Threshold-based insulin-pump interruption for reduction of hypoglycemia
New England Journal of Medicine,  Evidence Based Medicine  Clinical Article

Bergenstal RM et al. – The threshold–suspend feature of sensor–augmented insulin pumps is designed to minimize the risk of hypoglycemia by interrupting insulin delivery at a preset sensor glucose value. Authors evaluated sensor–augmented insulin–pump therapy with and without the threshold–suspend feature in patients with nocturnal hypoglycemia. This study showed that over a 3–month period the use of sensor–augmented insulin–pump therapy with the threshold–suspend feature reduced nocturnal hypoglycemia, without increasing glycated hemoglobin values.

Methods

  • randomly assigned patients with type 1 diabetes and documented nocturnal hypoglycemia to receive sensor–augmented insulin–pump therapy with or without the threshold–suspend feature for 3 months.
  • The primary safety outcome was the change in the glycated hemoglobin level.
  • The primary efficacy outcome was the area under the curve (AUC) for nocturnal hypoglycemic events.
  • Two–hour threshold–suspend events were analyzed with respect to subsequent sensor glucose values.

Results

  • A total of 247 patients were randomly assigned to receive sensor–augmented insulin–pump therapy with the threshold–suspend feature (threshold–suspend group, 121 patients) or standard sensor–augmented insulin–pump therapy (control group, 126 patients).
  • The changes in glycated hemoglobin values were similar in the two groups.
  • The mean AUC for nocturnal hypoglycemic events was 37.5% lower in the threshold–suspend group than in the control group (980+–1200 mg per deciliter [54.4+–66.6 mmol per liter]×minutes vs. 1568+–1995 mg per deciliter [87.0+–110.7 mmol per liter]×minutes, P<0.001).
  • Nocturnal hypoglycemic events occurred 31.8% less frequently in the threshold–suspend group than in the control group (1.5+–1.0 vs. 2.2+–1.3 per patient–week, P<0.001).
  • The percentages of nocturnal sensor glucose values of less than 50 mg per deciliter (2.8 mmol per liter), 50 to less than 60 mg per deciliter (3.3 mmol per liter), and 60 to less than 70 mg per deciliter (3.9 mmol per liter) were significantly reduced in the threshold–suspend group (P<0.001 for each range).
  • After 1438 instances at night in which the pump was stopped for 2 hours, the mean sensor glucose value was 92.6+–40.7 mg per deciliter (5.1+–2.3 mmol per liter).
  • Four patients (all in the control group) had a severe hypoglycemic event; no patients had diabetic ketoacidosis.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Internal Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Internal Medicine Articles

1 Statins and physical activity in older men the osteoporotic fractures in men study JAMA Internal Medicine, June 12, 2014    Evidence Based Medicine    Clinical Article

2 Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials BMJ, June 11, 2014    Evidence Based Medicine    Clinical Article

3 CPAP, weight loss, or both for obstructive sleep apnea New England Journal of Medicine, June 13, 2014    Evidence Based Medicine    Clinical Article

4 Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: A meta-analysis JAMA, June 26, 2014    Evidence Based Medicine    Clinical Article

5 Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort Journal of Internal Medicine, April 22, 2014    Evidence Based Medicine    Clinical Article

6 Outpatient antibiotic prescribing in the United States: 2000 to 2010 Full Text BMC Medicine, June 19, 2014    Free full text    Evidence Based Medicine    Clinical Article

7 Efficacy and safety of nebivolol and valsartan as fixed-dose combination in hypertension: a randomised, multicentre study The Lancet, May 30, 2014    Evidence Based Medicine    Clinical Article

8 Enzalutamide in metastatic prostate cancer before chemotherapy New England Journal of Medicine, June 3, 2014    Evidence Based Medicine    Clinical Article

9 Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry BMJ, June 10, 2014    Evidence Based Medicine    Clinical Article

10 HIV infection: epidemiology, pathogenesis, treatment, and prevention The Lancet, June 5, 2014    Evidence Based Medicine    Clinical Article

11 Cryptogenic stroke and underlying atrial fibrillation New England Journal of Medicine, June 27, 2014    Evidence Based Medicine    Clinical Article

12 Resveratrol levels and all-cause mortality in older community-dwelling adults JAMA Internal Medicine, May 13, 2014    Evidence Based Medicine    Clinical Article

13 Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson's disease (PD MED): a large, open-label, pragmatic randomised trial The Lancet, June 18, 2014    Evidence Based Medicine    Clinical Article

14 Outpatient glycemic control with a bionic pancreas in type 1 diabetes New England Journal of Medicine, June 20, 2014    Evidence Based Medicine    Clinical Article

15 Rosuvastatin for sepsis-associated acute respiratory distress syndrome New England Journal of Medicine, May 20, 2014    Evidence Based Medicine    Clinical Article

16 Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications JAMA, June 17, 2014    Evidence Based Medicine    Clinical Article

17 5{alpha}-reductase inhibitors and risk of high-grade or lethal prostate cancer JAMA Internal Medicine, June 3, 2014    Evidence Based Medicine    Clinical Article

18 Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials BMJ, June 9, 2014    Evidence Based Medicine    Clinical Article

19 Fracture prediction after discontinuation of 4 to 5 years of alendronate therapy: The FLEX study JAMA Internal Medicine, May 7, 2014    Evidence Based Medicine    Clinical Article

20 Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia JAMA, June 4, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Internal Medicine: New England Journal of Medicine, The Lancet, Archives of Internal Medicinemore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close