Closed-loop technology could benefit people with type 2 diabetes

The results from a world-first trial testing closed-loop technology for the management of type 2 diabetes have been announced by scientists at the University of Cambridge.

Closed-loop systems continuously monitors blood sugars levels. An algorithm calculates the amount of insulin required to keep blood sugars in target range, and then automatically delivers this through an insulin pump. 

Most research to date has focused on the benefits of the cutting-edge technology for people with type 1 diabetes. And thanks to decades of clinical trials and a recent NHS pilot roll out of the tech, draft guidance has now been released that could see hybrid closed-loop technology recommended for thousands of people living with type 1.

Many people with type 2 diabetes also need to take insulin to manage their condition, but before technology like this can be made available to people with type 2, we need research to understand if it would be effective and safe.

Unlike the hybrid closed-loops systems that are approved for people with type 1 diabetes, researchers are testing a fully closed-loop system to help manage type 2. The differences between these systems are:

• With hybrid closed-loop systems, people with type 1 diabetes need to tell their device what they are about to eat to receive their mealtime insulin dose.
• A fully closed-loop system works to control blood sugar levels entirely automatically. This is possible for people with type 2 diabetes because they’re still producing some of their own insulin, which gives a helping hand to the insulin administered by the device.  

With our funding, our scientists previously showed that fully closed-loop technology could transform care for people with type 2 diabetes during hospital stays. Now, researchers at the University of Cambridge have studied the system for the first time in people with type 2 diabetes while they used it at home.

Closing in on closed-loop technology

The Cambridge trial involved 26 people living with type 2 diabetes who use insulin. They tested the fully closed-loop system for eight weeks and spent eight weeks on their standard treatment of multiple daily insulin injections and finger-prick tests. The researchers compared blood sugar levels between closed-loop vs standard insulin treatment.  

The results of the trial suggest that the technology is a safe and effective way to help people with type 2 diabetes manage their blood sugar levels. The research team found:

• People spent on average two-thirds (66%) of their time within the target blood sugar range when using the closed-loop technology – double that while using insulin injections (32%)
• People spent one-third (33%) of their time with high blood sugar levels (above 10mmol/L) – this was doubled to 67% when using insulin injections
• People had lower average long-term blood sugar (HbA1c) levels of 7.3% after using the closed-loop technology, compared to 8.7% after standard insulin treatment
• No one experienced dangerously low blood sugar levels during the study with either treatment.

The team also asked participants about the pros and cons of the tech and the impact it had on their daily life. These results revealed:

• Nine out of 10 of those taking part said it meant they could spend less time self-managing their diabetes
• Stopping the need for injections or finger-pricks and having greater confidence in managing blood sugar levels were highlighted as key benefits 
• Downsides included increased anxiety about the risk of hypos (low blood sugar) and annoyances about the practicality of wearing the devices.

First steps to wider access

We’ve long supported research to develop the artificial pancreas and are committed to making sure this technology can benefit as many people with diabetes as possible in the future.

It’s really encouraging to see the research evidence build, which will be required in order to offer this type of technology to some people with type 2 in the future. Before that can happen, we’ll need larger and longer-term studies to confirm the potential benefits and understand the practicalities.

Most of the people who took part in this small trial were White, and everyone lived in the same area – so the study isn’t representative of the wider population of people living with type 2 diabetes.

The group taking part also had an average HbA1c level of 9% at the start of the study, so we don’t know if the tech would be as beneficial for people with type 2 and a lower HbA1c.

It’s also possible that some the benefits seen could be down to participants having access to continuous glucose monitoring for the first time (all were testing with finger pricks previously). So there’s more we need to untangle about which type of diabetes technology could be most helpful and cost-effective for people with type 2.

The research team at the University of Cambridge team now plan to carry out follow-on bigger studies to get more answers.