Perioperative Considerations for Evolving Artificial Pancreas Devices

• Published in: Anesthesia and analgesia Vol. 128; no. 5; pp. 902 - 906
• Main Authors: Long, Micah T, Coursin, Douglas B, Rice, Mark J
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.05.2019
• Subjects: Algorithms; Anesthesia, Closed-Circuit - methods; Anesthesiology - methods; Anesthesiology - standards; Blood Glucose; Blood Glucose Self-Monitoring - methods; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - therapy; Equipment Design; Humans; Hyperglycemia; Hypoglycemia - therapy; Hypoglycemic Agents - administration & dosage; Inpatients; Insulin - administration & dosage; Insulin Infusion Systems; Monitoring, Ambulatory - methods; Outpatients; Pancreas, Artificial; Perioperative Period; Treatment Outcome
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000003779

Type 1 diabetes mellitus is a lifelong condition. It requires intensive patient involvement including frequent glucose measurements and subcutaneous insulin dosing to provide optimal glycemic control to decrease short- and long-term complications of diabetes mellitus without causing hypoglycemia. Variations in insulin pharmacokinetics and responsiveness over time in addition to illness, stress, and a myriad of other factors make ideal glucose control a challenge. Control-to-range and control-to-target artificial pancreas devices (closed-loop artificial pancreas devices [C-APDs]) consist of a continuous glucose monitor, response algorithm, and insulin delivery device that work together to automate much of the glycemic management for an individual while continually adjusting insulin dosing toward a glycemic target. In this way, a C-APD can improve glycemic control and decrease the rate of hypoglycemia. The MiniMed 670G (Medtronic, Fridley, MN) system is currently the only Food and Drug Administration–cleared C-APD in the United States. In this system, insulin delivery is continually adjusted to a glucose concentration, and the patient inputs meal-time information to modify insulin delivery as needed. Data thus far suggest improved glycemic control and decreased hypoglycemic events using the system, with decreased need for patient self-management. Thus, the anticipated use of these devices is likely to increase dramatically over time. There are limited case reports of safe intraoperative use of C-APDs, but the Food and Drug Administration has not cleared any device for such use. Nonetheless, C-APDs may offer an opportunity to improve patient safety and outcomes through enhanced intraoperative glycemic control. Anesthesiologists should become familiar with C-APD technology to help develop safe and effective protocols for their intraoperative use. We provide an overview of C-APDs and propose an introductory strategy for intraoperative study of these devices.