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Forlenza GP, Tabatabai I, Lewis DM. Point-Counterpoint: The Need for Do-It-Yourself (DIY) Open Source (OS) AID Systems in Type 1 Diabetes Management. Diabetes Technol Ther 2024. [PMID: 38669472 DOI: 10.1089/dia.2024.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
In the last decade, technology developed by people with diabetes and their loved ones has added to the options for diabetes management. One such example is that of automated insulin delivery (AID) algorithms, which were created and shared as open source by people living with type 1 diabetes (T1D) years before commercial systems were first available. Now, numerous options for commercial systems exist in some countries, yet tens of thousands of people with diabetes are still choosing Open-Source AID (OS-AID), previously called "do-it-yourself" (DIY) systems, which are noncommercial versions of these open-source AID systems. In this article, we provide point and counterpoint perspectives regarding (1) safety and efficacy, (2) regulation and support, (3) user choice and flexibility, (4) access and affordability, and (5) patient and provider education, for open source and commercial AID systems. The perspectives reflected here include that of a person living with T1D who uses and has developed OS-AID systems, a physician-researcher based in the United States who conducts clinical trials to support development of commercial AID systems and supports people with diabetes using all types of AID, and an endocrinologist with T1D who uses both systems and treats people with diabetes using all types of AID.
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Affiliation(s)
- Gregory P Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ideen Tabatabai
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Wang YY, Ying HM, Tian F, Qian XL, Zhou ZF, Zhou CC. Automated insulin delivery in children with type 1 diabetes during physical activity: a meta-analysis. J Pediatr Endocrinol Metab 2024; 0:jpem-2024-0098. [PMID: 38700489 DOI: 10.1515/jpem-2024-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES The aim of this study was to evaluating the performance of the automated insulin delivery (AID) in adolescents, and children with type 1 diabetes (T1D) during physical activity. METHODS Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words "Child", "Insulin Infusion Systems", and "Diabetes Mellitus" from inception to 17th March 2024 to evaluate the performance of the AID in adolescents, and children with T1D during physical activity. RESULTS Twelve studies involving 514 patients were identified. AID did not show a beneficial effect on duration of hypoglycemia<70 mg/dL during study period (p>0.05; I 2=96 %) and during the physical activity (p>0.99). Percentage of sensor glucose values in TIR was higher in AID than the non-AID pumps during study period (p<0.001; I 2=94 %). The duration of hyperglycemic time was significantly decreased in AID group compared to the non-AID pumps group during study period (p<0.05; I 2>50 %). CONCLUSIONS AID improved TIR and decreased the duration of hyperglycemic time, but did not appear to have a significant beneficial effect on the already low post-exercise duration of hypoglycemia achievable by open loop or sensor-augmented pumps in adolescents and children with T1D during physical activity; further research is needed to confirm the beneficial effect of AID on duration of hypoglycemia.
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Affiliation(s)
- Yuan-Yuan Wang
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, China
| | - Hui-Min Ying
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, China
| | - Fang Tian
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, China
| | - Xiao-Lu Qian
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China
| | - Chun-Cong Zhou
- Department of Urolithiasis and Anorectal Surgery, Ningbo No. 2 Hospital, Ningbo, Zhejiang Province, China
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Nwosu BU, Pellizzari M, Pavlovic MN, Ciron J, Talib R, Sohail R. Virtual insulin pump initiation is safe effective in children adolescents with type 1 diabetes. Front Clin Diabetes Healthc 2024; 5:1362627. [PMID: 38745900 PMCID: PMC11091709 DOI: 10.3389/fcdhc.2024.1362627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Objective There is no head-to-head comparison of the safety and efficacy of virtual versus in-office insulin pump initiation for youth with type 1 diabetes in the US. The study's aim was to determine the safety and efficacy of virtual versus in-office pump initiation in pediatric type 1 diabetes. Research design and methods A longitudinal retrospective study of 112 subjects: 65% (n=73), ages 11.2 ± 3.8 years(y), received in-office training; and 35% (n=39), ages 12.0 ± 4.0y, received virtual training. The number of White subjects was 40 (55%) in the in-office group, and 25 (66%) in the remote group; while Black subjects were 11 (15%) in the in-office group and 4 (10%) in the virtual group. Data were collected at pump initiation, 3 and 6 months. Results There were no significant differences in sex, race, height, weight, BMI, and the duration of diabetes between the groups at baseline. There was no significant difference in A1c between the groups at 0, 3, and 6 months. A1c correlated significantly with the glucose management indicator at 0, 3, and 6 months: baseline: r=0.49, p<0.0001; 3 months: r=0.77, p<0.0001; and 6 months: r=0.71, p<0.0001. There was no relationship between A1c or TIR and pubertal status, BMI, sex, or race. A1c was significantly elevated in the non-White individuals at 6 months only: 57.9 mmol/mol (50.8-69.4) versus 51.9 mmol/mol (46.5-59.6)], p=0.007. Conclusion Virtual insulin pump initiation is safe and effective in children with type 1 diabetes. This approach could accelerate the adoption of the use of diabetes technology in minority populations in the US.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States
| | - Margaret Pellizzari
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Maia N. Pavlovic
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States
| | - Jason Ciron
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Rashida Talib
- Division of Endocrinology, Department of Pediatrics, Cohen Children’s Medical Center, Hempstead, NY, United States
| | - Rubab Sohail
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, NY, United States
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Folk S, Zappe J, Wyne K, Dungan KM. Comparative Effectiveness of Hybrid Closed-Loop Automated Insulin Delivery Systems Among Patients with Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241234948. [PMID: 38557128 DOI: 10.1177/19322968241234948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical trials have demonstrated the efficacy and safety of hybrid closed-loop (HCL) systems, yet few studies have compared outcomes in the real-world setting. METHOD This retrospective study analyzed patients from an academic endocrinology practice between January 1, 2018, and November 18, 2022. The inclusion criteria were diagnosis code for type I diabetes (T1D), >18 years of age, new to any HCL system [Medtronic 670G/770G (MT), Tandem Control IQ (CIQ), or Omnipod 5 (OP5)], and availability of a pump download within three months. The outcomes included %time in range (TIR) of 70 to 180 mg/dL, %time below range (TBR) <70 mg/dL at 90 days, and HbA1c for 91 to 180 days. RESULT Of the 176 participants, 47 were MT, 74 CIQ, and 55 OP5. Median (25%, 75%) change in HbA1c was -0.1 (-0.8, 0.3), -0.6 (-1.1, -0.15), and -0.55 (-0.98, 0)% for MT, CIQ, and OP5, respectively, (P = .04). TIR was 70 (57, 76), 67 (59, 75), and 68 (60, 76)% (P = .95) at 90 days while TBR was 2 (1, 3), 1 (0, 2), and 1 (0, 1)%, respectively, (P = .002). The %time in automated delivery was associated with TIR and change in HbA1c. After controlling other factors including %time in automated delivery, HCL type was not an independent predictor of change in HbA1c nor TIR but remained a significant predictor of TBR. CONCLUSION There were significant reductions in HbA1c in CIQ and OP5. TIR was similar across pumps, but TBR was highest with MT. The %time in automated delivery likely explains differences in change in HbA1c but not TBR between HCL systems.
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Affiliation(s)
- Sara Folk
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janet Zappe
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kathleen Wyne
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kathleen M Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
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Propper-Lewinsohn T, Elran-Barak R, Gillon-Keren M, Yackobovitch-Gavan M, Liberman A, Phillip M, Shalitin S. Disordered Eating Behaviors Among Adolescents and Young Adults with Type 1 Diabetes Treated with Insulin Pumps and Hybrid Closed-Loop Systems. Diabetes Technol Ther 2024; 26:229-237. [PMID: 38090768 DOI: 10.1089/dia.2023.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Background and Aims: Disordered eating behaviors (DEB) are more common among individuals with type 1 diabetes (T1D) compared to those without, and for insulin pump users may be associated with higher hemoglobin A1c (HbA1c). We investigated DEB risk factors among insulin pump-treated individuals with T1D and clinical characteristics of hybrid closed-loop (HCL) systems' users by DEB level. Methods: An observational, cross-sectional study of 167 insulin pump-treated individuals with T1D, 13-21 years of age. Data were obtained from patients' medical charts with additional self-reported questionnaires, including assessment of DEB. Results: DEB were found in 71 (42.5%) individuals, and positively associated with female sex (β = 2.98 [standard error (SE) = 1.31], P = 0.025), body mass index (BMI)-Z-score (β = 2.12 [SE = 0.64], P = 0.001), HbA1c (β = 1.40 [SE = 0.45], P = 0.02), and higher rate of pump discontinuation (β = 4.48 [SE = 1.99], P = 0.026). The use of HCL systems compared to insulin pumps was associated with higher BMI-Z-score (odds ratio [OR]: 3.46 [95% confidence interval, CI: 1.52-7.87], P = 0.003) and tendency to lower HbA1c level (OR: 0.44 [95% CI: 0.18-1.09], P = 0.078) among individuals without DEB, and with lower HbA1c level (OR: 0.29 [95% CI: 0.10-0.83], P = 0.022) and higher socioeconomic status (OR: 1.73 [95% CI: 1.09-2.74], P = 0.020) among individuals with DEB. Conclusions: DEB are common among individuals with T1D treated with insulin pumps and are associated with higher HbA1c levels. Among T1D individuals with DEB, HCL system use is associated with lower HbA1c compared to insulin pump treatment. Our findings highlight the importance of regular screening for DEB and its risk factors to improve pump treatment and diabetes management. Moreover, individuals with DEB using HCL systems may benefit from reduced HbA1c levels.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Polsky S, Buschur E, Dungan K, Garcetti R, Nease E, Malecha E, Bartholomew A, Johnson C, Pyle L, Snell-Bergeon J. Randomized Trial of Assisted Hybrid Closed-Loop Therapy Versus Sensor-Augmented Pump Therapy in Pregnancy. Diabetes Technol Ther 2024. [PMID: 38386437 DOI: 10.1089/dia.2024.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Objective: Examine gestational safety, glycemic and health outcomes, of a hybrid closed-loop (HCL) system without pregnancy-specific glucose targets. Research Design: This was a pilot feasibility investigator-initiated, two-site, single-blind, randomized controlled trial of sensor-augmented pump therapy (SAPT) versus HCL therapy in type 1 diabetes pregnancies. Participants were enrolled in the first trimester and randomized at 14-18 weeks of gestation and used SAPT or HCL until 4-6 weeks postpartum. We compared continuous glucose monitoring (CGM) metrics, severe hypoglycemia (SH), diabetic ketoacidosis (DKA), adverse skin reactions, and pregnancy outcomes between groups. Results: Baseline characteristics were similar between groups (n = 11 HCL and n = 12 SAPT). There was no SH or DKA episode after randomization. Time spent <54 mg/dL did not differ between groups. Time spent <63 mg/dL decreased in both groups, significantly in the HCL group (3.5% [1.3% standard error] second trimester and 2.8% [1.3%] third trimester vs. 7.9% [1.3%] run-in phase, P < 0.05 for both). Mean sensor glucose was lower with SAPT compared to HCL therapy in the third trimester (119 [4] mg/dL SAPT vs. 132 [4] mg/dL HCL, P < 0.05). Third trimester time-in-range (TIR; 63-140 mg/dL) increased with SAPT (68.2% [3.1%] vs. 64.3% [3.1%] run-in phase, P < 0.05). Gestational health outcomes did not differ between groups. The HCL group used assistive techniques, such as fake carbohydrate boluses and exiting HCL overnight. Conclusions: CGM within group differences were seen for time <63 mg/dL favoring HCL therapy and TIR favoring SAPT (third trimester vs. baseline). Safety and adverse pregnancy outcomes were similar between groups.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Buschur
