Dual Chamber AP Prevents Nighttime Lows Better

Study finds an insulin and glucagon artificial pancreas outperforms an insulin-only artificial pancreas in staving off lows.



As we come closer to having an artificial pancreas on the market, there has been a lively debate about what an artificial pancreas should be. The discussion largely centers around whether an artificial pancreas pump should be single-chamber, meaning that it delivers insulin only, or dual-chamber, meaning it would deliver insulin and glucagon. So far, artificial pancreas studies have largely focused on either single-chamber or dual-chamber systems, but there has been little research pitting these two systems head to head.

This month, researchers from Montreal Children’s Hospital released evidence that indicated that a dual-chamber system outperformed a single-chamber system in providing tight blood glucose control and preventing nighttime bouts of hypoglycemia, according to a press release. The study, which compared the results of the two types of systems alongside traditional insulin pump therapy, found that children on the dual chamber system avoided all serious bouts of nighttime hypoglycemia during the trial period. In this case, that meant children on the dual chamber system never needed to treat a nighttime low during the study.

“This is significant when considering that hypoglycaemic (sic) events occurred on 16 per cent of nights with conventional pump therapy, and 4 per cent of nights with the single-hormone artificial pancreas,” said researcher Ahmad Haidar in the press release.

The trial took place at a diabetes summer camp, where it seems almost all real-world artificial pancreas trials with children seem to take place these days. Researchers favor using these camps because they provide engaged trial participants, rough-and-tumble real world conditions, and close medical supervision.

The researchers cautioned that the study’s results are just the beginning of determining whether a dual chamber artificial pancreas is the best way to go. On the upside, they said anything that curbed the anxiety of nighttime hypoglycemia would clear a barrier toward tighter blood glucose control, and that could prevent long-term complications from Type 1 diabetes. However, the dual chamber approach requires more gear and another infusion site for the glucagon, which can be a significant surface area issue on the bodies of small children. Also, the researchers would like to see longer-term studies of glucagon use.

Still, this is a beginning step in amassing hard data to address the debate of single chamber vs. dual chamber artificial pancreas systems.

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Craig Idlebrook is chief editor for Insulin Nation and Información Sobre Diabetes, and was founding editor for Type 2 Nation. You can reach him at cidlebrook@selfrx.com.