Background: Hyperglycemia and glycemic variability has been associated with poor patient outcomes in inpatient settings, including increased morbidity and mortality, as well as prolonged hospital stays. One population in particular that struggle with glycemic control in an inpatient setting are patients with type 2 diabetes. The current standard of care (manual glucose monitoring and insulin administration) is time and labor intensive, and inadequately controls patient serum glucose levels. The purpose of this systematic review is to find if current evidence suggests utilizing closed-loop insulin delivery systems to improve glycemic control in non-critically ill, inpatient, patient with type 2 diabetes when compared to the current standard of care.
Methods: A comprehensive search of available medical literature was conducted using the search platforms MEDLINE-PubMed, Web of Science, CINAHL, and Cochrane Collective using the keyword search terms “closedloop insulin” OR “artificial pancreas” AND “inpatient” AND “type 2 diabetes”. The articles produced were reviewed for relevance and eligibility. A risk of bias assessment was performed on included studies. Results: Initial search results from the database search yielded 6 articles for review. Two of the 6 articles did not meet eligibility criteria and were eliminated. All of the remaining 4 studies strongly supported the use of closed-loop insulin devices to better manage glycemic control of T2D in inpatient settings. Due to low sample sizes and lack of diversity among researchers there was a high risk of bias, and further research is necessary to more definitively support the results.
Conclusion: While further studies are needed, the current evidence available suggests utilizing closed-loop insulin delivery systems provides greater control over patient serum glucose levels without increased risk of hypoglycemia. With this in mind, hospitals should strongly consider implementing artificial pancreases when managing blood sugar levels in patients with type 2 diabetes who require insulin. Future studies may want to include a cost-benefit analysis in order to determine if this is a feasible treatment to implement for all patients requiring glucose management.
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