- Division of Diabetes, Endocrinology and Metabolism, Ohio State University, Columbus, Ohio, USA
| | - Kathleen Dungan
- Division of Diabetes, Endocrinology and Metabolism, Ohio State University, Columbus, Ohio, USA
| | - Rachel Garcetti
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily Nease
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily Malecha
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anna Bartholomew
- Division of Maternal and Fetal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Carly Johnson
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Eldib A, Dhaver S, Kibaa K, Atakov-Castillo A, Salah T, Al-Badri M, Khater A, McCarragher R, Elenani O, Toschi E, Hamdy O. Evaluation of hybrid closed-loop insulin delivery system in type 1 diabetes in real-world clinical practice: One-year observational study. World J Diabetes 2024; 15:455-462. [PMID: 38591074 PMCID: PMC10999042 DOI: 10.4239/wjd.v15.i3.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/08/2023] [Accepted: 01/15/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND In 2016, the Food and Drug Administration approved the first hybrid closed-loop (HCL) insulin delivery system for adults with type 1 diabetes (T1D). There is limited information on the impact of using HCL systems on patient-reported outcomes (PROs) in patients with T1D in real-world clinical practice. In this independent study, we evaluated glycemic parameters and PROs over one year of continuous use of Medtronic's 670G HCL in real-world clinical practice. AIM To assess the effects of hybrid closed loop system on glycemic control and quality of life in adults with T1D. METHODS We evaluated 71 patients with T1D (mean age: 45.5 ± 12.1 years; 59% females; body weight: 83.8 ± 18.7 kg, body mass index: 28.7 ± 5.6 kg/m2, A1C: 7.6% ± 0.8%) who were treated with HCL at Joslin Clinic from 2017 to 2019. We measured A1C and percent of glucose time-in-range (%TIR) at baseline and 12 months. We measured percent time in auto mode (%TiAM) for the last two weeks preceding the final visit and assessed PROs through several validated quality-of-life surveys related to general health and diabetes management. RESULTS At 12 mo, A1C decreased by 0.3% ± 0.1% (P = 0.001) and %TIR increased by 8.1% ± 2.5% (P = 0.002). The average %TiAM was only 64.3% ± 32.8% and was not associated with A1C, %TIR or PROs. PROs, provided at baseline and at the end of the study, showed that the physical functioning submodule of 36Item Short-Form Health Survey increased significantly by 22.9% (P < 0.001). Hypoglycemia fear survey/worry scale decreased significantly by 24.9% (P < 0.000); Problem Areas In Diabetes reduced significantly by -17.2% (P = 0.002). The emotional burden submodules of dietary diversity score reduced significantly by -44.7% (P = 0.001). Furthermore, analysis of Clarke questionnaire showed no increase in awareness of hypoglycemic episodes. WHO-5 showed no improvements in subject's wellbeing among participants after starting the 670G HCL system. Finally, analysis of Pittsburgh Sleep Quality Index showed no difference in sleep quality, sleep latency, or duration of sleep from baseline to 12 mo. CONCLUSION The use of HCL in real-world clinical practice for one year was associated with significant improvements in A1C, %TIR, physical functioning, hypoglycemia fear, emotional distress, and emotional burden related to diabetes management. However, these changes were not associated with time in auto mode.
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Affiliation(s)
- Ahmed Eldib
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Shilton Dhaver
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
| | - Karim Kibaa
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Astrid Atakov-Castillo
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
| | - Tareq Salah
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Marwa Al-Badri
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Abdelrahman Khater
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Ryan McCarragher
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
| | - Omnia Elenani
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
| | - Elena Toschi
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Osama Hamdy
- Department of Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
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Longendyke R, Grundman JB, Majidi S. Acute and Chronic Adverse Outcomes of Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:123-133. [PMID: 38272591 DOI: 10.1016/j.ecl.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes is associated with both acute and chronic complications. Acute complications include diabetic ketoacidosis and severe hypoglycemia. Chronic complications can be microvascular or macrovascular. Microvascular complications include retinopathy, nephropathy, and neuropathy. The pathophysiology of microvascular complications is complex. Hyperglycemia is a common underlying risk factor, underscoring the importance of optimizing glycemic management. Patients with type 1 diabetes are also at increased risk of macrovascular complications including coronary artery disease and vascular disease. The American Diabetes Association provides screening guidelines for chronic complications of diabetes. Adherence to these guidelines is an important aspect of diabetes care.
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Affiliation(s)
- Rachel Longendyke
- Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
| | - Jody B Grundman
- Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Shideh Majidi
- Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
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Forlenza GP, Dai Z, Niu F, Shin JJ. Reducing Diabetes Burden in Medtronic's Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:7-16. [PMID: 38377321 DOI: 10.1089/dia.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background: The MiniMed™ 780G advanced hybrid closed-loop system (MM780G) builds on the basal automation and low-glucose protection features of the MiniMed™ 670G and 770G systems. While previous publications have focused on glycemic control improvements with MM780G, burden reduction has not been fully described. Methods: Data from two 3-month pivotal trials for the MM670G with Guardian™ Sensor 3 (GS3) (104 adults; 125 children) and MM780G with Guardian™ 4 Sensor (G4S) (67 adults;109 children) were compared. Real-world data (RWD) from United States users (N = 3851) transitioning from MM770G+GS3 to MM780G+G4S were also analyzed. Analyses included a new metric for diabetes management burden (i.e., pentagon composite metric), glycemic outcomes and system burden (e.g., closed-loop exits and fingersticks per day). Results: Diabetes burden metric (-22.8% and -28.5%), time in range (+3.1% [*P = 0.035] and +6.4% [P < 0.001]) and time below range (-1.8% [*P < 0.001] and -0.7% [*P < 0.001]) significantly improved, compared to MM670G for adult and pediatric participants, respectively. The pediatric mean sensor glucose (SG) reduced by -8.6 mg/dL (*P < 0.001), while the adults' saw no change. Closed-loop use significantly increased for both cohorts (+17.1% [*P < 0.001] and +20.5% [*P < 0.001]). Closed-loop exits were significantly reduced to about 1 per week (-0.5 [*P < 0.001] and -0.7 [*P < 0.001]); fingerstick tests were also reduced (-6.2 [*P < 0.001] and -6.9 [*P < 0.001]). Similar outcomes were observed from U.S. RWD. Conclusions: MiniMed™ 780G with G4S use was associated with significant reduction in diabetes management burden with fewer closed-loop exits, fingersticks and other interactions, and improvements in glycemic control when compared to the MiniMed™ 670G with GS3.
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Affiliation(s)
- Gregory P Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Zheng Dai
- Medtronic Diabetes, Northridge, California, USA
| | - Fang Niu
- Medtronic Diabetes, Northridge, California, USA
| | - John J Shin
- Medtronic Diabetes, Northridge, California, USA
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Thrasher JR, Arrieta A, Niu F, Cameron KR, Cordero TL, Shin J, Rhinehart AS, Vigersky RA. Early Real-World Performance of the MiniMed™ 780G Advanced Hybrid Closed-Loop System and Recommended Settings Use in the United States. Diabetes Technol Ther 2024; 26:24-31. [PMID: 38377317 DOI: 10.1089/dia.2023.0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background: The MiniMed™ 780G system (MM780G) with Guardian™ 4 sensor includes a 100 mg/dL glucose target (GT) and automated insulin corrections up to every 5 min and was recently approved for use in the United States. In the present study, early real-world MM780G performance and the use of recommended system settings (100 mg/dL GT with an active insulin time of 2 h), by individuals with type 1 diabetes, were evaluated. Methods: CareLink™ personal data uploaded between the launch of the MM780G to August 22, 2023 were aggregated and underwent retrospective analysis (based on user consent) and if users had ≥10 days of continuous glucose monitoring (CGM) data. The 24-h day CGM metrics, including mean glucose, percentage of time spent in (%TIR), above (%TAR), and below (%TBR) target range (70-180 mg/dL), in addition to delivered insulin and closed-loop (CL) exits, were compared between an overall group (n = 7499) and individuals who used recommended settings (each, for >95% of the time). An analysis of the same metrics for MiniMed™ 770G system (MM770G) users (n = 3851) who upgraded to the MM780G was also conducted (paired t-test or Wilcoxon signed-rank test, P < 0.05 considered statistically significant). Results: For MM780G users, CGM use, and time in CL were >90% and all MM780G CGM metrics exceeded consensus-recommended goals. With recommended settings (22% of all users), mean %TIR and %TITR (70-140 mg/dL) were 81.4% and 56.4%, respectively. For individuals who upgraded from the MM770G, %TIR and %TITR increased from 73.2% to 78.3% and 45.8% to 52.6%, respectively, while %TAR reduced from 25.1% to 20.2% (P < 0.001, for all three). CL exits/week averaged <1, for all MM780G users. Conclusions: Early real-world MM780G use in the United States demonstrated a high percentage of time in range with low time above and below range. These outcomes are similar to those observed for real-world MM780G use in other countries.
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Affiliation(s)
- James R Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Fang Niu
- Medtronic Diabetes, Northridge, California, USA
| | | | | | - John Shin
- Medtronic Diabetes, Northridge, California, USA
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11
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Considine EG, Sherr JL. Real-World Evidence of Automated Insulin Delivery System Use. Diabetes Technol Ther 2024; 26:53-65. [PMID: 38377315 PMCID: PMC10890954 DOI: 10.1089/dia.2023.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: Pivotal trials of automated insulin delivery (AID) closed-loop systems have demonstrated a consistent picture of glycemic benefit, supporting approval of multiple systems by the Food and Drug Administration or Conformité Européenne mark receipt. To assess how pivotal trial findings translate to commercial AID use, a systematic review of retrospective real-world studies was conducted. Methods: PubMed and EMBASE were searched for articles published after 2018 with more than five nonpregnant individuals with type 1 diabetes (T1D). Data were screened/extracted in duplicate for sample size, AID system, glycemic outcomes, and time in automation. Results: Of 80 studies identified, 20 met inclusion criteria representing 171,209 individuals. Time in target range 70-180 mg/dL (3.9-10.0 mmol/L) was the primary outcome in 65% of studies, with the majority of reports (71%) demonstrating a >10% change with AID use. Change in hemoglobin A1c (HbA1c) was reported in nine studies (range 0.1%-0.9%), whereas four reported changes in glucose management indicator (GMI) with a 0.1%-0.4% reduction noted. A decrease in HbA1c or GMI of >0.2% was achieved in two-thirds of the studies describing change in HbA1c and 80% of articles where GMI was described. Time below range <70 mg/dL (<3.9 mmol/L) was reported in 16 studies, with all but 1 study showing stable or reduced levels. Most systems had >90% time in automation. Conclusion: With larger and more diverse populations, and follow-up periods of longer duration (∼9 months vs. 3-6 months for pivotal trials), real-world retrospective analyses confirm pivotal trial findings. Given the glycemic benefits demonstrated, AID is rapidly becoming the standard of care for all people living with T1D. Individuals should be informed of these systems and differences between them, have access to and coverage for these technologies, and receive support as they integrate this mode of insulin delivery into their lives.
