A University of Otago-led trial has "unequivocally" shown major benefits of automated insulin delivery for young people with type 1 diabetes.
Lead of the Co-Pilot Trial, Professor Ben Wheeler, of Otago's Department of Women's and Children's Health, says the study and its findings are "extremely important" for the millions of people worldwide living with type 1 diabetes and more people need to benefit from the transformative technology.
The group has published its latest findings in NEJM Evidence. The 80 person 13-week randomised trial involved seven to 25-year-olds who were struggling to control their glucose levels.
Ben Wheeler
Participants were divided into an automated insulin delivery group and a control group (with usual care). The researchers found automated insulin delivery significantly reduced glucose levels compared to usual diabetes care, without low blood sugar or increasing other adverse events.
"As far as we are aware, these are the largest published benefits, ever, in a randomised controlled trial for glucose regulation.
"This will be life changing and we expect clinical practice to change worldwide," Professor Wheeler says.
Type 1 diabetes is an auto-immune disease that requires constant monitoring of blood glucose levels, and regular doses of insulin to keep concentrations within a healthy range and avoid health complications.
Traditional treatment involves pricking fingers multiple times per day, injecting insulin manually, and monitoring diet and exercise, to make sure blood glucose doesn't go too high or too low.
In comparison, automated insulin pumps, acting as an artificial pancreas, use a continuous glucose monitor to analyse glucose levels and a pump with a computer-controlled algorithm to administer insulin as required.
Professor Wheeler says there is strong evidence that using automation technology is the most effective way to manage type 1 diabetes for many people.
However, safety and engagement have been key barriers and concerns preventing the promotion and uptake of the technology in young people, particularly those with very unhealthy diabetes.
"Our findings show we must now challenge historical norms and policies by prioritising the initiation of automated insulin delivery among these individuals, who may not have traditionally been viewed as ideal candidates, ensuring that they can fully benefit from this transformative, burden-reducing technology.
"Those with the worst managed diabetes have the most to gain. We need to get these devices into the hands of Māori, Pacific, people of low socioeconomic status, children and youth as a priority –
this is vital worldwide, and especially important for equity," he says.
Another finding of the study was the use of automated insulin delivery leading to improvements in psychosocial outcomes including behaviours related to fear of hypoglycemia, diabetes treatment satisfaction, and perceived diabetes control.
"For people with diabetes, we believe these psychosocial benefits are as important as improved glucose outcomes. Automated insulin delivery systems have potential to alleviate diabetes burdens not only for people with type 1 diabetes faced with the daily therapy demands, but also their families."
