Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD). With the increasing prevalence of diabetes, the number of people with diabetes and ESRD requiring renal replacement therapy is also increasing. A study recently published in ‘Nature Medicine’ revealed that a fully closed-loop improves glucose control and reduces hypoglycemia compared with standard insulin therapy in adult outpatients with type 2 diabetes requiring dialysis.

      The open-label, multinational, two-centre, randomized crossover trial was conducted in 26 adults with type 2 diabetes requiring dialysis (17 men, 9 women, average age 68 ± 11 years and with diabetes duration of 20 ± 10 years. The study compared the Cambridge fully closed-loop system using faster insulin aspart (‘closed-loop’) with standard insulin therapy and a masked continuous glucose monitor (‘control’) in random order. The primary endpoint was a time in target glucose range. The observations from the study showed that the proportion of time in target glucose range was 52.8 ± 12.5% with closed-loop vs. 37.7 ± 20.5% with the control. It was also noted that closed-loop also reduces the time spent in hypoglycemia compared with control. The researchers opined that the study cohort was satisfied with the closed-loop system to have their glucose levels controlled automatically and were willing to recommend the system.

      Benefits of the closed-loop system reported by study participants included a reduced need for finger-prick glucose checks, less time required to manage diabetes, resulting in more personal time and freedom, and improved peace of mind and reassurance. Device burden and discomfort wearing the insulin pump and carrying the smartphone were the most common limitations reported by participants.