Efficacy and Feasibility of Fully Automated Closed Loop Insulin Pump Therapy after Islet Auto-Transplantation

Abstract

Background: TPIAT may relieve pain from chronic pancreatitis while minimizing diabetes risk. Avoiding hyperglycemia minimizes islet apoptosis during engraftment. Closed Loop therapy may improve glycemic control in this population. Methods: Analysis of 14 patients (36% male; age 35.9±11.4 years) at transition from IV to subcutaneous insulin (POD=6±1.4 days). Subjects were block randomized to CL pump (n=7) or multiple daily injections (n=7) for 72 hours. Results: Mean glucose was significantly lower in the experimental group than in the control group (111±4 v. 130±13mg/dL; p=0.003). Glycemic variability (StDev 14.1±3.3 v. 21.0±10.2mg/dL; p=0.115), hyperglycemia AUC (2025±1177 v. 7860±11444min*mg/dL; p=0.2045) and hypoglycemia AUC (146±270 v. 1615±4267min*mg/dL; p=0.3813) trended lower in the CL group than in the control group. Discussion: CL therapy was superior to conventional therapy in maintaining euglycemia without increased hypoglycemia. This technology is promising as a tool to maintain euglycemia and minimize hypoglycemia after TPIAT.