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Affiliation(s)
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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12
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Garg SK, McVean JJ. Development and Future of Automated Insulin Delivery (AID) Systems. Diabetes Technol Ther 2024; 26:1-6. [PMID: 38377322 DOI: 10.1089/dia.2023.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Satish K Garg
- Department of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
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13
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Vigersky RA, Shin J. The Myth of MARD ( Mean Absolute Relative Difference): Limitations of MARD in the Clinical Assessment of Continuous Glucose Monitoring Data. Diabetes Technol Ther 2024; 26:38-44. [PMID: 38377323 DOI: 10.1089/dia.2023.0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The mean absolute relative difference (MARD) is a numerical metric that has been adopted by the diabetes technology community as the main indicator that describes the accuracy of a glucose sensor at a single point in time. The appropriateness of this adoption is questionable because there is limited evidence that MARD has meaningful clinical relevance in the current era of sensor technology. The calculation may be simple, but evaluation of MARD can be very complex because it is substantially impacted by the design of the data collection in an accuracy study. Factors that can influence the overall MARD include participant demographics such as type of diabetes and age, site of sensor wear, and the percentage of collected values in each glycemic range during the study that is, in turn, a function of the study design. MARD is only one of several important statistical metrics such as bias and precision that are relevant to assessing accuracy of a sensor. Furthermore, these analytic metrics convey little information about the safety and effectiveness of sensor use with an automated insulin delivery system or a standalone device. There are no clinical studies in people with diabetes (PWD) proving that MARD can accurately differentiate between a safe and unsafe sensor or between a more and less clinically effective sensor. Moreover, there are alternatives to MARD that can do this in a clinically meaningful way, which include error grid analyses and clinical studies in PWD. This review attempts to demythologize the status of MARD for the diabetes community in an effort to shift the focus from MARD to using clinically relevant assessments.
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Affiliation(s)
- Robert A Vigersky
- Medical Affairs, Medtronic Diabetes, Biostatistics, Northridge, California, USA
| | - John Shin
- Medical Affairs, Medtronic Diabetes, Biostatistics, Northridge, California, USA
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14
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Grosman B, Roy A, Lintereur L, Turksoy K, Benedetti A, Cordero TL, Vigersky RA, McVean J, Rhinehart AS, Cohen O. A Peek Under the Hood: Explaining the MiniMed™ 780G Algorithm with Meal Detection Technology. Diabetes Technol Ther 2024; 26:17-23. [PMID: 38377324 DOI: 10.1089/dia.2023.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The MiniMed™ 780G system (780G) received Conformité Européenne mark in June 2020 and was, recently, approved by the U.S. Food and Drug Administration (April 2023). Clinical trials and real-world analyses have demonstrated MiniMed™ 780G system safety and effectiveness and that glycemic outcomes (i.e., time in range) improve with recommended settings use. In this publication, we will explain the iterative development of the 780G algorithm and how this technology has simplified diabetes management.
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Affiliation(s)
| | - Anirban Roy
- Medtronic Diabetes, Northridge, California, USA
| | | | | | | | | | | | | | | | - Ohad Cohen
- Medtronic Diabetes, Northridge, California, USA
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15
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Schütz A, Rami-Merhar B, Schütz-Fuhrmann I, Blauensteiner N, Baumann P, Pöttler T, Mader JK. Retrospective Comparison of Commercially Available Automated Insulin Delivery With Open-Source Automated Insulin Delivery Systems in Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241230106. [PMID: 38366626 DOI: 10.1177/19322968241230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Automated insulin delivery (AID) systems have shown to improve glycemic control in a range of populations and settings. At the start of this study, only one commercial AID system had entered the Austrian market (MiniMed 670G, Medtronic). However, there is an ever-growing community of people living with type 1 diabetes (PWT1D) using open-source (OS) AID systems. MATERIALS AND METHODS A total of 144 PWT1D who used either the MiniMed 670G (670G) or OS-AID systems routinely for a period of at least three to a maximum of six months, between February 18, 2020 and January 15, 2023, were retrospectively analyzed (116 670G aged from 2.6 to 71.8 years and 28 OS-AID aged from 3.4 to 53.5 years). The goal is to evaluate and compare the quality of glycemic control of commercially available AID and OS-AID systems and to present all data by an in-depth descriptive analysis of the population. No statistical tests were performed. RESULTS The PWT1D using OS-AID systems spent more time in range (TIR)70-180 mg/dL (81.7% vs 73.9%), less time above range (TAR)181-250 mg/dL (11.1% vs 19.6%), less TAR>250 mg/dL (2.5% vs 4.3%), and more time below range (TBR)54-69 mg/dL (2.2% vs 1.7%) than PWT1D using the 670G system. The TBR<54 mg/dL was comparable in both groups (0.3% vs 0.4%). In the OS-AID group, median glucose level and glycated hemoglobin (HbA1c) were lower than in the 670G system group (130 vs 150 mg/dL; 6.2% vs 7.0%). CONCLUSION In conclusion, both groups were able to achieve satisfactory glycemic outcomes independent of age, gender, and diabetes duration. However, the PWT1D using OS-AID systems attained an even better glycemic control with no clinical safety concerns.
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Affiliation(s)
- Anna Schütz
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Schütz-Fuhrmann
- Karl Landsteiner Institute, Endocrinology and Nephrology, Vienna, Austria
- Department of Endocrinology and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Nicole Blauensteiner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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16
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Hölzen L, Schultes B, Meyhöfer SM, Meyhöfer S. Hypoglycemia Unawareness-A Review on Pathophysiology and Clinical Implications. Biomedicines 2024; 12:391. [PMID: 38397994 PMCID: PMC10887081 DOI: 10.3390/biomedicines12020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Hypoglycemia is a particular problem in people with diabetes while it can also occur in other clinical circumstances. Hypoglycemia unawareness describes a condition in which autonomic and neuroglycopenic symptoms of hypoglycemia decrease and hence are hardly perceivable. A failure to recognize hypoglycemia in time can lead to unconsciousness, seizure, and even death. The risk factors include intensive glycemic control, prior episodes of severe hypoglycemia, long duration of diabetes, alcohol consumption, exercise, renal failure, and sepsis. The pathophysiological mechanisms are manifold, but mainly concern altered brain glucose sensing, cerebral adaptations, and an impaired hormonal counterregulation with an attenuated release of glucagon, epinephrine, growth hormone, and other hormones, as well as impaired autonomous and neuroglycopenic symptoms. Physiologically, this counterregulatory response causes blood glucose levels to rise. The impaired hormonal counterregulatory response to recurrent hypoglycemia can lead to a vicious cycle of frequent and poorly recognized hypoglycemic episodes. There is a shift in glycemic threshold to trigger hormonal counterregulation, resulting in hypoglycemia-associated autonomic failure and leading to the clinical syndrome of hypoglycemia unawareness. This clinical syndrome represents a particularly great challenge in diabetes treatment and, thus, prevention of hypoglycemia is crucial in diabetes management. This mini-review provides an overview of hypoglycemia and the associated severe complication of impaired hypoglycemia awareness and its symptoms, pathophysiology, risk factors, consequences, as well as therapeutic strategies.
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Affiliation(s)
- Laura Hölzen
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany
| | - Bernd Schultes
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Metabolic Center St. Gallen, friendlyDocs Ltd., 9016 St. Gallen, Switzerland
| | - Sebastian M. Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Svenja Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
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17
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Kanbour S, Everett E. Addressing disparities in technology use among patients with type 1 diabetes: a review. Curr Opin Endocrinol Diabetes Obes 2024; 31:14-21. [PMID: 37882585 PMCID: PMC10841459 DOI: 10.1097/med.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE OF REVIEW The benefits of continuous glucose monitors (CGMs) and insulin pumps in the management of type 1 diabetes (T1D) are widely recognized. However, glaring disparities in access exist, particularly in marginalized and economically disadvantaged groups that stand to benefit significantly from diabetes technology use. We will review recent data describing drivers of these disparities and approaches to address the disparities. RECENT FINDINGS Several qualitative studies were published in recent years that have investigated the drivers of disparities reported over the past decades. These studies report that in addition to typical barriers seen in the diabetes technology, marginalized patients have unique challenges that make insulin pumps and CGMs less accessible. SUMMARY Barriers to technology use in these groups include stigmatization, lack of support, financial constraints, provider biases, stringent insurance policies, and clinic infrastructure. To address inequities, multifaceted strategies across community, healthcare, and provider sectors are essential. Key initiatives include enhancing public awareness, refining health policies, ensuring access to high-quality care, and emphasizing patient-centered approaches. The equitable use of technology can narrow the gap in T1D outcomes. The social and economic implications of suboptimal T1D management further underscore the urgency of these efforts for both improved health outcomes and cost-efficient care.
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Affiliation(s)
- Sarah Kanbour
- Division of Endocrinology, Diabetes, & Metabolism, AMAN Hospital, Doha, Qatar
| | - Estelle Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles. California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles. California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles. California, USA
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18
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Benioudakis ES, Karlafti E, Kalaitzaki A, Kalpou MA, Georgiou ED, Savopoulos C, Didangelos T. Comparison of the Sensor-Augmented Pump System with the Advanced Hybrid Closed-Loop Delivery System: Quality of Life, Diabetes Distress, and Glycaemic Outcomes in a Real-Life Context. Curr Diabetes Rev 2024; 20:e310523217505. [PMID: 37259938 DOI: 10.2174/1573399820666230531161858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1D) is a chronic disease that requires exogenous insulin administration and intensive management to prevent any complications. Recent innovations in T1D management technologies include the Advanced Hybrid Closed-Loop delivery system (AHCL). The pioneer AHCL system provides automated basal and automated bolus corrections when needed. OBJECTIVE This study aimed to compare the Advanced Hybrid Closed-Loop (AHCL) system and the Sensor-Augmented Pump (SAP) with Predictive Low Glucose Management (PLGM) system, in relation to glycaemic outcomes, general and diabetes-related Quality of Life (QoL), and diabetes distress. METHODS General and diabetes-related QoL were assessed with the Diabetes Quality of Life Brief Clinical Inventory (DQOL-BCI) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. Diabetes distress was assessed with the Diabetes Distress Scale for Type 1 diabetes (T1-DDS). RESULTS Eighty-nine T1D adults participated in the study, mostly females (65.2%), with a mean age of 39.8 (± 11.5 years). They had on average 23 years of diabetes (± 10.7) and they were on continuous subcutaneous insulin infusion therapy. Significant differences favoring the AHCL over the SAP + PLGM system were demonstrated by lower mean glucose levels, less time above range, lower scores on DQOL-BCI, T1-DDS, and higher scores on WHOQOL-BREF. Finally, the linear regression models revealed the association of time in range in most of the above aspects. CONCLUSION This study highlighted the advantages of the AHCL system over the SAP + PLGM system in the real-world setting in relation to general and diabetes-related QoL, diabetes distress, and glycaemic outcomes.
