1077-P: Treatment of Post-pancreatectomy Diabetes in Individuals with Congenital Hyperinsulinism Using a Bihormonal Bionic Pancreas
Authors: RAYANNAVAR ARPANA , MITTEER LAUREN M. , LORD KATHERINE , HAWKES COLIN PATRICK , BALLIRO COURTNEY A. , EL-KHATIB FIRAS , DAMIANO EDWARD , RUSSELL STEVEN J. , DE LEON DIVA 
Published: June 2019

Congenital Hyperinsulinism (HI) is a disorder of beta-cell function that results in severe hypoglycemia. Near-total pancreatectomy (Ppx) is necessary for intractable hypoglycemia in the most severe cases, which results in diabetes later in life. The evolution of diabetes after Ppx is characterized by marked hypo- and hyper-glycemia due to residual dysregulated insulin secretion and glucagon deficiency. We aim to evaluate the safety and efficacy of a bihormonal bionic pancreas (BHBP) in individuals with HI and post-Ppx diabetes. Autonomously adaptive dosing algorithms in the BHBP use data from an integrated continuous glucose monitor (CGM) to control subcutaneous delivery of insulin and glucagon. Our hypothesis is that the BHBP will result in improved glycemic control compared to conventional insulin pump (CIP) therapy. This is an open-label, random-order, crossover, pilot study. Subjects with HI and post-Ppx diabetes are randomly assigned to BHBP therapy or CIP therapy during a 4-day inpatient stay, followed by the opposite intervention at least 1 week later. The BHBP was initialized with only the subject’s body weight. The coprimary outcomes are mean glucose and time with CGM glucose &lt; 60 mg/dL analyzed over days 2-4. Seven subjects age 7-25 years (4 F) with mean A1C of 7.5% (SD 0.57) have completed the study to date. Mean CGM glucose was 148 mg/dL (SD 14) during the BHBP period vs. 156 mg/dL (SD 28) during the CIP period. All subjects had mean glucose during their BHBP period at or below 169 mg/dL (corresponding to A1C of 7.5%), whereas only 57% of subjects met this goal during their CIP period. Mean time with CGM glucose &lt; 60 mg/dL was 0.07% (SD 0.60%) during the BHBP period vs. 1.71% (SD 3.48) during the CIP period. The BHBP was well tolerated. Relative to CIP therapy, the BHBP was able to produce, with greater ease of use, comparable, if not superior, results in terms of mean glucose and reduced frequency of hypoglycemia in individuals with HI and post-Ppx diabetes.

Disclosure
A. Rayannavar: None. L.M. Mitteer: None. K. Lord: None. C.P. Hawkes: None. C.A. Balliro: None. F. El-Khatib: Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. E. Damiano: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; Beta Bionics. Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. Stock/Shareholder; Spouse/Partner; Beta Bionics. Other Relationship; Self; Ascensia Diabetes Care, Senseonics. S.J. Russell: Advisory Panel; Self; Companion Medical, Unomedical a/s. Consultant; Self; Flexion Therapeutics. Research Support; Self; Beta Bionics, MITRE Corporation, Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Self; ADOCIA, Ascensia Diabetes Care, Ascensia Diabetes Care, Lilly Diabetes, Roche Diabetes Care, Senseonics. D. De Leon: Consultant; Self; Crinetics, Novartis Pharmaceuticals Corporation, ProSciento, Soleno Therapeutics, Zealand Pharma A/S. Employee; Spouse/Partner; Merck & Co., Inc. Research Support; Self; Crinetics, Dexcom, Inc., Zealand Pharma A/S. Stock/Shareholder; Self; Merck & Co., Inc.

Funding
Zealand Pharma A/S; Dexcom, Inc.; University of Pennsylvania; Children's Hospital of Philadelphia Women's Committee; National Institutes of Health (T32DK06368-14 to A.R.); Pediatric Endocrine Society