Utility and Safety of Backup Insulin Regimens Generated by the Bionic Pancreas: A Randomized Study

The bionic pancreas (BP) is initialized with body weight only and doses insulin autonomously without carbohydrate counting, instead using qualitative meal announcements. In case of device malfunction, the BP generates and continuously updates backup insulin doses for injection or pump users, including long-acting insulin dose, a four-period basal insulin profile, short-acting meal doses, and a glucose correction factor. Following a 13-week trial in type 1 diabetes, participants using the BP (6-83 years) completed 2-4 days, in which they were randomly assigned to their prestudy insulin regimen (N = 147) or to follow BP-provided guidance (N = 148). Glycemic outcomes with BP guidance were similar to those reinstituting their prestudy insulin regimen, with both groups having higher mean glucose and lower time-in-range than while using the BP during the 13-week trial. In conclusion, a backup insulin regimen automatically generated by the BP can be safely implemented if need arises to discontinue use of the BP. Clinical Trial Registry: clinicaltrials.gov; NCT04200313.

Automated summary

This article describes how the bionic pancreas (BP) autonomously doses insulin without carbohydrate counting, using qualitative meal announcements. In case of device malfunction, the BP generates backup insulin doses for injection or pump users, including long-acting insulin dose, a four-period basal insulin profile, short-acting meal doses, and a glucose correction factor. In a 13-week trial, participants using the BP had similar glycemic outcomes compared to those using their prestudy insulin regimen, with both groups having higher mean glucose and lower time-in-range than while using the BP. In conclusion, a backup insulin regimen automatically generated by the BP can be safely implemented if needed.