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Affiliation(s)
- Emmanouil S Benioudakis
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyroula Kalaitzaki
- Department of Social Work, Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Health Sciences Faculty, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Maria-Alexandra Kalpou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos D Georgiou
- Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | - Christos Savopoulos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Cobry EC, Pyle L, Karami AJ, Sakamoto C, Meltzer LJ, Jost E, Towers L, Paul Wadwa R. Impact of 6-months of an advanced hybrid closed-loop system on sleep and psychosocial outcomes in youth with type 1 diabetes and their parents. Diabetes Res Clin Pract 2024; 207:111087. [PMID: 38181984 PMCID: PMC10942664 DOI: 10.1016/j.diabres.2023.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Youth with type 1 diabetes (T1D) and parents experience reduced quality of life and sleep quality due to nocturnal monitoring, hypoglycemia fear, and diabetes-related disruptions. This study examined the sleep and quality of life impact of advanced technology. METHODS Thirty-nine youth with T1D, aged 2-17 years, starting an advanced hybrid closed-loop (HCL) system and a parent participated in an observational study. Surveys, actigraphy, sleep diaries, and glycemic data (youth) were captured prior to HCL, at one week, 3 months, and 6 months. Outcomes were modeled using linear mixed effects models with random intercepts to account for within-subject correlation, with least-squares means at each timepoint compared to baseline. RESULTS Parents and youth reported improvements in health-related quality of life and fear of hypoglycemia after HCL initiation. Concurrently, nocturnal glycemia improved. Actigraphy-derived sleep outcomes showed improved 6 month adolescent efficiency and 3 and 6 month parent wake after sleep onset. Additionally, parents reported improved subjective sleep quality and child sleep-related impairment at 3 months. CONCLUSIONS With nocturnal glycemic improvements in youth using HCL technology, some aspects of parent and youth sleep and quality of life improved. This may reflect decreased parental monitoring and worry and highlights benefits for youth beyond glycemia.
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Affiliation(s)
- Erin C Cobry
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA.
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA; Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Angela J Karami
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA
| | - Casey Sakamoto
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA; Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Lisa J Meltzer
- National Jewish Health, Denver, CO, USA; Nyxeos Consulting, Denver, CO, USA
| | - Emily Jost
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA
| | - Lindsey Towers
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA
| | - R Paul Wadwa
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO, USA
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Raimond LH, O'Donnell S, Bøggild-Damkvist T, Filges T, Lomborg K. Open-source automated insulin delivery systems and formal healthcare: A qualitative study of challenges in the interaction between service-users with type 1 diabetes and healthcare professionals. Chronic Illn 2023; 19:836-847. [PMID: 36437583 DOI: 10.1177/17423953221142341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the challenges that open-source automated insulin delivery systems pose to the encounter between service-users and healthcare professionals and how these challenges might be addressed in the future. METHODS Five adult service-users and six healthcare professionals participated in semi-structured interviews. A six-step thematic analysis was conducted, the focus being on challenges and needs for improvement of the interactions. RESULTS The analysis revealed three overarching challenges and wishes: (1) Lack of exchange of experiences. Service-users are reticent about disclosing their use of the systems to healthcare professionals. (2) Unclear ethical responsibility. Service-users are aware of their responsibility and guidelines can help to alleviate healthcare professional's legal responsibility; however, ambiguities around ethical responsibility for healthcare professionals remain an impediment to meaningful clinical interactions. (3) Unresolved individual and mutual expectations. Service-users expect better access to technology and focus on psychosocial aspects. In contrast, healthcare professionals fear the burden associated with the rising technical expectations. CONCLUSION Transparency and openness towards open-source systems need to be part of service-user and healthcare professionals interaction. Requirements for future care include improved knowledge about the systems, an openminded approach towards user-driven initiatives among healthcare professionals, and a focus on psychosocial aspects in the interaction.
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Affiliation(s)
- Linda H Raimond
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Type1 - Diabetes Think Tank, Copenhagen, Denmark
| | | | | | - Tine Filges
- Type1 - Diabetes Think Tank, Copenhagen, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Piccini B, Felicioni M, Pessina B, Bertini M, Casalini E, Ceccotti C, Farina S, Ferrari M, Lenzi L, Monzali F, Toni S. Glycemic Control, Basal/Bolus Distribution, BMI and Meal Management in Children and Adolescents with Type 1 Diabetes and Advanced Hybrid Closed Loop. Nutrients 2023; 15:4875. [PMID: 38068733 PMCID: PMC10707798 DOI: 10.3390/nu15234875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Evidence about the impact of advanced hybrid closed loop (AHCL) on body mass index (BMI) and eating habits in children with type 1 diabetes (T1D) is lacking. This real-world study aimed at evaluating glycemic control, BMI, meals and basal/bolus distribution in young subjects with T1D treated by AHCL. Glycemic metrics, HbA1c, basal/bolus distribution, meals/day, BMI, total daily dose (TDD), and carbohydrates/kg (CHO/kg) have been evaluated in 83 subjects, aged 13 ± 4.5 years, in manual mode, 3 and 6 months after auto-mode. Time in range (TIR) increased after 3 months, exceeding the target of 70% and was maintained at 6 months. While coefficient of variation (CV) did not change, the glucose management indicator (GMI) decreased in auto-mode (6.7 ± 0.3 vs. 7.1 ± 0.5%; p < 0.001), as well as HbA1c. Basal proportion decreased in favor of boluses (38.3 ± 7.3 vs. 43.6 ± 10.9%; p < 0.001). Meals increased at 3 and 6 months (4.4 ± 1.2 vs. 5.0 ± 1.5, p 0.002 and 5.1 ± 1.7, p < 0.001), as well as TDD/kg, without changes in BMI and CHO consumed. No differences in meal composition have arisen from food diaries. In conclusion, AHCL ensured the achievement and maintenance of target TIR in young T1D subjects. The number of meals, TDD, and insulin bolus proportion increased over time, but BMI remained stable.
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Affiliation(s)
- Barbara Piccini
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Matteo Felicioni
- Department of Pediatrics, University of Perugia, 06156 Perugia, Italy;
| | - Benedetta Pessina
- Department of Pediatrics, Meyer University Children’s Hospital IRCCS, University of Florence, 50139 Florence, Italy;
| | - Mattia Bertini
- Department of Pediatrics, Santa Maria Alle Scotte University Hospital, University of Siena, 53100 Siena, Italy; (M.B.); (C.C.)
| | - Emilio Casalini
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, 16147 Genova, Italy;
| | - Chiara Ceccotti
- Department of Pediatrics, Santa Maria Alle Scotte University Hospital, University of Siena, 53100 Siena, Italy; (M.B.); (C.C.)
| | - Silvia Farina
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Marta Ferrari
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Lorenzo Lenzi
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Francesca Monzali
- Dietology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy;
| | - Sonia Toni
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
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Prahalad P, Maahs DM. Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program. Diabetes Spectr 2023; 36:299-305. [PMID: 37982062 PMCID: PMC10654131 DOI: 10.2337/dsi23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.
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Affiliation(s)
- Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - David M. Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
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24
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Messer LH, Berget C, Centi S, Mcnair B, Forlenza GP. Evaluation of a New Clinical Tool to Enhance Clinical Care of Control-IQ Users. J Diabetes Sci Technol 2023; 17:1602-1609. [PMID: 35227129 PMCID: PMC10658699 DOI: 10.1177/19322968221081890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to develop and test a new Clinic Tool to assist health care professionals with clinical care of persons with diabetes using the Control-IQ system. METHODS A Clinic Tool was iteratively developed with input from diabetes clinicians, which outlined a systematic process for assessing data, reviewing insulin settings, providing education, and documenting the encounter. Diabetes clinicians were recruited to trial the Clinical Tool in up to five clinical encounters (in-person, telehealth, or telephone). Quantitative surveys and free-text responses, including a knowledge quiz and the System Usability Scale (SUS), were administered to determine clinician satisfaction, confidence, knowledge, and implications for practice. RESULTS Twenty-nine clinicians (43% endocrinologists, mean 10.7 years in practice) enrolled in the study and completed 89 encounters using the Control-IQ Clinic Tool. Participants spent an average of 10 minutes using the Tool and reported excellent SUS scores within the 90%-95% percentile for usability. Knowledge quiz scores increased in 42% of participants. Both familiarity with Control-IQ and confidence providing clinical care to Control-IQ users significantly improved (P = .009 and P < .001 respectively). Ninety percent of participants agreed that the Tool will change their clinical care going forward. CONCLUSION The Control-IQ Clinical Tool is highly usable and impacted clinical care delivery to Control-IQ users. Tools that serve to improve clinician confidence in delivery of care to diabetes device users should be expanded, leveraged, and studied to assess the impact on adherence and glycemic control for persons with diabetes.
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Affiliation(s)
- Laurel H. Messer
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sophia Centi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan Mcnair
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory P. Forlenza
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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25
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Pihoker C, Shulman DI, Forlenza GP, Kaiserman KB, Sherr JL, Thrasher JR, Buckingham BA, Kipnes MS, Bode BW, Carlson AL, Lee SW, Latif K, Liljenquist DR, Slover RH, Dai Z, Niu F, Shin J, Jonkers RAM, Roy A, Grosman B, Vella M, Cordero TL, McVean J, Rhinehart AS, Vigersky RA. Safety and Glycemic Outcomes During the MiniMed TM Advanced Hybrid Closed-Loop System Pivotal Trial in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:755-764. [PMID: 37782145 DOI: 10.1089/dia.2023.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: During MiniMed™ advanced hybrid closed-loop (AHCL) use by adolescents and adults in the pivotal trial, glycated hemoglobin (A1C) was significantly reduced, time spent in range (TIR) was significantly increased, and there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA). The present study investigated the same primary safety and effectiveness endpoints during AHCL use by a younger cohort with type 1 diabetes (T1D). Methods: An intention-to-treat population (N = 160, aged 7-17 years) with T1D was enrolled in a single-arm study at 13 investigational centers. There was a run-in period (∼25 days) using HCL or sensor-augmented pump with/without predictive low-glucose management, followed by a 3-month study period with AHCL activated at two glucose targets (GTs; 100 and 120 mg/dL) for ∼45 days each. The mean ± standard deviation values of A1C, TIR, mean sensor glucose (SG), coefficient of variation (CV) of SG, time at SG ranges, and insulin delivered between run-in and study were analyzed (Wilcoxon signed-rank test or t-test). Results: Compared with baseline, AHCL use was associated with reduced A1C from 7.9 ± 0.9% (N = 160) to 7.4 ± 0.7% (N = 136) (P < 0.001) and overall TIR increased from the run-in 59.4 ± 11.8% to 70.3 ± 6.5% by end of study (P < 0.001), without change in CV, time spent below range (TBR) <70 mg/dL, or TBR <54 mg/dL. Relative to longer active insulin time (AIT) settings (N = 52), an AIT of 2 h (N = 19) with the 100 mg/dL GT increased mean TIR to 73.4%, reduced TBR <70 mg/dL from 3.5% to 2.2%, and reduced time spent above range (TAR) >180 mg/dL from 28.7% to 24.4%. During AHCL use, there was no severe hypoglycemia or DKA. Conclusions: In children and adolescents with T1D, MiniMed AHCL system use was safe, A1C was lower, and TIR was increased. The lowest GT and shortest AIT were associated with the highest TIR and lowest TBR and TAR, all of which met consensus-recommended glycemic targets. ClinicalTrials.gov ID: NCT03959423.
