COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

Threshold-Suspend: The First Step in the Artificial Pancreas

Many people in the type 1 diabetes community were most excited about the threshold-suspend ASPIRE study[5] news at this year's ADA annual meeting. This is the first step on the road to an artificial pancreas, and the results, which showed that this device reduces nighttime hypoglycemia rates, has moved the conversation from whether an artificial pancreas will be possible to when it will be available.

This study used the Paradigm® Veo™ (Medtronic, Inc.; Minneapolis, Minnesota) pump that is now sold in the United States as the Medtronic MiniMed® 530G. The device uses an integrated continuous glucose monitor that interrupts the delivery of insulin for 2 hours when the patient reaches a preset hypoglycemia level and doesn't respond to alarms. A threshold-suspend group was compared with a control group who used a standard pump and continuous glucose monitor.

In the trial, the intervention group experienced a reduction of 32% in nocturnal hypoglycemia events and a 37.5% reduction in the severity and duration of those events without increasing A1c levels. The system also resulted in no severe nocturnal hypoglycemia in the threshold-suspend group compared with 4 events in the control group. This system is most useful during the night for people who don't wake up to alarms and cannot treat their low blood glucose levels.

This is a tiny but real step forward in the development of smart systems that don't require patients to be constantly making adjustments, now that the pump knows when to stop insulin delivery. Eventually, we will have smarter pumps that will predict low blood glucose levels and deal with high glucose levels as well, as the artificial pancreas progresses.

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