A new study has revealed the use of fully closed-loop subcutaneous insulin delivery in mixed elective surgery improves glucose control without a higher risk of hypoglycaemia.
Perioperative management of glucose levels is challenging so researchers wanted to explore whether fully closed-loop subcutaneous insulin delivery would improve glycaemic control compared with standard insulin therapy in insulin-requiring patients undergoing elective surgery.
In total, 44 patients undergoing a variety of individual surgeries, including abdominal, vascular, orthopaedic, neuro and thoracic surgery, were successfully enrolled in the single-centre, open-label, randomised controlled trial.
Half received fully closed-loop insulin delivery with fast-acting insulin aspart while the remaining patients were placed in a control group which received standard insulin therapy.
The study treatment was administered from hospital admission to discharge for a maximum of 20 days.
The primary end point was the proportion of time with sensor glucose in the target range (5.6–10.0 mmol/L).
The mean proportion of time that sensor glucose was in the target range was 76.7 ± 10.1% in the closed-loop group and 54.7 ± 20.8% in the control group (mean difference 22.0 percentage points [95% CI 11.9; 32.0%]; P < 0.001).
No episodes of severe hypoglycaemia (<3.0 mmol/L) or hyperglycaemia with ketonemia or any study-related adverse events occurred in either group, reported David Herzig, of Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Switzerland, and colleagues.
The group concluded: “In the context of mixed elective surgery, the use of fully closed-loop subcutaneous insulin delivery improves glucose control without a higher risk of hypoglycaemia.”
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