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Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dorothy I Shulman
- University of South Florida, Pediatric Diabetes and Endocrinology, Tampa, Florida, USA
| | - Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | | | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James R Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Bruce A Buckingham
- Stanford University School of Medicine, Pediatric Diabetes and Endocrinology, Stanford, California, USA
| | - Mark S Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | - Bruce W Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Scott W Lee
- Department of Endocrinology, Loma Linda University, Loma Linda, California, USA
| | - Kashif Latif
- AM Diabetes and Endocrinology Center, Bartlett, Tennessee, USA
| | | | - Robert H Slover
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Fang Niu
- Medtronic, Northridge, California, USA
| | - John Shin
- Medtronic, Northridge, California, USA
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26
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Macon EL, Devore MH, Lin YK, Music MB, Wooten M, McMullen CA, Woodcox AM, Marksbury AR, Beckner Z, Patel BV, Schoeder LA, Iles AN, Fisher SJ. Current and future therapies to treat impaired awareness of hypoglycemia. Front Pharmacol 2023; 14:1271814. [PMID: 37942482 PMCID: PMC10628050 DOI: 10.3389/fphar.2023.1271814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.
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Affiliation(s)
- Erica L. Macon
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Micah H. Devore
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Megan B. Music
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Mason Wooten
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Colleen A. McMullen
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Andrea M. Woodcox
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Ashlee R. Marksbury
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Zachary Beckner
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Bansi V. Patel
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Lily A. Schoeder
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Ashley N. Iles
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Simon J. Fisher
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
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Papa G, Cannarella R, Condorelli RA, Finocchiaro C, Calogero AE, La Vignera S. Glycometabolic outcomes in adult type 1 diabetic patients switching to closed-loop systems. Diabetes Res Clin Pract 2023; 204:110907. [PMID: 37708979 DOI: 10.1016/j.diabres.2023.110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate glycometabolic outcomes in AID technology-naïve T1D patients after switching to Hybrid Closed Loop (HCL) and Advanced Hybrid Closed Loop (AHCL) systems. RESEARCH DESIGN AND METHODS This was a 12-month, prospective, observational, two-center study on 54 type 1 diabetes (T1D) patients aged 19-65 years managed with multiple daily injections (MDI) or Continuous Subcutaneous Insulin Infusion (CSII) in open-loop to evaluate the superiority in terms of effectiveness and safety of Automated Insulin Delivery (AID) systems. RESULTS HbA1c levels significantly improved at the end of the study. Time spent with glucose levels in target range (TIR70-180 mg/dL, 3.9-10 mmol/L) increased from 50.5 ± 15.6% at baseline to 73.6 ± 8.0% at 12 months (p < 0.001); time spent above range (TAR180-250 mg/dL, 10-13.9 mmol/L and TAR≥250 mg/dL, 13.9 mmol/L) decreased from 30.6 ± 9.0% and 14.2 ± 10.2 at baseline to 19.3 ± 5.3% and 4.8 ± 3.3% at 12 months (p < 0.001 for both), respectively; time spent below range (TBR54-69 mg/dL, 3-3.8 mmol/L and TBR<54 mg/dL, 3.0 mmol/L) decreased from 3.5 ± 2.6% and 1.2 ± 1.4% at baseline to 1.9 ± 1.5% and 0.4 ± 0.7% at the end of the study (p < 0.001 for both); coefficient of variation (CV) decreased from 35.9 ± 7.8% at baseline to 33.0 ± 5.3% (p < 0.05). Satisfaction with the new technology was scored as high. CONCLUSION AID-naïve T1D patients switching to HCL/AHCL systems have significantly and safely improved their glycometabolic outcomes with their high satisfaction with the new type of treatment.
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Affiliation(s)
- Giuseppe Papa
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Concetta Finocchiaro
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Pei Y, Ke W, Lu J, Lin Y, Zhang Z, Peng Y, Bi Y, Li Y, Hou J, Zhang X, Chen X, Treminio Y, Lee SW, Shin J, Rhinehart AS, Vigersky RA, Mu Y. Safety Event Outcomes and Glycemic Control with a Hybrid Closed-Loop System Used by Chinese Adolescents and Adults with Type 1 Diabetes Mellitus. Diabetes Technol Ther 2023; 25:718-725. [PMID: 37578804 DOI: 10.1089/dia.2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background: While evidence supports glycemic control benefits for individuals with type 1 diabetes mellitus (T1DM) using hybrid closed-loop (HCL) systems, HCL automated insulin delivery therapy in China has not been assessed. This study evaluated safety events and effectiveness during HCL system use by Chinese adolescents and adults with T1DM. Methods: Sixty-two participants (n = 12 adolescents with a mean ± standard deviation [SD] of 15.5 ± 1.1 years and n = 50 adults [mean ± SD of 37.6 ± 11.1 years]) with T1DM and baseline A1C of 7.1% ± 1.0% underwent a run-in period (∼2 weeks) using open-loop Manual Mode (sensor-augmented pump) insulin delivery with the MiniMed™ 770G system with the Guardian™ Sensor (3) glucose sensor, followed by a study period (4 weeks) with HCL Auto Mode enabled. Analyses compared continuous glucose monitoring data and insulin delivered during the run-in versus study period (Wilcoxon signed-rank test or t-test). Safety events included rates of severe hypoglycemia and diabetic ketoacidosis (DKA). Results: Compared to baseline run-in, overall Auto Mode use increased time in range (TIR, 70-180 mg/dL) from 75.3% to 80.9% (P < 0.001) and reduced time below range (TBR, <70 mg/dL) from 4.7% to 2.2% (P < 0.001). Subgroup analysis demonstrated that participants (n = 29) with baseline A1C <7.0% had TBR that reduced from 5.6% to 2.0%, while participants (n = 21) with baseline A1C ≥7.5% had time above range (TAR, >180 mg/dL) that reduced from 31.6% to 20.8%. Auto Mode use also increased the percentage achieving combined recommendations for time at sensor glucose ranges (i.e., TIR of >70%, TBR of <4% and TAR of <25%) from 24.2% at baseline to 77.4% at study end. Total daily insulin dose reduced from 42.8 ± 19.8 to 40.7 ± 18.9 U (P = 0.013). There were no severe hypoglycemic, DKA, or serious adverse events. Conclusions: Chinese adolescents and adults, some of whom met target A1C at baseline, safely achieved significantly improved glycemia with 1 month of MiniMed 770G system use when compared to open-loop insulin delivery. ClinicalTrials.gov ID: NCT04663295.
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Affiliation(s)
- Yu Pei
- Chinese PLA General Hospital, Beijing, China
| | - Weijian Ke
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Lu
- Nanjing Drum Tower Hospital, Nanjing, China
| | - Yi Lin
- Shanghai General Hospital, Shanghai, China
| | | | | | - Yan Bi
- Nanjing Drum Tower Hospital, Nanjing, China
| | - Yanbing Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | - John Shin
- Medtronic, Northridge, California, USA
| | | | | | - Yiming Mu
- Chinese PLA General Hospital, Beijing, China
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29
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Ghanim R, Kaushik A, Park J, Abramson A. Communication Protocols Integrating Wearables, Ingestibles, and Implantables for Closed-Loop Therapies. Device 2023; 1:100092. [PMID: 38465200 PMCID: PMC10923538 DOI: 10.1016/j.device.2023.100092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Body-conformal sensors and tissue interfacing robotic therapeutics enable the real-time monitoring and treatment of diabetes, wound healing, and other critical conditions. By integrating sensors and drug delivery devices, scientists and engineers have developed closed-loop drug delivery systems with on-demand therapeutic capabilities to provide just-in-time treatments that correspond to chemical, electrical, and physical signals of a target morbidity. To enable closed-loop functionality in vivo, engineers utilize various low-power means of communication that reduce the size of implants by orders of magnitude, increase device lifetime from hours to months, and ensure the secure high-speed transfer of data. In this review, we highlight how communication protocols used to integrate sensors and drug delivery devices, such as radio frequency communication (e.g., Bluetooth, near-field communication), in-body communication, and ultrasound, enable improved treatment outcomes.
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Affiliation(s)
- Ramy Ghanim
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Anika Kaushik
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Jihoon Park
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Alex Abramson
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
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30
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Cobry EC, Vigers T, Berget C, Messer LH, Wadwa RP, Pyle L, Forlenza GP. Frequency and Causes of Nocturnal Alarms in Youth and Young Adults With Type 1 Diabetes Using a First-Generation Hybrid Closed-Loop System. Diabetes Spectr 2023; 37:118-123. [PMID: 38756430 PMCID: PMC11093760 DOI: 10.2337/ds23-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background Meeting glycemic recommendations is challenging for youth with type 1 diabetes. Diabetes technology, including continuous glucose monitoring (CGM) and hybrid closed-loop (HCL) automated insulin delivery systems, significantly increase achievement of glycemic targets; however, many youth struggle to sustain use of early HCL systems. Nocturnal alarm fatigue contributes to disrupted sleep and device discontinuation. Methods We examined the frequency and causes of nocturnal (10:00 p.m. to 6:00 a.m.) alarms in pediatric patients (N = 76, median age 14.5 years [interquartile range 11.8-17.0 years, range 7-24 years]) starting on a first-generation HCL system in a prospective observational study. Device data were analyzed with linear mixed-effects models to examine change across time at 3-month intervals for 12 months. Results At baseline (HCL system in nonautomated mode), participants averaged 3.3 ± 0.6 alarms per night. In the 2 weeks after starting HCL (automated) mode, alarm frequency significantly increased to 5.4 ± 0.5 times per night (P <0.001). Alarm frequency decreased through the remainder of the observational period; however, CGM sensor and HCL system use also declined. The types of alarms were evenly distributed among sensor maintenance, sensor threshold, pump, and HCL-specific alarms. Conclusion These data show that HCL system nocturnal alarms are frequent and may be barriers to sleep quality and device use. Further research is needed to assess the impact of diabetes technology on sleep and to determine method to improve sleep quality with technology use.
