Closed-Loop Insulin Delivery for Perioperative Glycemic Control

What is it about?

In this study, a closed-loop subcutaneous insulin delivery system was compared to standard insulin therapy in insulin-requiring patients undergoing elective surgery. The closed-loop group showed significantly improved glycemic control without an increased risk of hypoglycemia. The trial enrolled 45 participants, with 23 in the closed-loop group and 22 in the control group. The results showed a higher proportion of time spent in the glycemic target range for the closed-loop group compared to the control group. The study was conducted at a single center, and the sample size was limited. However, the findings support the use of fully closed-loop subcutaneous insulin delivery for improving glycemic control in insulin-requiring patients undergoing elective surgery.

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Why is it important?

This research is important because it assesses the efficacy and safety of fully closed-loop subcutaneous insulin delivery in patients with diabetes undergoing elective surgery. Hyperglycemia is a common complication in the perioperative period, which can lead to various adverse outcomes. The study shows that the use of fully closed-loop insulin delivery improves glucose control without an increased risk of hypoglycemia, which is particularly important in patients undergoing surgery. Key Takeaways: 1. The study randomized 45 patients with diabetes (other than type 1) undergoing elective surgery to receive either fully closed-loop subcutaneous insulin delivery (n=23) or standard insulin therapy (n=22). 2. The primary end point was the proportion of time with sensor glucose in the target range (5.6-10.0 mmol/L). 3. The fully closed-loop group had a significantly higher proportion of time in the target range (76.7 ± 10.1%) compared to the control group (54.7 ± 20.8%) (mean difference 22.0 percentage points, P < 0.001). 4. No episodes of severe hypoglycemia (<3.0 mmol/L) or hyperglycemia with ketonemia occurred in either group. 5. The study supports the use of fully closed-loop subcutaneous insulin delivery in improving glucose control in patients with diabetes undergoing elective surgery without an increased risk of hypoglycemia.