Effects of the Artificial Pancreas on Glucose Control, Cardiac Arrhythmia Risk and Sleep in Older People with Type 1 Diabetes

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Research questions: This proposal will help me to answer three key research questions: In older people with type 1 diabetes, does the artificial pancreas: a) improve glucose control, b) reduce arrhythmia risk and c) improve sleep parameters when compared to usual care?Background: Type 1 diabetes (T1D) is a life-long condition, with affected individuals requiring daily insulin treatment to survive and avoid serious complications. As life expectancy of people with T1D increases, the number of older people living with the condition grows. Recommended treatment goals for specific age groups with T1D have been published, but achieving these remains challenging due to the ever-present risk of low blood glucose levels (hypoglycaemia). In addition, older people with diabetes are often disadvantaged due to unequal access to new treatments and technologies. Older people with type 1 diabetes often face unique challenges and have a higher risk of severe hypoglycaemia (extremely low blood glucose leading to loss of consciousness)due to loss of usual hypoglycaemia symptoms such as feeling hungry or anxious, which in some cases, can be fatal. Some researchers have speculated that frequent and severe hypoglycaemia can make the heart beat too fast or irregularly, which can lead to death. A number of studies have tried to prove a link between the two. However until recently, simultaneous continuous monitoring of glucose levels and heart rhythm have been rarely performed, especially in older people with T1D. Compared to younger age groups, a disproportionate number of older people suffer from severe hypoglycaemia, which is a possible mechanism of sudden or heart-related deaths in older people with T1D. Several studies have shown higher rates of sleep disturbance (poor sleep quality and shorter sleep duration) in people with T1D compared to those without T1D, which can have negative effects on glucose levels and psychosocial health. The impact of sleep disturbance in older people with T1D, specifically in relation to self-management and adherence behaviours, is unknown. Current continuous glucose monitoring and insulin pump devices do not automatically alter insulin delivery or insulin dose, and still require the person to make self-adjustments to their insulin. This may lead to potentially high or low sugar levels, and its associated risks. In contrast, the artificial pancreas automatically controls insulin delivery, which is carefully altered by computer software according to minute-to-minute changes in sugar levels detected by the continuous glucose monitoring. However, access to this technology designed to reduce the burden of diabetes remains limited in older people. Evaluation of new treatment strategies to improve health outcomes in this under-served population is needed. Research environment: In partnership with Manchester Heart Centre, University of Manchester's Centre for Biological Timing and Cambridge Artificial Pancreas Group,I will compare glucose control with the artificial pancreas against usual insulin therapy in older people (>60 years old) with T1D, and study whether low and high glucose levels in this group affect changes in heart rate, rhythm and sleep patterns. Up to 40 participants will be invited to the study. Each participant will wear an artificial pancreas device, and a portable heart and sleep monitor during the study to record and analyse their glucose, sleep and heart rhythm respectively. Expected impact and conclusions: The results will improve our understanding of the impact of the artificial pancreas in this age group, and define the links between glucose levels, cardiac arrhythmia and sleep traits. The results are expected to have major benefits for older people with T1D, their carers, healthcare providers and policy makers. This proposal will support my academic career in developing new research skills and knowledge beyond my current areas of expertise.