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 sort 1 diabetes, new knowledge suggests this know-how has lots of the similar advantages in sort 2 – particularly, bettering time in vary and A1C whereas lowering 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 folks with sort 1 diabetes are slowly starting to achieve folks with sort 2.

For example, many insurance coverage corporations now cowl CGMs for folks with sort 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 permitted Stelo by Dexcom, a CGM designed particularly for folks with sort 2 diabetes who are usually not taking insulin.

Nevertheless, much less progress has been made with reimbursement by insurance coverage corporations 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 methods.

AID improves time in vary throughout completely different methods and settings

Analysis reveals that AID results in lots of the similar advantages in sort 2 diabetes as in sort 1 diabetes: improved time in vary, lowered hypoglycemia, and lowered A1C. Importantly, these advantages had been constant throughout completely different research settings and no matter which AID system was used.

A research 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 Heart in Minnesota, stated this discovering is consistent 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 lengthen to folks with sort 2 diabetes within the “actual world.”

In a research introduced at ATTD, MiniMed 780G customers had been capable of 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 folks with sort 2 diabetes,” Forlenza stated.

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

For Carlson, this discovering raises an vital 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 research investigated the Omnipod 5 AID system in 24 contributors 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. 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 drugs at USC, additionally highlighted reductions in complete day by day insulin dose amongst contributors on MDI – one more means wherein AID may simplify sort 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 know-how poses new questions for the way forward for diabetes care. That’s, how would possibly the mixture of know-how and medicines optimize outcomes for folks with sort 2 diabetes?

Within the Omnipod 5 research, half of the sufferers had 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 had been solely taking insulin. Contributors within the GLP-1 or SGLT-2 group noticed a 24% improve in time in vary from 28% at first of the research to 62% at eight weeks. In the meantime, contributors 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 may 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 cut back insulin wants. Combining these highly effective medicines with AID could assist folks with sort 2 diabetes enhance glycemic management and shed extra pounds. It’s attainable these enhancements may even assist folks work towards diabetes remission.

What about AID for older adults with sort 2 diabetes?

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

Aged folks have a better threat of extreme hypoglycemia and hypoglycemia or ketoacidosis. Diabetes administration for older adults will also be difficult by impaired cognition or dementia, lowered mobility, and issue accessing care.

On this context, the CLOSE AP+ research investigated AID assisted by nurses in folks with sort 2 diabetes unable to handle their very own a number of day by day injections (MDI) at house. CLOSE AP+ examined Management-IQ know-how in 25 contributors who had a median 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 below 10%. Total, Reznik highlighted {that a} majority of contributors reached the American Diabetes Affiliation tips for older folks with diabetes. These tips advocate:

• At the very least 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 value noting that contributors utilizing Management-IQ know-how noticed a major 1.3% discount in A1C. Over 90% of contributors 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 research.

In the end, the CLOSE AP+ research confirmed that AID can be utilized safely in folks with sort 2 diabetes who require house nursing care. This confirms the advantages of AID lengthen past the “normal” 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 protected and efficient for folks with sort 2 diabetes. Each medical trials and real-world knowledge present that this know-how 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 an excellent 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 sort 2 diabetes, practically double the enhancements sometimes seen in sort 1 diabetes.

Nevertheless, 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 may AID be utilized in all folks with sort 2, no matter their insulin wants and whether or not or not they’re assembly glycemic targets?
• Is earlier expertise with know-how crucial for profitable use of AID in folks with sort 2 diabetes?
• Does AID assist with diabetes self-management (resembling carb consciousness)?
• What function will major care suppliers present in supporting AID on this inhabitants?

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

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