Our scientists at the University of Cambridge are world-leaders in the development of the artificial pancreas for Type 1 diabetes. They have now turned their attention to inpatient diabetes, specifically complex cases where people need extra support with nutrition in hospitals.
Many people in hospitals can’t get all of the nutrition they need through a regular diet, and they instead rely on a feeding tube or a drip into their blood stream. But this can make the management of blood glucose levels particularly challenging – with extra time and support from healthcare professionals needed. Also, due to efforts to avoid hypoglycaemia (low blood glucose levels that can lead to complications, coma or death), it can also lead to high blood glucose.
The research team, based across the UK and Switzerland, recruited 43 people with complex cases of diabetes – either Type 2 diabetes, or diabetes induced by pancreatic disease or steroids – staying in hospital, all needing insulin to manage their blood glucose levels alongside extra nutritional support.
Half were set up with an artificial pancreas – or closed-loop insulin delivery system – which continuously monitored blood glucose levels, calculated the amount of insulin required (through an algorithm on a device such as a tablet or mobile phone), and automatically delivered insulin through a pump.
They found that people using the artificial pancreas spent 68% of time, on average, with blood glucose levels within target range (5.6 to 10 mmol/l). People continuing with their usual care spent an average of 36% of time within target range.
Overall, the artificial pancreas led to improvements in blood glucose control without an increased risk of hypoglycaemia.
Further research is needed in larger groups of people and for longer periods of time, but this is the first time the benefits of the artificial pancreas have been demonstrated in this particular group of patients – who require significantly higher levels of support.
Dr Elizabeth Robertson, our Director of Research, said:
“Hospital stays can be a challenging and scary time for anyone, but we know that it is particularly daunting for those living with diabetes, who in fact make up one in six of all people in hospitals. We’re working hard to improve hospital conditions for people with diabetes, including through the funding of research studies like this one.
“Finding more effective ways to support healthcare professionals to care for people with diabetes in hospitals, particularly in complex cases like this, is absolutely vital.”
Dr Charlotte Boughton, lead researcher at the University of Cambridge Metabolic Research Laboratories, said:
“Our study shows that closed-loop insulin delivery is safe and more effective than standard insulin therapy in one of the most challenging inpatient cohorts. We are now planning to undertake larger inpatient studies looking at whether the improved glucose control achieved with closed-loop can translate into improved clinical outcomes, including length of stay for inpatients.”
This research was funded by Diabetes UK, the Swiss National Science Foundation, the National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Trust and the European Foundation for the Study of Diabetes.