (CGM) and automated control algorithms, and then discusses the latest results from Protocol 3 of the International Diabetes Closed-Loop Trial (NCT 03563313), which tested the new Control IQ system from Tandem Diabetes Care.
Control-IQ uses a Dexcom G6 CGM that does not require fingerstick calibrations, and a control algorithm originally developed at the University of Virginia, which modulates basal rate, administers automated insulin corrections, and has a dedicated safety system to anticipate and prevent hypoglycemia. Protocol 3 is the largest AP study attempted to date, executed at 7 sites in the United States enrolling N=168 participants with type 1 diabetes randomized 2:1 to Control IQ vs. sensor-augmented pump therapy (SAP), each participating for 6 months. All 168 participants concluded the study and now continue to use the system in a protocol extension. First results were revealed at the 2019 Scientific Sessions of the American Diabetes Association, showing that Control IQ was significantly (all p-levels <0.001) superior to SAP according to all accepted CGM metrics of glycemic control, including time in range, frequency of hypoglycemia and hyperglycemia, average glucose, glycemic variability, as well as HbA1c.
We can therefore conclude that, a century after the discovery of insulin, viable AP technology is within reach and entering the mainstream clinical practice. The AP is here to stay, and is on its way to fulfil its promise as the digital-age optimal treatment for diabetes.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology