ESPE Abstracts (2016) 86 S3.3

Optimizing Nocturnal Diabetes Control: Optimising Insulin Delivery with New Technology: But Where is the Evidence?

Roman Hovorka

Cambridge, UK

The use of insulin pumps is increasing particularly in the paediatric population with between 50% to 74% pump users below the age of 6 years. Real-time continuous glucose monitoring enables greater understanding of glucose excursions, provides low and high glucose alarms, and facilitates more responsive insulin dose adjustments. An enhancement of the sensor-augmented insulin therapy pump is the low-glucose suspend (LGS) and predictive low glucose management (PLGM) features reducing the risk of hypoglycaemia in hypoglycaemia prone individuals. The LGS function allows insulin to be automatically suspended for up to two hours when sensor glucose falls below a present threshold. The hypoglycaemia-prediction algorithms and automatic pump suspension enable insulin delivery to be suspended when hypoglycaemia is predicted. The Artificial Pancreas (closed loop system) automatically delivers insulin according to real-time sensor glucose levels, below and above preset insulin amount, combining glucose sensor, insulin pump and a control algorithm, to achieve as much as possible functionality of a healthy pancreas. In youth, closed-loop prototypes have been tested extensively under controlled laboratory conditions demonstrating reduced risk nocturnal hypoglycaemia and increased time in target glucose range. The risk of hypoglycaemia may be further reduced with the use of bihormonal (also known as dual-hormone) closed-loop systems delivering subcutaneous glucagon when hypoglycaemia is observed or predicted. Pioneering home studies have been performed to demonstrate benefits during free living. Performance of closed-loop systems is damped by variable and relatively slow absorption of currently available rapid-acting insulin analogues, which delays onset and prolongs insulin action. This may attenuate daytime closed-loop performance due to rapid glycaemic fluctuations observed during meal-times and exercise, as reflected by relatively better closed-loop glycaemic performance overnight compared to daytime.

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