Dual-Hormone Artificial Pancreas Reduces Glucose Variability in T1D

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Insulin and amylin were administered in a basal-bolus manner with a fixed ratio mimicking a co-formulation.
Insulin and amylin were administered in a basal-bolus manner with a fixed ratio mimicking a co-formulation.
The following article is part of conference coverage from the American Diabetes Association's 78th Scientific Sessions (ADA 2018) in Orlando,Florida. Endocrinology Advisor's staff will report on medical research and technological advances in diabetes and diabetes education, conducted by experts in the field. Check back for the latest news from ADA 2018.

A dual-hormone artificial pancreas that delivered rapid insulin and amylin in a fixed ratio improved glucose control and reduced glucose variability, according to research presented at the American Diabetes Association's 78th Scientific Sessions held in Orlando, Florida, June 22 - 26, 2018.

Lead investigator Ahmad Haidar, PhD, and colleagues conducted a randomized crossover study to compare a dual-hormone artificial pancreas employing regular or rapid insulin and amylin with a rapid insulin-alone artificial pancreas in adults (n=12) with type 1 diabetes.  Using the dual-hormone artificial pancreas, insulin and amylin were delivered simultaneously in a bolus manner in a fixed ratio (6 μg/U) similar to a co-formulation.

Participants were hospitalized for a 24-hour period on 3 occasions, during which time they consumed 3 meals and a bedtime snack.  Overall, the participants assigned to the dual-hormone artificial pancreas spent more time within the target blood glucose range of 70 to 180 mg/dL compared with participants assigned the rapid insulin-alone artificial pancreas (P=.03).  The time spent in the target blood glucose range during daytime was the highest in the dual-hormone rapid insulin and amylin artificial pancreas group, followed by the regular insulin and amylin artificial pancreas and the rapid insulin-alone artificial pancreas groups (78±16%, 66±21%, and 58±26%, respectively). Time spent in the target blood glucose range overnight was higher in the rapid insulin-alone artificial pancreas group followed by the dual-hormone rapid insulin and amylin artificial pancreas and the regular insulin and amylin artificial pancreas groups (77±20, 71±29, and 65±19, respectively).

Glucose variability also decreased more in the dual-hormone rapid insulin and amylin artificial pancreas group vs the rapid insulin-alone artificial pancreas group (P=.01), without increasing the risk for hypoglycemia.  Two participants in the dual-hormone rapid insulin and amylin artificial pancreas group reported a moderate nausea. 

The investigators conclude that “that a dual-hormone artificial pancreas delivering rapid insulin and amylin with fixed ratio improves glucose control and reduces glucose variability compared [with] insulin-alone, first-generation, artificial pancreas.”

According to a statement by Dr Haidar in a press release,“[we] were expecting some benefits with the insulin-plus-pramlintide artificial pancreas, yet we were impressed by both the extent of improvements and the lack of side effects, considering these benefits were achieved without increasing the risk of dangerous low glucose levels. This study shows that the first-generation, insulin-only artificial pancreas can be improved by delivering other hormones along with insulin, which will hopefully encourage the development of insulin-plus-pramlintide co-formulations.”

Please refer to reference for a complete list of authors' disclosures.

For more coverage of ADA 2018, click here. 

Reference

Haidar A, Tsoukas M, Twardy S, et al. Insulin-plus-pramlintide artificial pancreas in type 1 diabetes—randomized controlled trial. Presented at: ADA 2018 78th Scientific Sessions; June 22-26, 2018; Orlando, FL. Abstract 210-P.

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