Closed-loop insulin delivery offers glycaemic benefits during sleep, but poorer sleep quality

According to a study published in Diabetes Technology & Therapeutics, while closed-loop insulin delivery systems can increase glucose time in range and reduce hypoglycemia episodes (compared with sensor-augmented pump therapy) it can detract from sleep quality.

First-generation closed-loop systems incorporate continuous glucose monitoring that communicates with an insulin pump and glucose-responsive automated basal insulin dosing. This randomized trial reported on the glycemic impact of closed-loop therapy during sleep – as well as sleep quality – compared to sensor-augmented pump therapy among older adults with Type 1 diabetes.

The trial found that the glycemic benefits of closed-loop therapy are greatest overnight, when dietary intake and physical activity have less impact on insulin requirements. However, the technology also reduced sleep quality due to system alarms, requirements for user intervention, and device-related physical discomfort.

Accordingly, the authors are encouraging prioritizing sleep quality during the advancement of closed-loop technology, noting: “As closed-loop technologies improve in the future, with advanced glucose sensors and increasingly automated algorithms, less sleep disruption by system alarms is anticipated.”

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