Dual‐hormone artificial pancreas: benefits and limitations compared with single‐hormone systems

Abstract

Technological advances have made the artificial pancreas a reality. This has the potential to improve the lives of individuals with Type 1 diabetes by reducing the risk of hypoglycaemia, achieving better overall glucose control, and enhancing quality of life. Both single-hormone (insulin-only) and dual-hormone (insulin and glucagon) systems have been developed; however, a focused review of the relative benefits of each artificial pancreas system is needed. We reviewed studies that directly compared single- and dual-hormone systems to evaluate the efficacy of each system for preventing hypoglycaemia and maintaining glycaemic control, as well as their utility in specific situations including during exercise, overnight and during the prandial period. We observed additional benefits with the dual-hormone artificial pancreas for reducing the risk of hypoglycaemic events overall and during exercise over the study duration. The single-hormone artificial pancreas was sufficient for maintenance of euglycaemia in the overnight period and for preventing late-onset post-exercise hypoglycaemia. Future comparative studies of longer duration are required to determine whether one system is superior for improving mean glucose control, eliminating severe hypoglycaemia, or improving quality of life.

The Bio-inspired Artificial Pancreas for Type 1 Diabetes Control in the Home: System Architecture and Preliminary Results

“…There is already clinical evidence that by announcing exercise, an artificial pancreas can better cope with such perturbation by reducing the exercise-induced hypoglycaemia [21]. Another possible solution to address this challenge is the incorporation of glucagon delivery as counter regulatory action to insulin in a dual-hormone AP [22]. Although a dual-hormone AP has a potential benefit over its insulin-only counterpart, its development and commercialization has been delayed by the lack of a commercial stable glucagon solution [23].…”

Low doses of dasiglucagon consistently increase plasma glucose levels from hypoglycaemia and euglycaemia in people with type 1 diabetes mellitus

“…As currently available glucagon formulations show limited stability, daily glucagon renewal is required, making the use of DHAP systems cumbersome . Because of this practical limitation, mainly short‐term efficacy and safety have been demonstrated to date …”

“…[10][11][12] Because of this practical limitation, mainly shortterm efficacy and safety have been demonstrated to date. [13][14][15][16][17][18] Dasiglucagon is a novel, stable glucagon analogue in a ready-touse aqueous solution with in-use stability data for at least 7 days at body temperature, making it a promising candidate for long-term use in DHAP systems.…”

Closed loop systems in type 1 diabetes

“…Systems can have a pump that infuses insulin alone, or a dual pump that can also infuse glucagon, a pancreatic hormone that increases blood glucose if plasma glucose falls too low. In their recent non-systematic review, Peters and Haidar7 argue that dual systems are better than insulin pumps with the low glucose suspend facility during hypoglycaemic episodes, because glucagon restores normoglycaemia faster than stopping insulin.…”