Reducing the need for carbohydrate counting in type 1 diabetes using closed‐loop automated insulin delivery (artificial pancreas) and empagliflozin: A randomized, controlled, non‐inferiority, crossover pilot trial

For those with type 1 diabetes (T1D), determining doses of insulin for meals through carbohydrate (carb) counting is one of the most frustrating and challenging elements of self-management. While it is hoped that automated insulin delivery systems can eliminate this issue in the future, currently these “hybrid closed loop” systems only adjust basal insulin and do not remove the burden of carb counting. In this study, investigators examined if empagliflozin, a drug that decreases meal-induced rises in blood sugar, could help the automated insulin delivery algorithm work better with meals and therefore reduce the need for carb counting. The study overall showed that adding empagliflozin to automated-insulin-delivery substantially improves time in target range (by 14%) compared to standard open loop pump therapy without empagliflozin. Use of a simple meal announcement with automated insulin delivery and empagliflozin gave similar glucose control as full carb counting, but it was clear that no meal announcement at all even with empagliflozin resulted in worse control. These pilot study results offer the promise that empagliflozin can improve glucose control on an automated insulin delivery system, can partially relieve carb counting burden, but does not completely eliminate the need to announce meals. A larger, longer-term study is currently underway in which the participants are using the artificial pancreas system and empagliflozin over the course of months in a free-living, unsupervised setting to better understand the combined benefit.