Might AID Rework Type 2 Diabetes Care?

This content material initially appeared on diaTribe. Republished with permission.

By April Hopcroft

Whereas AID has historically been utilized in sort 1 diabetes, new knowledge suggests this expertise has most of the identical advantages in sort 2 – specifically, enhancing time in vary and A1C whereas decreasing hypoglycemia. Plus, AID dramatically simplifies blood sugar administration. 

From steady glucose monitoring (CGM) to automated insulin supply (AID) methods, diabetes applied sciences that started as improvements for individuals with sort 1 diabetes are slowly starting to achieve individuals with sort 2.

For example, many insurance coverage firms now cowl CGMs for individuals with sort 2 diabetes who take insulin in addition to those that should not on insulin however have a historical past of hypoglycemia. And earlier this week, the FDA accredited Stelo by Dexcom, a CGM designed particularly for individuals with sort 2 diabetes who should not taking insulin.

Nonetheless, much less progress has been made with reimbursement by insurance coverage firms for AID. Off-label use of AID drew vital consideration on the ATTD 2024 convention, with presenters highlighting the advantages for many individuals with diabetes throughout a spread of settings and methods.

AID improves time in vary throughout completely different methods and settings

Analysis reveals that AID results in most of the identical advantages in sort 2 diabetes as in sort 1 diabetes: improved time in vary, diminished hypoglycemia, and diminished A1C. Importantly, these advantages have been constant throughout completely different examine settings and no matter which AID system was used.

A examine of 30 Tandem Management-IQ customers with sort 2 diabetes discovered that point in vary elevated by about 15% from 56% at baseline to 71% at six weeks. This interprets to a rise of three.6 hours per day spent in vary.

Dr. Anders Carlson, diabetes medical director on the Worldwide Diabetes Middle in Minnesota, mentioned this discovering is in step with research in sort 1 diabetes in addition to the time in goal vary tips for sort 1 diabetes.

Outdoors of medical trials, analysis means that the advantages of AID prolong to individuals with sort 2 diabetes within the “actual world.”

In a examine offered at ATTD, MiniMed 780G customers have been in a position to obtain 71-75% time in vary exterior of a medical trial, once more assembly the targets for diabetes. “That is actually compelling proof that in a real-world setting, this AID system can work for individuals with sort 2 diabetes,” Forlenza mentioned.

Individuals who used the really useful MiniMed 780G settings (i.e. the bottom glucose goal) achieved a time in vary of 80%.

For Carlson, this discovering raises an necessary query – what are the optimum settings for AID in sort 2 diabetes? For example, since low blood sugar (hypoglycemia) is much less of a priority, it could be helpful to have extra aggressive targets from the get-go.

One other examine investigated the Omnipod 5 AID system in 24 members with sort 2 diabetes, discovering sturdy enhancements in time in vary with minimal hypoglycemia. Amongst these on MDI, time in vary elevated from 43% at baseline to 58% at six months. Individuals on basal insulin solely noticed even bigger enhancements in time in vary, from 31% at baseline to 65% at six months.

Dr. Anne Peters, professor of medication at USC, additionally highlighted reductions in complete day by day insulin dose amongst members on MDI – yet one more approach wherein AID might simplify sort 2 diabetes administration.

How may combining AID with GLP-1s and SGLT-2s have an effect on glucose ranges?

Rising use of GLP-1 receptor agonists, SGLT-2 inhibitors, and diabetes expertise poses new questions for the way forward for diabetes care. That’s, how may the mix of expertise and drugs optimize outcomes for individuals with sort 2 diabetes?

Within the Omnipod 5 examine, half of the sufferers have been additionally taking a GLP-1 or SGLT-2. Total, Omnipod customers taking a GLP-1 or SGLT-2 noticed larger enhancements in time in vary in comparison with those that have been solely taking insulin. Individuals within the GLP-1 or SGLT-2 group noticed a 24% improve in time in vary from 28% at the beginning of the examine to 62% at eight weeks. In the meantime, members not utilizing a GLP-1 or SGLT-2 improved their time in vary by 18%, from 35% at baseline to 53% at eight weeks.

