Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

• Published in: Diabetes, obesity & metabolism Vol. 24; no. 10; pp. 1967 - 1975
• Main Authors: Zeng, Baoqi, Jia, Hao, Gao, Le, Yang, Qingqing, Yu, Kai, Sun, Feng
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2022; Wiley Subscription Services, Inc
• Subjects: artificial pancreas; Diabetes; Diabetes mellitus (insulin dependent); hypoglycaemia; Hypoglycemia; Insulin; insulin infusion systems; Meta-analysis; Pancreas; type 1 diabetes; meta-analysis; type 1 diabetes; artificial pancreas; insulin infusion systems; hypoglycemia
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.14781

Aim To evaluate the efficacy and safety of a dual‐hormone artificial pancreas (DH) in type 1 diabetes. Material and Methods PubMed, Embase, the Cochrane Library and ClinicalTrials.gov were searched for studies published up to February 16, 2022. We included randomized controlled trials that compared DH with single­hormone artificial pancreas (SH), continuous subcutaneous insulin infusion (CSII) or sensor‐augmented pumps (SAP), and predictive low glucose suspend systems (PLGS) in type 1 diabetes. The primary outcome was percent time in target (3.9‐10 mmol/L [70‐180 mg/dL]). Data were summarized as mean differences (MDs) or risk differences (RDs). Results A total of 17 randomized crossover trials (438 participants) were included. There were nine trials of DH versus SH, 13 trials of DH versus SAP/CSII, and two trials of DH versus PLGS. For time in target, DH showed no significant difference in time in target compared with SH (MD 2.69%, 95% confidence interval [CI] −0.38 to 5.76) but resulted in 16.05% (95% CI 12.06 to 20.05) and 6.89% (95% CI 2.63 to 11.14) more time in target range compared with SAP/CSII and PLGS, respectively. DH slightly reduced time in hypoglycaemia (MD −1.20%, 95% CI −1.85 to −0.56) but increased the risk of gastrointestinal symptoms (RD 0.18, 95% CI 0.08 to 0.27) compared with SH. Conclusions The results of this study suggest that DH has a comparable effect on time in target compared with SH, but is associated with a longer time in target range compared with SAP/CSII and PLGS. The DH slightly reduced time in hypoglycaemia but may increase the risk of gastrointestinal symptoms compared with the SH. PROSPERO registration number: CRD42022314015.