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Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care
Open accessAbstract
BACKGROUND: In patients with diabetes, hospitalization can complicate the achievement of recommended glycemic targets. There is increasing evidence that a closed-loop delivery system (artificial pancreas) can improve glucose control in patients with type 1 diabetes. We wanted to investigate whether a closed-loop system could also improve glycemic control in patients with type 2 diabetes who were receiving noncritical care. METHODS: In this randomized, open-label trial conducted on general wards in two tertiary hospitals located in the United Kingdom and Switzerland, we assigned 136 adults with type 2 diabetes who required subcutaneous insulin therapy to receive either closed-loop insulin delivery (70 patients) or conventional subcutaneous insulin therapy, according to local clinical practice (66 patients). The primary end point was the percentage of time that the sensor glucose measurement was within the target range of 100 to 180 mg per deciliter (5.6 to 10.0 mmol per liter) for up to 15 days or until hospital discharge. RESULTS: The mean (±SD) percentage of time that the sensor glucose measurement was in the target range was 65.8±16.8% in the closed-loop group and 41.5±16.9% in the control group, a difference of 24.3±2.9 percentage points (95% confidence interval [CI], 18.6 to 30.0; P<0.001); values above the target range were found in 23.6±16.6% and 49.5±22.8% of the patients, respectively, a difference of 25.9±3.4 percentage points (95% CI, 19.2 to 32.7; P<0.001). The mean glucose level was 154 mg per deciliter (8.5 mmol per liter) in the closed-loop group and 188 mg per deciliter (10.4 mmol per liter) in the control group (P<0.001). There was no significant between-group difference in the duration of hypoglycemia (as defined by a sensor glucose measurement of <54 mg per deciliter; P=0.80) or in the amount of insulin that was delivered (median dose, 44.4 U and 40.2 U, respectively; P=0.50). No episode of severe hypoglycemia or clinically significant hyperglycemia with ketonemia occurred in either trial group. CONCLUSIONS: Among inpatients with type 2 diabetes receiving noncritical care, the use of an automated, closed-loop insulin-delivery system resulted in significantly better glycemic control than conventional subcutaneous insulin therapy, without a higher risk of hypoglycemia. (Funded by Diabetes UK and others; ClinicalTrials.gov number, NCT01774565 .).
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“In a randomized controlled trial, people with type 2 diabetes receiving noncritical care had significantly better glycemia with the use of an automated, fully closed-loop insulin delivery system than with conventional subcutaneous insulin therapy, without a higher risk of hypoglycemia (59).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [59]
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Metadata
- Authors
- Bally, L., Thabit, H., Hartnell, S., Andereggen, E., Ruan, Y., Wilinska, M. E., Evans, M. L., Wertli, M. M., Coll, A. P., Stettler, C., & Hovorka, R.
- Affiliations
- University of Bern (CH)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-08-09
- Volume
- 379
- Issue
- 6
- Pages
- 547-556
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2810166631
- Cited by
- 232
- References
- 27
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 29 · 2023: 24 · 2022: 21 · 2021: 22 · 2020: 37 · 2019: 41 · 2018: 9
- FWCI
- 21.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Apollo
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Diabetes UK (14/0004878)
- European Foundation for the Study of Diabetes
- Universität Bern
- Swiss Diabetes Foundation
- University Hospital Bern
- National Institute for Health Research Cambridge Biomedical Research Centre and Wellcome Strategic Award (100574/Z/12/Z)
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (P1BEP3_165297)
- JDRF
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- artificial pancreas, type 2 diabetes, glycemic control, subcutaneous insulin therapy, continuous glucose monitoring, hypoglycemia, hyperglycemia, hospitalization, glycemic targets, insulin dose, general ward patients
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Hospitalization, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Pancreas, Artificial, Infusions, Subcutaneous
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