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Affiliation(s)
- Erin C. Cobry
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tim Vigers
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Cari Berget
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laurel H. Messer
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - R. Paul Wadwa
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Gregory P. Forlenza
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
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Deshpande S, Doyle FJ, Dassau E. Glucose Rate-of-Change and Insulin-on-Board Jointly Weighted Zone Model Predictive Control. IEEE Trans Control Syst Technol 2023; 31:2261-2274. [PMID: 38525198 PMCID: PMC10958373 DOI: 10.1109/tcst.2023.3291573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
We present design and evaluation of closed-loop insulin delivery using zone model predictive control (MPC) featuring an adaptive weighting scheme to address prolonged hyperglycemia due to changes in insulin sensitivity, underdelivery from profile mismatch, and meal composition. In the MPC cost function, the penalty on predicted glucose deviation from the upper zone boundary is weighted by a joint function of predicted glucose rate-of-change (ROC) and insulin-on-board (IOB). The asymmetric weighting gradually increases when glucose ROC and IOB were jointly low, independent of glucose magnitude, to limit hyperglycemia while aggressively reduces for negative glucose ROC to avoid hypoglycemia. The proposed controller was evaluated using two simulation scenarios: an induced resistance scenario and a nominal scenario to highlight the performance over a reference zone MPC with glucose ROC weighting only. The continuous adaption scheme resulted in consistent improvement for the entire glucose range without incurring additional risk of hypoglycemia. For the induced resistance and no feedforward bolus scenario, the percent time in 70-180 mg/dL was higher (53.5% versus 48.9%, p<0.001) with larger improvement in the overnight percent time in tighter glucose range 70-140 mg/dL (70.9% versus 52.9%, p<0.001). The results from extensive simulations, as well as clinical validation in three different outpatient studies demonstrate the utility and safety of the proposed zone MPC.
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
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Shalit R, Minsky N, Laron-Hirsh M, Cohen O, Kurtz N, Roy A, Grosman B, Benedetti A, Tirosh A. Unannounced Meal Challenges Using an Advanced Hybrid Closed-Loop System. Diabetes Technol Ther 2023; 25:579-588. [PMID: 37335759 DOI: 10.1089/dia.2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: The advanced hybrid closed-loop (AHCL) algorithm combines automated basal rates and corrections yet requires meal announcement for optimal outcomes. We aimed to compare the performance of the MiniMed™ 780G AHCL algorithm with and without meal announcement. Methods: In a single-arm study involving 14 adults with type 1 diabetes, we evaluated the safety and efficacy of AHCL when meals were not announced. Participants stayed at a supervised environment for 5 days, during which the outcomes of not announcing meals (≤80 g of carbohydrate) were assessed. Next, participants entered a 90-day at-home "unannounced" phase, during which all meals (≤80 g of carbohydrate) were unannounced, followed by a 90-day at-home phase in which all meals were announced. Results: Time in range (TIR 70-180 mg/dL) was lower in the unannounced versus announced periods (67.5% ± 12.5% vs. 77.7% ± 9.5%; P < 0.01, respectively), with more time spent in hyperglycemia range 180-250 mg/dL (22.7% ± 7.7% vs. 15.7% ± 7.2%) and >250 mg/dL (7.9% ± 6.4% vs. 3.6% ± 2.7%), but less time in hypoglycemia range 54-70 mg/dL (1.6% ± 1% vs. 2.8% ± 1.8%) and <54 mg/dL (0.3% ± 0.4% vs. 0.7% ± 0.9%). Not announcing meals containing up to 60 g of carbohydrate did not lead to increase in postprandial extreme dysglycemia >250 mg/dL, and up to 20 g of unannounced carbohydrates did not significantly change the TIR 70-180 mg/dL compared with full announcement. Conclusion: The AHCL system is optimized for use with meal announcement. While not announcing meals of ≤80 g carbohydrates appears to be safe, it results in suboptimal postprandial glycemic control, especially with high-carbohydrate meals. Not announcing small meals (≤20 g carbohydrate) does not deteriorate glycemic control. Clinical Trial Registration number: NCT04479826.
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Affiliation(s)
- Roy Shalit
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noga Minsky
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maya Laron-Hirsh
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ohad Cohen
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Medtronic, Northridge, California, USA
| | | | | | | | | | - Amir Tirosh
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Cordero TL, Dai Z, Arrieta A, Niu F, Vella M, Shin J, Rhinehart AS, McVean J, Lee SW, Slover RH, Forlenza GP, Shulman DI, Pop-Busui R, Thrasher JR, Kipnes MS, Christiansen MP, Buckingham BA, Pihoker C, Sherr JL, Kaiserman KB, Vigersky RA. Glycemic Outcomes During Early Use of the MiniMed™ 780G Advanced Hybrid Closed-Loop System with Guardian™ 4 Sensor. Diabetes Technol Ther 2023; 25:652-658. [PMID: 37252734 PMCID: PMC10460682 DOI: 10.1089/dia.2023.0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Safety and significant improvement in overall glycated hemoglobin (A1C) and percentage of time spent in (TIR), below (TBR), and above (TAR) glucose range were demonstrated in the pivotal trial of adolescents and adults using the MiniMed™ advanced hybrid closed-loop (AHCL) system with the adjunctive, calibration-required Guardian™ Sensor 3. The present study evaluated early outcomes of continued access study (CAS) participants who transitioned from the pivotal trial investigational system to the approved MiniMed™ 780G system with the non-adjunctive, calibration-free Guardian™ 4 Sensor (MM780G+G4S). Study data were presented alongside those of real-world MM780G+G4S users from Europe, the Middle East, and Africa. Methods: The CAS participants (N = 109, aged 7-17 years and N = 67, aged >17 years) used the MM780G+G4S for 3 months and data of real-world MM780G+G4S system users (N = 10,204 aged ≤15 years and N = 26,099 aged >15 years) were uploaded from September 22, 2021 to December 02, 2022. At least 10 days of real-world continuous glucose monitoring (CGM) data were required for analyses. Glycemic metrics, delivered insulin and system use/interactions underwent descriptive analyses. Results: Time in AHCL and CGM use were >90% for all groups. AHCL exits averaged 0.1/day and there were few blood glucose measurements (BGMs) (0.8/day-1.0/day). Adults in both cohorts met most consensus recommendations for glycemic targets. Pediatric groups met recommendations for %TIR and %TBR, although not those for mean glucose variability and %TAR, possibly due to low use of recommended glucose target (100 mg/dL) and active insulin time (2 h) settings (28.4% in the CAS cohort and 9.4% in the real-world cohort). The CAS pediatric and adult A1C were 7.2% ± 0.7% and 6.8% ± 0.7%, respectively, and there were no serious adverse events. Conclusions: Early clinical use of the MM780G+G4S was safe and involved minimal BGMs and AHCL exits. Consistent with real-world pediatric and adult use, outcomes were associated with achievement of recommended glycemic targets. Clinical Trial Registration number: NCT03959423.
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Affiliation(s)
| | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Fang Niu
- Medtronic, Northridge, California, USA
| | | | - John Shin
- Medtronic, Northridge, California, USA
| | | | | | - Scott W. Lee
- Department of Endocrinology, Loma Linda University, Loma Linda, California, USA
| | - Robert H. Slover
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Gregory P. Forlenza
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Dorothy I. Shulman
- University of South Florida Diabetes and Endocrinology, Department of Pediatrics, Tampa, Florida, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - James R. Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Mark S. Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | | | - Bruce A. Buckingham
- Stanford University School of Medicine, Department of Pediatric Endocrinology, Stanford, California, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Levy CJ, Raghinaru D, Kudva YC, Pandit K, Blevins T, Casaubon L, Desjardins D, Levister CM, O’Malley G, Reid C, Lum J, Kollman C, Beck RW. Beneficial Effects of Control-IQ Automated Insulin Delivery in Basal-Bolus and Basal-Only Insulin Users With Type 2 Diabetes. Clin Diabetes 2023; 42:116-124. [PMID: 38230336 PMCID: PMC10788662 DOI: 10.2337/cd23-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The t:slim X2 insulin pump with Control-IQ technology (Control-IQ) advanced hybrid closed-loop automated insulin delivery system was evaluated in this prospective single-arm trial. Thirty adults with type 2 diabetes using the Control-IQ system showed substantial glycemic improvement with no increase in hypoglycemia. Mean time in range (70-180 mg/dL) improved 15%, representing an increase of 3.6 hours/day, and mean glucose decreased by 22 mg/dL.
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Affiliation(s)
- Carol J. Levy
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Keta Pandit
- Texas Diabetes and Endocrinology, Austin, TX
| | | | | | - Donna Desjardins
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Camilla M. Levister
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grenye O’Malley
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Corey Reid
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John Lum
- Jaeb Center for Health Research, Tampa, FL
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O'Meara M, Mateus Acuña JC, Uribe A. Long-Term Benefits of an Integrated Continuous Glucose Monitoring and Insulin Pump System for Emergency Admissions, Hospitalization, and Metabolic Control in a Cohort of People With Diabetes: Retrospective Cohort Study. JMIR Diabetes 2023; 8:e46880. [PMID: 37610810 PMCID: PMC10483304 DOI: 10.2196/46880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND There is evidence in the literature that the use of sensor-augmented insulin pumps in patients with high-complexity diabetes improves metabolic control. However, there is no long-term information on clinical outcomes such as hospitalization or admission to the emergency room. This study describes outcomes for metabolic control, incidence of hospitalizations, and emergency room visits in a specific population using this technology. OBJECTIVE We aimed to assess long-term glycemic and clinical outcomes after the use of continuous subcutaneous insulin infusion and continuous glucose monitoring in people with diabetes. METHODS A retrospective cohort study was carried out in patients with diabetes previously treated with an intensive insulin regimen at a specialized diabetes treatment center who required a sensor-augmented insulin pump due to nonoptimal glycemic control. Glycated hemoglobin, severe hypoglycemic episodes, nonsevere hypoglycemic episodes, perception of hypoglycemia, and the incidence of emergency room visits and hospitalizations before and after treatment were evaluated. RESULTS Between January 2013 and August 2020, 74 patients with a median age of 36 (IQR 27-46) years were included in the study with a median 4 (IQR 2-7) years of follow-up. We found a statistically significant reduction in glycated hemoglobin (8.35% vs 7%; P<.001), nonsevere hypoglycemic episodes (71/74, 96% vs 62/74, 84%; P=.01), emergency room visits (42/73, 58% vs 4/62, 6%; P<.001), and hospitalizations (36/72, 50% vs 10/72, 14%; P<.001) after use of continuous subcutaneous insulin infusion. CONCLUSIONS The use of a sensor-augmented insulin pump associated with a strict follow-up program for patients with high-complexity diabetes led to a significant and sustained reduction in glycated hemoglobin and hypoglycemic episodes, as well as in the rate of emergency room visits and hospitalizations. These results encourage the adoption of this technology in patients who do not achieve metabolic control with optimal management of diabetes.
