Background and Aims: Pancreatic surgery challenges perioperative glucose management by abrupt changes in endogenous insulin stores, surgical stress, medication and nutritional support. We hypothesize that fully closed-loop (CL) insulin delivery, compared to usual care, may better accomodate the complex needs of this population.
Methods: In this subpopulation analysis of a randomized controlled trial (NCT04361799) we compared the CamAPS HX fully CL system using subcutaneous faster insulin aspart (CL) with standard insulin treatment (control) in patients undergoing pancreatic surgery. Glucose control was assessed using the Dexcom G6 continuous glucose monitoring (blinded in the control group) from hospital admission to discharge (max 20 days) .
Results: Twelve patients (6 per group, 58% female, mean±SD age 69±18 years, BMI 27.3±3.9 kg/m2, HbA1C 7.8±2.0 %, 66 % total pancreatectomy) were analyzed. Median [IQR] %time in target glucose range (5.6-10.0mmol/L) was 76.5 [75.3; 80.3] % with CL vs. 45.6 [24.1; 55.5] % with control (P=0.005) . Time in hypoglycemia (<3.9mM and <3.0mM) did not differ between groups (P=0.81 and P=0.46) . No study-related serious adverse events occurred in either group.
Conclusions: Perioperative fully CL in patients undergoing partial or total pancreatectomy improves glucose control compared to standard insulin therapy without a higher risk of hypoglycemia.
D.Herzig: None. R.Hovorka: Advisory Panel; Eli Lilly and Company, Other Relationship; CamDiab Ltd., Research Support; Abbott Diabetes, Dexcom, Inc., Medtronic, Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. A.Vogt: None. L.Bally: None. S.Suhner: None. L.Cecchini: None. J.L.Roos: None. D.Schürch: None. C.Nakas: None. G.Beldi: None. B.Gloor: None. M.E.Wilinska: Consultant; CamDiab Ltd.
Swiss Helmut Horten Foundation;Swiss Foundation for Anaesthesiology and Intensive Care;Product support by Dexcom Inc.;