Carlson mentioned this discovering means that combining GLP-1s or SGLT-2s with AID might probably result in even higher glycemic management than AID alone – although formal research will probably be wanted to check this speculation.

Equally, Dr. Gregory Forlenza, affiliate professor of pediatric endocrinology on the College of Colorado, famous the flexibility of GLP-1s to scale back insulin wants. Combining these highly effective drugs with AID could assist individuals with sort 2 diabetes enhance glycemic management and drop a few pounds. It’s potential these enhancements might even assist individuals work towards diabetes remission.

What about AID for older adults with sort 2 diabetes?

Beginning insulin might be difficult for individuals of all ages, however it may be particularly advanced for older adults or disabled individuals with sort 2 diabetes who obtain dwelling care.

Aged individuals have the next danger of extreme hypoglycemia and hypoglycemia or ketoacidosis. Diabetes administration for older adults can be sophisticated by impaired cognition or dementia, diminished mobility, and issue accessing care.

On this context, the CLOSE AP+ examine investigated AID assisted by nurses in individuals with sort 2 diabetes unable to handle their very own a number of day by day injections (MDI) at dwelling. CLOSE AP+ examined Management-IQ expertise in 25 members who had a mean age of 70 years.

At 12 weeks, time in vary improved considerably, from 37% to 63%. Time beneath vary was lower than 1%, whereas time above vary was underneath 10%. Total, Reznik highlighted {that a} majority of members reached the American Diabetes Affiliation tips for older individuals with diabetes. These tips advocate:

  • At the very least 50% time in vary (70-180 mg/dL)
  • Lower than 1% time beneath vary (<70 mg/dL)
  • Lower than 10% time above vary (>250 mg/dL)

It’s additionally price noting that members utilizing Management-IQ expertise noticed a big 1.3% discount in A1C. Over 90% of members reached an A1C of lower than 8% by the top of the trial, with none improve in extreme hypoglycemia. Dr. Yves Renzik, professor of endocrinology at CHU Caen Normandy in France, additionally highlighted excessive affected person confidence and excessive nurse satisfaction with the AID system on this examine.

In the end, the CLOSE AP+ examine confirmed that AID can be utilized safely in individuals with sort 2 diabetes who require dwelling nursing care. This confirms the advantages of AID prolong past the “customary” individual with sort 2 diabetes to older adults and folks with disabilities.

The underside line

Quite a few displays at ATTD 2024 demonstrated that AID is secure and efficient for individuals with sort 2 diabetes. Each medical trials and real-world knowledge present that this expertise will increase time in vary and improves A1C whereas minimizing hypoglycemia.

“I wish to emphasize that throughout all kinds of actual world and medical trial proof units, and throughout very completely different AID methods, everyone seems to be both doing a terrific job hitting a aim for time in vary or attaining an enormous enchancment in glucose management,” Forlenza mentioned. He famous that AID results in time in vary will increase of 15% to 24% in individuals with sort 2 diabetes, practically double the enhancements usually seen in sort 1 diabetes.

Nonetheless, a number of questions stay to be answered relating to optimum settings, bolusing, and the potential of AID when mixed with GLP-1s and SGLT-2s. Carlson highlighted the next areas for additional analysis:

  • Are individuals on MDI the one candidates for AID? Or might AID be utilized in all individuals with sort 2, no matter their insulin wants and whether or not or not they’re assembly glycemic objectives?
  • Is earlier expertise with expertise obligatory for profitable use of AID in individuals with sort 2 diabetes?
  • Does AID assist with diabetes self-management (corresponding to carb consciousness)?
  • What position will major care suppliers present in supporting AID on this inhabitants?

Past glycemic knowledge, it’s additionally necessary to contemplate person expertise with AID. Total, the info suggests that folks with sort 2 diabetes had good satisfaction and confidence in utilizing these methods. Even individuals who hadn’t beforehand used diabetes gadgets reported a optimistic expertise with AID, Peters famous.

“I actually wasn’t positive my sufferers would really like AID – many have been technology-naive individuals,” Peters mentioned. “However they liked it and so they wished to remain on it as a result of they felt it improved their glycemic management.”

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