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Affiliation(s)
- Miguel O'Meara
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Camilo Mateus Acuña
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
- Clínica Los Cobos Medical Center, Universidad del Bosque, Bogotá, Colombia
| | - Andrea Uribe
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
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Lei M, Lin B, Ling P, Liu Z, Yang D, Deng H, Yang X, Lv J, Xu W, Yan J. Efficacy and safety of Android artificial pancreas system use at home among adults with type 1 diabetes mellitus in China: protocol of a 26-week, free-living, randomised, open-label, two-arm, two-phase, crossover trial. BMJ Open 2023; 13:e073263. [PMID: 37558445 PMCID: PMC10414065 DOI: 10.1136/bmjopen-2023-073263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Do-it-yourself artificial pancreas system (DIY APS) is built using commercially available insulin pump, continuous glucose monitoring (CGM) and an open-source algorithm. Compared with commercial products, DIY systems are affordable, allow personalised settings and provide updated algorithms, making them a more promising therapy for most patients with type 1 diabetes mellitus (T1DM). Many small and self-reported observational studies have found that their real-world use was associated with potential metabolic and psychological benefits. However, rigorous-designed studies are urgently needed to confirm its efficacy and safety. METHODS AND ANALYSIS In this 26-week randomised, open-label, two-arm, two-phase, crossover trial, participants aged 18-75 years, with T1DM and glycated haemoglobin (HbA1c) 7-11%, will use AndroidAPS during one 12-week period and sensor-augmented pump during another 12-week period. This study will recruit at least 24 randomised participants. AndroidAPS consists of three components: (1) real-time CGM; (2) insulin pump; (3) AndroidAPS algorithm implemented in Android smartphone. The primary endpoint is time in range (3.9-10.0 mmol/L) derived from CGM. The main secondary endpoints include percentage of sensor glucose values below, within and above target range; mean sensor glucose value; measures of glycaemic variability and centralised HbA1c. Safety endpoints mainly include the frequency of hypoglycaemia events, diabetic ketoacidosis and other serious adverse events. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University. There will be verbal and written information regarding the trial given to each participant. The study will be disseminated through peer-reviewed publications and conference presentations. OVERALL STATUS Recruiting. STUDY START 11 February 2023. PRIMARY COMPLETION 31 July 2024. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05726461).
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Affiliation(s)
- Mengyun Lei
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Beisi Lin
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Ling
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhigu Liu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xubin Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Lv
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Conway RB, Gerard Gonzalez A, Shah VN, Geno Rasmussen C, Akturk HK, Pyle L, Forlenza G, Alonso GT, Snell-Bergeon J. Racial Disparities in Diabetes Technology Adoption and Their Association with HbA1c and Diabetic Ketoacidosis. Diabetes Metab Syndr Obes 2023; 16:2295-2310. [PMID: 37551339 PMCID: PMC10404403 DOI: 10.2147/dmso.s416192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
Aim Poorer glycemic control and higher diabetic ketoacidosis (DKA) rates are seen in racial/ethnic minorities with type 1 diabetes (T1D). Use of diabetes technologies such as continuous glucose monitors (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems has been shown to improve glycemic control and reduce DKA risk. We examined race/ethnicity differences in diabetes technology use and their relationship with HbA1c and DKA. Methods Data from patients aged ≥12 years with T1D for ≥1 year, receiving care from a single diabetes center, were examined. Patients were classified as Non-Hispanic White (n=3945), Non-Hispanic Black (Black, n=161), Hispanic (n=719), and Multiracial/Other (n=714). General linear models and logistic regression were used. Results Black (OR=0.22, 0.15-0.32) and Hispanic (OR=0.37, 0.30-0.45) patients were less likely to use diabetes technology. This disparity was greater in the pediatric population (p-interaction=0.06). Technology use associated with lower HbA1c in each race/ethnic group. Among technology users, AID use associated with lower HbA1c compared to CGM and/or CSII (HbA1c of 8.4% vs 9.2%, respectively), with the greatest difference observed for Black adult AID users. CSII use associated with a lower odds of DKA in the past year (OR=0.73, 0.54-0.99), a relationship that did not vary by race (p-interaction =0.69); this inverse association with DKA was not observed for CGM or AID. Conclusion Disparities in diabetes technology use, DKA, and glycemic control were apparent among Black and Hispanic patients with T1D. Differences in technology use ameliorated but did not fully account for disparities in HbA1c or DKA.
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Affiliation(s)
- Rebecca Baqiyyah Conway
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Viral N Shah
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Halis Kaan Akturk
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Pyle
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Forlenza
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Guy Todd Alonso
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Janet Snell-Bergeon
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Huang ES, Sinclair A, Conlin PR, Cukierman-Yaffe T, Hirsch IB, Huisingh-Scheetz M, Kahkoska AR, Laffel L, Lee AK, Lee S, Lipska K, Meneilly G, Pandya N, Peek ME, Peters A, Pratley RE, Sherifali D, Toschi E, Umpierrez G, Weinstock RS, Munshi M. The Growing Role of Technology in the Care of Older Adults With Diabetes. Diabetes Care 2023; 46:1455-1463. [PMID: 37471606 PMCID: PMC10369127 DOI: 10.2337/dci23-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 07/22/2023]
Abstract
The integration of technologies such as continuous glucose monitors, insulin pumps, and smart pens into diabetes management has the potential to support the transformation of health care services that provide a higher quality of diabetes care, lower costs and administrative burdens, and greater empowerment for people with diabetes and their caregivers. Among people with diabetes, older adults are a distinct subpopulation in terms of their clinical heterogeneity, care priorities, and technology integration. The scientific evidence and clinical experience with these technologies among older adults are growing but are still modest. In this review, we describe the current knowledge regarding the impact of technology in older adults with diabetes, identify major barriers to the use of existing and emerging technologies, describe areas of care that could be optimized by technology, and identify areas for future research to fulfill the potential promise of evidence-based technology integrated into care for this important population.
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Affiliation(s)
| | | | - Paul R. Conlin
- Harvard Medical School, Boston, MA
- Veteran Affairs Boston Healthcare System, Boston, MA
| | - Tali Cukierman-Yaffe
- Division of Endocrinology, Diabetes, and Metabolism, Ramat Gan, Israel
- Sheba Medical Centre, Ramat Gan, Israel
- Epidemiology Department, Sackler Faculty of Medicine, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - Sei Lee
- University of California San Francisco, San Francisco, CA
| | | | - Graydon Meneilly
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Naushira Pandya
- Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL
| | | | - Anne Peters
- University of Southern California, Los Angeles, CA
| | - Richard E. Pratley
- AdventHealth Diabetes Institute, AdventHealth Translational Research Institute, AdventHealth, Orlando, FL
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Lakshman R, Boughton C, Hovorka R. The changing landscape of automated insulin delivery in the management of type 1 diabetes. Endocr Connect 2023; 12:e230132. [PMID: 37289734 PMCID: PMC10448576 DOI: 10.1530/ec-23-0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 06/10/2023]
Abstract
Automated insulin delivery systems, also known as closed-loop or 'artificial pancreas' systems, are transforming the management of type 1 diabetes. These systems consist of an algorithm which responds to real-time glucose sensor levels by automatically modulating insulin delivery through an insulin pump. We review the rapidly changing landscape of automated insulin-delivery systems over recent decades, from initial prototypes to the different hybrid closed-loop systems commercially available today. We discuss the growing body of clinical trials and real-world evidence demonstrating their glycaemic and psychosocial benefits. We also address future directions in automated insulin delivery such as dual-hormone systems and adjunct therapy as well as the challenges around ensuring equitable access to closed-loop technology.
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Affiliation(s)
- Rama Lakshman
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Boughton
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
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Salinari A, Machì M, Armas Diaz Y, Cianciosi D, Qi Z, Yang B, Ferreiro Cotorruelo MS, Villar SG, Dzul Lopez LA, Battino M, Giampieri F. The Application of Digital Technologies and Artificial Intelligence in Healthcare: An Overview on Nutrition Assessment. Diseases 2023; 11:97. [PMID: 37489449 PMCID: PMC10366918 DOI: 10.3390/diseases11030097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
In the last decade, artificial intelligence (AI) and AI-mediated technologies have undergone rapid evolution in healthcare and medicine, from apps to computer software able to analyze medical images, robotic surgery and advanced data storage system. The main aim of the present commentary is to briefly describe the evolution of AI and its applications in healthcare, particularly in nutrition and clinical biochemistry. Indeed, AI is revealing itself to be an important tool in clinical nutrition by using telematic means to self-monitor various health metrics, including blood glucose levels, body weight, heart rate, fat percentage, blood pressure, activity tracking and calorie intake trackers. In particular, the application of the most common digital technologies used in the field of nutrition as well as the employment of AI in the management of diabetes and obesity, two of the most common nutrition-related pathologies worldwide, will be presented.
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Affiliation(s)
- Alessia Salinari
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | - Michele Machì
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | - Yasmany Armas Diaz
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | - Danila Cianciosi
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | - Zexiu Qi
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | - Bei Yang
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
| | | | - Santos Gracia Villar
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
- Department of Projects, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Extension, Universidad Internacional do Cuanza, Cuito P.O. Box 841, Angola
| | - Luis Alonso Dzul Lopez
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
- Department of Projects, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Projects, Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA
| | - Maurizio Battino
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Department of Clinical Sciences, Faculty of Medicine, Polytechnic University of Marche, 60131 Ancona, Italy
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
| | - Francesca Giampieri
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
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Friedman JG, Coyne K, Aleppo G, Szmuilowicz ED. Beyond A1C: exploring continuous glucose monitoring metrics in managing diabetes. Endocr Connect 2023; 12:e230085. [PMID: 37071558 PMCID: PMC10305570 DOI: 10.1530/ec-23-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/19/2023]
Abstract
Hemoglobin A1c (HbA1c) has long been considered a cornerstone of diabetes mellitus (DM) management, as both an indicator of average glycemia and a predictor of long-term complications among people with DM. However, HbA1c is subject to non-glycemic influences which confound interpretation and as a measure of average glycemia does not provide information regarding glucose trends or about the occurrence of hypoglycemia and/or hyperglycemia episodes. As such, solitary use of HbA1c, without accompanying glucose data, does not confer actionable information that can be harnessed to guide targeted therapy in many patients with DM. While conventional capillary blood glucose monitoring (BGM) sheds light on momentary glucose levels, in practical use the inherent infrequency of measurement precludes elucidation of glycemic trends or reliable detection of hypoglycemia or hyperglycemia episodes. In contrast, continuous glucose monitoring (CGM) data reveal glucose trends and potentially undetected hypo- and hyperglycemia patterns that can occur between discrete BGM measurements. The use of CGM has grown significantly over the past decades as an ever-expanding body of literature demonstrates a multitude of clinical benefits for people with DM. Continually improving CGM accuracy and ease of use have further fueled the widespread adoption of CGM. Furthermore, percent time in range correlates well with HbA1c, is accepted as a validated indicator of glycemia, and is associated with the risk of several DM complications. We explore the benefits and limitations of CGM use, the use of CGM in clinical practice, and the application of CGM to advanced diabetes technologies.
