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

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Bekiari, Eleni, Kitsios, Konstantinos, Thabit, Hood, Tauschmann, Martin, Athanasiadou, Eleni, Karagiannis, Thomas, Haidich, Anna-Bettina, Hovorka, Roman +1 more·2018·BMJ
DOI 10.1136/bmj.k1310PMC PMC5902803
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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.

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  • Quality of life and treatment satisfaction scores are superior with sensor-augmented pump systems compared with multiple daily injections and blood glucose monitoring.

    “Furthermore, scores for QoL and treatment satisfaction are also superior with SAP systems compared with MDI and BGM.1188–1191”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1188]

    The Methods > Patient involvement section says quality-of-life data were not extracted. Methods > Outcomes lists glycaemic measures but not treatment satisfaction, and the passages found do not compare SAP with MDI and blood glucose monitoring on either score. The claimed superiority cannot be verified from our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Authors
Bekiari, E., Kitsios, K., Thabit, H., Tauschmann, M., Athanasiadou, E., Karagiannis, T., Haidich, A.-B., Hovorka, R., & Tsapas, A.
Affiliations
  • Aristotle University of Thessaloniki (GR)
  • University of Cambridge (GB)
ORCID
Venue
BMJ
Publisher
BMJ
Published
2018-04-18
Volume
361
Pages
k1310
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.k1310
PMC
PMC5902803
OpenAlex
W2802855656
Cited by
437
References
14
Citations by year
2026: 21 · 2025: 33 · 2024: 42 · 2023: 50 · 2022: 64 · 2021: 73 · 2020: 68 · 2019: 65 · 2018: 19
FWCI
8.65
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
  • Wellcome Trust (100574/Z/12/Z, 100574/B/12/Z)
  • National Institute for Health and Care Research (100574/Z/12/Z, EME/14/23/09, 14/23/09)
  • Cambridge University Hospitals (146281)
  • Research Committee, Aristotle University of Thessaloniki
  • NIHR Cambridge Biomedical Research Centre (100574/Z/12/Z)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
artificial pancreas, type 1 diabetes, continuous glucose monitoring, insulin pump therapy, glycemic control, time in range, hypoglycemia, HbA1c, outpatients, insulin dose reduction, treatment safety, risk of bias, subgroup analysis, HbA1c variability
MeSH terms
Diabetes Mellitus, Type 1, Humans, Hyperglycemia, Hypoglycemia, Outpatients, Randomized Controlled Trials as Topic, Pancreas, Artificial, Patient Safety

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