Automated glycemic control with the bionic pancreas in cystic fibrosis-related diabetes: A pilot study

Abstract

Cystic fibrosis-related diabetes (CFRD) is the most common extrapulmonary manifestation of cystic fibrosis. The current standard of care for CFRD involves treatment with insulin, typically via multiple daily injections. We conducted a small pilot study comparing usual care with automated glycemic control using the bihormonal (insulin and glucagon) and insulin-only configurations of the bionic pancreas. Both configurations of the bionic pancreas achieved good glycemic control, with mean glucose levels <150 mg/dl and minimal hypoglycemia. Subjects reported improved treatment satisfaction and reduced burden of diabetes management with the bionic pancreas. Further investigation of automated glycemic control in the treatment of CFRD is warranted.

Keywords: Automated glycemic control; Bionic pancreas; Closed loop; Continuous glucose monitor; Cystic fibrosis; Cystic fibrosis-related diabetes; Glucagon; Insulin.

Figure 1.. Distributions of Mean Glucose Levels and Hypoglycemia.

Distribution of mean CGM glucose levels and hypoglycemia in the UC, IOBP and BHBP arms. Mean CGM glucose levels for each participant in each arm (shown as circles) are connected by black lines. For each participant, the circle diameter is proportional to the percentage of CGM glucose values < 54 mg/dl. The heavy circles and heavy red line represent the group means. The horizontal red dashed line refers to the glucose level corresponding to the ADA therapy goal of 154 mg/dl (HbA1c <7%).