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Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.

TitleArtificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2018
AuthorsBekiari, E., Kitsios K., Thabit H., Tauschmann M., Athanasiadou E., Karagiannis T., Haidich A-B., Hovorka R., & Tsapas A.
JournalBMJ
Volume361
Paginationk1310
Date Published2018 Apr 18
ISSN1756-1833
KeywordsDiabetes Mellitus, Type 1, Humans, Hyperglycemia, Hypoglycemia, Outpatients, Pancreas, Artificial, Patient Safety, Randomized Controlled Trials as Topic
Abstract

OBJECTIVE: To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes.DESIGN: Systematic review and meta-analysis of randomised controlled trials.DATA SOURCES: Medline, Embase, Cochrane Library, and grey literature up to 2 February 2018.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials in non-pregnant outpatients with type 1 diabetes that compared the use of any artificial pancreas system with any type of insulin based treatment. Primary outcome was proportion (%) of time that sensor glucose level was within the near normoglycaemic range (3.9-10 mmol/L). Secondary outcomes included proportion (%) of time that sensor glucose level was above 10 mmol/L or below 3.9 mmol/L, low blood glucose index overnight, mean sensor glucose level, total daily insulin needs, and glycated haemoglobin. The Cochrane Collaboration risk of bias tool was used to assess study quality.RESULTS: 40 studies (1027 participants with data for 44 comparisons) were included in the meta-analysis. 35 comparisons assessed a single hormone artificial pancreas system, whereas nine comparisons assessed a dual hormone system. Only nine studies were at low risk of bias. Proportion of time in the near normoglycaemic range (3.9-10.0 mmol/L) was significantly higher with artificial pancreas use, both overnight (weighted mean difference 15.15%, 95% confidence interval 12.21% to 18.09%) and over a 24 hour period (9.62%, 7.54% to 11.7%). Artificial pancreas systems had a favourable effect on the proportion of time with sensor glucose level above 10 mmol/L (-8.52%, -11.14% to -5.9%) or below 3.9 mmol/L (-1.49%, -1.86% to -1.11%) over 24 hours, compared with control treatment. Robustness of findings for the primary outcome was verified in sensitivity analyses, by including only trials at low risk of bias (11.64%, 9.1% to 14.18%) or trials under unsupervised, normal living conditions (10.42%, 8.63% to 12.2%). Results were consistent in a subgroup analysis both for single hormone and dual hormone artificial pancreas systems.CONCLUSIONS: Artificial pancreas systems are an efficacious and safe approach for treating outpatients with type 1 diabetes. The main limitations of current research evidence on artificial pancreas systems are related to inconsistency in outcome reporting, small sample size, and short follow-up duration of individual trials.

DOI10.1136/bmj.k1310
Alternate JournalBMJ
PubMed ID29669716
PubMed Central IDPMC5902803
Grant ListEME/14/23/09 / / Department of Health / United Kingdom

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