Preventing Nocturnal Hypoglycemia: Single- vs Dual-Hormone Artificial Pancreas System

Single-hormone (insulin only) and dual-hormone (insulin and glucagon) artificial pancreas systems perform equally well in preventing nocturnal hypoglycemia in adults with type 1 diabetes (T1D) and hypoglycemia unawareness, according to a randomized crossover study published in Diabetes Technology & Therapeutics.

While use of a dual-hormone artificial pancreas may be necessary in some patients with T1D, the benefits of single-hormone systems include reduced cost and device complexity.

Researchers in Canada compared the efficacy of dual- and single-hormone artificial pancreas systems overnight in 18 adult participants with hypoglycemia unawareness and 17 adult participants with hypoglycemia awareness.

They hypothesized that the glucagon in dual-hormone systems would provide additional nocturnal hypoglycemia prevention in patients with hypoglycemia unawareness.

Results demonstrated that in participants with and without hypoglycemia unawareness, none of the hypoglycemic outcomes differed in the single- or dual-hormone artificial pancreas systems. However, participants with hypoglycemia unawareness experienced 2 hypoglycemic events on dual-hormone system nights and 3 events on single-hormone system nights, and participants with hypoglycemia awareness did not experience any hypoglycemic events on dual-hormone system nights and 1 event on single-hormone system nights.

While more glucagon was delivered to participants with hypoglycemia awareness compared with participants with hypoglycemia unawareness (P =.03), the percentage of time that plasma glucose was lower than 4.0 mmol/L was not different in the 2 groups in either system.

The investigators concluded that “our study suggests that single-hormone artificial pancreas systems may be sufficient for overnight control, even in a high-risk group of hypoglycemia unaware participants with documented nocturnal hypoglycemia.” However, longer studies over the course of multiple days and nights may be needed to determine possible specific benefits in patients with type 1 diabetes and hypoglycemia unawareness.

Reference

Abitbol A, Rabasa-Lhoret R, Messier V, et al. Overnight glucose control with dual- and single-hormone artificial pancreas in type 1 diabetes with hypoglycemia unawareness: a randomized controlled trial [published online February 2, 2018]. Diabetes Technol Ther. doi:10.1089/dia.2017.0353