Could AID Transform Type 2 Diabetes Care?

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

By April Hopcroft

Whereas AID has historically been utilized in kind 1 diabetes, new knowledge suggests this expertise has most of the similar advantages in kind 2 – particularly, 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) techniques, diabetes applied sciences that started as improvements for folks with kind 1 diabetes are slowly starting to achieve folks with kind 2.

As an illustration, many insurance coverage firms now cowl CGMs for folks with kind 2 diabetes who take insulin in addition to those that are usually 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 folks with kind 2 diabetes who are usually not taking insulin.

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

AID improves time in vary throughout totally different techniques and settings

Analysis exhibits that AID results in most of the similar advantages in kind 2 diabetes as in kind 1 diabetes: improved time in vary, decreased hypoglycemia, and decreased A1C. Importantly, these advantages had been constant throughout totally different examine settings and no matter which AID system was used.

A examine of 30 Tandem Management-IQ customers with kind 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, stated this discovering is in step with research in kind 1 diabetes in addition to the time in goal vary pointers for kind 1 diabetes.

Exterior of scientific trials, analysis means that the advantages of AID lengthen to folks with kind 2 diabetes within the “actual world.”

In a examine introduced at ATTD, MiniMed 780G customers had been in a position to obtain 71-75% time in vary exterior of a scientific 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 folks with kind 2 diabetes,” Forlenza stated.

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

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

One other examine investigated the Omnipod 5 AID system in 24 individuals with kind 2 diabetes, discovering robust 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. Contributors 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 each day insulin dose amongst individuals on MDI – one more method wherein AID might simplify kind 2 diabetes administration.

How would possibly 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 would possibly the mixture of expertise and drugs optimize outcomes for folks with kind 2 diabetes?

Within the Omnipod 5 examine, half of the sufferers had been additionally taking a GLP-1 or SGLT-2. General, Omnipod customers taking a GLP-1 or SGLT-2 noticed larger enhancements in time in vary in comparison with those that had been solely taking insulin. Contributors within the GLP-1 or SGLT-2 group noticed a 24% improve in time in vary from 28% firstly of the examine to 62% at eight weeks. In the meantime, individuals 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 stated 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 can be wanted to check this speculation.

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

What about AID for older adults with kind 2 diabetes?

Beginning insulin will be difficult for folks of all ages, however it may be particularly advanced for older adults or disabled folks with kind 2 diabetes who obtain house care.

Aged folks have the next danger of extreme hypoglycemia and hypoglycemia or ketoacidosis. Diabetes administration for older adults can be difficult by impaired cognition or dementia, decreased mobility, and problem accessing care.

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

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

• Not less than 50% time in vary (70-180 mg/dL)
• Lower than 1% time under vary (<70 mg/dL)
• Lower than 10% time above vary (>250 mg/dL)

It’s additionally price noting that individuals utilizing Management-IQ expertise noticed a big 1.3% discount in A1C. Over 90% of individuals reached an A1C of lower than 8% by the tip 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.

Finally, the CLOSE AP+ examine confirmed that AID can be utilized safely in folks with kind 2 diabetes who require house nursing care. This confirms the advantages of AID lengthen past the “commonplace” particular person with kind 2 diabetes to older adults and other people with disabilities.

The underside line

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

“I need to emphasize that throughout all kinds of actual world and scientific trial proof units, and throughout very totally different AID techniques, everyone seems to be both doing an ideal job hitting a objective for time in vary or attaining an enormous enchancment in glucose management,” Forlenza stated. He famous that AID results in time in vary will increase of 15% to 24% in folks with kind 2 diabetes, practically double the enhancements usually seen in kind 1 diabetes.

Nonetheless, a number of questions stay to be answered concerning 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 folks on MDI the one candidates for AID? Or might AID be utilized in all folks with kind 2, no matter their insulin wants and whether or not or not they’re assembly glycemic targets?
• Is earlier expertise with expertise essential for profitable use of AID in folks with kind 2 diabetes?
• Does AID assist with diabetes self-management (corresponding to carb consciousness)?
• What function will major care suppliers present in supporting AID on this inhabitants?

Past glycemic knowledge, it’s additionally essential to think about consumer expertise with AID. General, the info suggests that individuals with kind 2 diabetes had good satisfaction and confidence in utilizing these techniques. Even individuals who hadn’t beforehand used diabetes units reported a constructive expertise with AID, Peters famous.

“I actually wasn’t certain my sufferers would love AID – many had been technology-naive folks,” Peters stated. “However they cherished it they usually needed to remain on it as a result of they felt it improved their glycemic management.”