Fully Closed-Loop Glucose Control Shows Better T1D Glycemic Control Versus Traditional Insulin Therapy

A recent study, published in Diabetes Care, found that fully closed-loop insulin delivery with CamAPS HX improved glucose control compared with insulin pump therapy with continuous glucose monitoring (CGM) in adult patients with type 1 diabetes (T1D) and suboptimal glycemic control.

Investigators conducted a single-center, randomized crossover study, which included 26 patients with T1D who were using insulin pump therapy but still had suboptimal glycemic control. The participants had an average HbA1c level of 9.2%, indicating poor long-term blood glucose management. The researchers aimed to compare the effectiveness of fully closed-loop insulin delivery with ultrarapid insulin lispro, using the CamAPS HX system, against traditional insulin pump therapy with CGM. The primary endpoint of the study was the proportion of time glucose levels fell within the target range of 3.9 to 10.0 mmol/L (70-180 mg/dL).

Patients using the fully closed-loop system spent a significantly greater amount of time within this range compared with those using traditional insulin pump therapy with CGM. Specifically, the closed-loop system yielded a mean percentage of 50.0%, while the CGM group achieved only 36.2%, for a difference of 13.2 percentage points.

Additionally, time spent with glucose levels exceeding 10 mmol/L (180 mg/dL) was significantly lower in the closed-loop group (49.0%) compared with the CGM group (62.9%). Mean glucose levels were also lower with the closed-loop system (10.7 mmol/L) than with CGM (12.0 mmol/L). Lastly, the study found that the proportion of time with glucose levels below 3.9 mmol/L (70 mg/dL) was similar between the 2 periods, with minimal risk of hypoglycemia. This is an important safety consideration, as avoiding severe low blood sugar events is a primary concern for individuals with T1D.