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Affiliation(s)
- Jared G Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Kasey Coyne
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Ekhlaspour L, Raghinaru D, Forlenza GP, Isganaitis E, Kudva YC, Lam DW, Levister C, O’Malley G, Church MM, Lum JW, Buckingham B, Brown SA. Outcomes in Pump- and CGM-Baseline Use Subgroups in the International Diabetes Closed-Loop Trial. J Diabetes Sci Technol 2023; 17:935-942. [PMID: 35473359 PMCID: PMC10347978 DOI: 10.1177/19322968221089361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We investigated the potential benefits of automated insulin delivery (AID) among individuals with type 1 diabetes (T1D) in sub-populations of baseline device use determined by continuous glucose monitor (CGM) use status and insulin delivery via multiple daily injections (MDI) or insulin pump. MATERIALS AND METHODS In a six-month randomized, multicenter trial, 168 individuals were assigned to closed-loop control (CLC, Control-IQ, Tandem Diabetes Care), or sensor-augmented pump (SAP) therapy. The trial included a two- to eight-week run-in phase to train participants on study devices. The participants were stratified into four subgroups: insulin pump and CGM (pump+CGM), pump-only, MDI and CGM (MDI+CGM), and MDI users without CGM (MDI-only) users. We compared glycemic outcomes among four subgroups. RESULTS At baseline, 61% were pump+CGM users, 18% pump-only users, 10% MDI+CGM users, and 11% MDI-only users. Mean time in range 70-180 mg/dL (TIR) improved from baseline in the four subgroups using CLC: pump+CGM, 62% to 73%; pump-only, 61% to 70%; MDI+CGM, 54% to 68%; and MDI-only, 61% to 69%. The reduction in time below 70 mg/dL from baseline was comparable among the four subgroups. No interaction effect was detected with baseline device use for TIR (P = .67) or time below (P = .77). On the System Usability Questionnaire, scores were high at 26 weeks for all subgroups: pump+CGM: 87.2 ± 12.1, pump-only: 89.4 ± 8.2, MDI+CGM 87.2 ± 9.3, MDI: 78.1 ± 15. CONCLUSIONS There was a consistent benefit in patients with T1D when using CLC, regardless of baseline insulin delivery modality or CGM use. These data suggest that this CLC system can be considered across a wide range of patients.
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Affiliation(s)
- Laya Ekhlaspour
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Gregory P. Forlenza
- Barbara Davis Center for Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Elvira Isganaitis
- Research Division, Joslin Diabetes Center, Inc., Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David W. Lam
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camilla Levister
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grenye O’Malley
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - John W. Lum
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Bruce Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sue A. Brown
- University of Virginia Center for Diabetes Technology, Charlottesville, VA, USA
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Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, London, UK
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Amigó J, Ortiz-Zúñiga Á, de Urbina AMO, Sánchez M, Dos-Santos M, Abad M, Cuadra F, Simó R, Hernández C, Simó-Servat O. Switching from treatment with sensor augmented pump to hybrid closed loop system in type 1 diabetes: impact on glycemic control and neuropsychological tests in the real world. Diabetes Res Clin Pract 2023:110730. [PMID: 37236365 DOI: 10.1016/j.diabres.2023.110730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
AIMS The aim of this study is to assess in the real world the impact of initiating hybrid closed loop (HCL) on glycemic control and quality of life in patients using sensor-augmented pump (SAP). METHODS In this prospective study, patients using SAP changed to an HCL system in a specialized hospital. HCL devices used were Medtronic 780G®, Tandem Control-IQ® and Diabeloop® system. Glucometric data and hypoglycemia and neuropsychological tests were assessed at baseline and 3 months after initiating HCL. RESULTS A total of 66 consecutive patients were included (74% women, mean age 44±11 years, diabetes duration 27.2 ±11 years). Significant improvements were observed in coefficient of variation (from 35.6% to 33.1%), time in range (from 62.2 % to 73.8%), time above 180 mg/dl (from 26.9% to 18%), time below 70 mg/dl (from 3.3% to 2.1%) and time below 55 mg/dl (from 0.7% to 0.3%). In addition, significant improvements were observed in fear of hypoglycemia and grade of distress associated to treatment and to interpersonal sphere. CONCLUSIONS Switching from SAP to HCL system improves time in range and reduces time in hypoglycemia and glycemic variability at 3 months. These changes are accompanied by significant reduction of neuropsychological burden related to diabetes.
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Affiliation(s)
- Judit Amigó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Ángel Ortiz-Zúñiga
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Ana M Ortiz de Urbina
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mònica Sánchez
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marcos Dos-Santos
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mercè Abad
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Fátima Cuadra
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Cristina Hernández
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain.
| | - Olga Simó-Servat
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain.
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Vargas E, Nandhakumar P, Ding S, Saha T, Wang J. Insulin detection in diabetes mellitus: challenges and new prospects. Nat Rev Endocrinol 2023:10.1038/s41574-023-00842-3. [PMID: 37217746 DOI: 10.1038/s41574-023-00842-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Tremendous progress has been made towards achieving tight glycaemic control in individuals with diabetes mellitus through the use of frequent or continuous glucose measurements. However, in patients who require insulin, accurate dosing must consider multiple factors that affect insulin sensitivity and modulate insulin bolus needs. Accordingly, an urgent need exists for frequent and real-time insulin measurements to closely track the dynamic blood concentration of insulin during insulin therapy and guide optimal insulin dosing. Nevertheless, traditional centralized insulin testing cannot offer timely measurements, which are essential to achieving this goal. This Perspective discusses the advances and challenges in moving insulin assays from traditional laboratory-based assays to frequent and continuous measurements in decentralized (point-of-care and home) settings. Technologies that hold promise for insulin testing using disposable test strips, mobile systems and wearable real-time insulin-sensing devices are discussed. We also consider future prospects for continuous insulin monitoring and for fully integrated multisensor-guided closed-loop artificial pancreas systems.
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Affiliation(s)
- Eva Vargas
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ponnusamy Nandhakumar
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Shichao Ding
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Tamoghna Saha
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
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Emerson H, Guy M, McConville R. Offline reinforcement learning for safer blood glucose control in people with type 1 diabetes. J Biomed Inform 2023; 142:104376. [PMID: 37149275 DOI: 10.1016/j.jbi.2023.104376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
The widespread adoption of effective hybrid closed loop systems would represent an important milestone of care for people living with type 1 diabetes (T1D). These devices typically utilise simple control algorithms to select the optimal insulin dose for maintaining blood glucose levels within a healthy range. Online reinforcement learning (RL) has been utilised as a method for further enhancing glucose control in these devices. Previous approaches have been shown to reduce patient risk and improve time spent in the target range when compared to classical control algorithms, but are prone to instability in the learning process, often resulting in the selection of unsafe actions. This work presents an evaluation of offline RL for developing effective dosing policies without the need for potentially dangerous patient interaction during training. This paper examines the utility of BCQ, CQL and TD3-BC in managing the blood glucose of the 30 virtual patients available within the FDA-approved UVA/Padova glucose dynamics simulator. When trained on less than a tenth of the total training samples required by online RL to achieve stable performance, this work shows that offline RL can significantly increase time in the healthy blood glucose range from 61.6±0.3% to 65.3±0.5% when compared to the strongest state-of-art baseline (p<0.001). This is achieved without any associated increase in low blood glucose events. Offline RL is also shown to be able to correct for common and challenging control scenarios such as incorrect bolus dosing, irregular meal timings and compression errors. The code for this work is available at: https://github.com/hemerson1/offline-glucose.
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Affiliation(s)
- Harry Emerson
- University of Bristol, 1 Cathedral Square, Bristol, BS1 5TS, United Kingdom.
| | - Matthew Guy
- University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom.
| | - Ryan McConville
- University of Bristol, 1 Cathedral Square, Bristol, BS1 5TS, United Kingdom.
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Peacock S, Frizelle I, Hussain S. A Systematic Review of Commercial Hybrid Closed-Loop Automated Insulin Delivery Systems. Diabetes Ther 2023; 14:839-855. [PMID: 37017916 PMCID: PMC10126177 DOI: 10.1007/s13300-023-01394-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Several different forms of automated insulin delivery systems (AID systems) have recently been developed and are now licensed for type 1 diabetes (T1D). We undertook a systematic review of reported trials and real-world studies for commercial hybrid closed-loop (HCL) systems. METHODS Pivotal, phase III and real-world studies using commercial HCL systems that are currently approved for use in type 1 diabetes were reviewed with a devised protocol using the Medline database. RESULTS Fifty-nine studies were included in the systematic review (19 for 670G; 8 for 780G; 11 for Control-IQ; 14 for CamAPS FX; 4 for Diabeloop; and 3 for Omnipod 5). Twenty were real-world studies, and 39 were trials or sub-analyses. Twenty-three studies, including 17 additional studies, related to psychosocial outcomes and were analysed separately. CONCLUSIONS These studies highlighted that HCL systems improve time In range (TIR) and arouse minimal concerns around severe hypoglycaemia. HCL systems are an effective and safe option for improving diabetes care. Real-world comparisons between systems and their effects on psychological outcomes require further study.
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Affiliation(s)
- Sofia Peacock
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Isolda Frizelle
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK.
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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Beck RW, Kanapka LG, Breton MD, Brown SA, Wadwa RP, Buckingham BA, Kollman C, Kovatchev B. A Meta-Analysis of Randomized Trial Outcomes for the t:slim X2 Insulin Pump with Control-IQ Technology in Youth and Adults from Age 2 to 72. Diabetes Technol Ther 2023; 25:329-342. [PMID: 37067353 PMCID: PMC10171957 DOI: 10.1089/dia.2022.0558] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Objective: To evaluate the effect of hybrid-closed loop Control-IQ technology (Control-IQ) in randomized controlled trials (RCTs) in subgroups based on baseline characteristics such as race/ethnicity, socioeconomic status (SES), prestudy insulin delivery modality (pump or multiple daily injections), and baseline glycemic control. Methods: Data were pooled and analyzed from 3 RCTs comparing Control-IQ to a Control group using continuous glucose monitoring in 369 participants with type 1 diabetes (T1D) from age 2 to 72 years old. Results: Time in range 70-180 mg/dL (TIR) in the Control-IQ group (n = 256) increased from 57% ± 17% at baseline to 70% ± 11% during follow-up, and in the Control group (n = 113) was 56% ± 15% and 57% ± 14%, respectively (adjusted treatment group difference = 11.5%, 95% confidence interval +9.7% to +13.2%, P < 0.001), an increase of 2.8 h/day on average. Significant reductions in mean glucose, hyperglycemia metrics, hypoglycemic metrics, and HbA1c were also observed. A statistically similar beneficial treatment effect on time in range 70-180 mg/dL was observed across the full age range irrespective of race-ethnicity, household income, prestudy continuous glucose monitor use, or prestudy insulin delivery method. Participants with the highest baseline HbA1c levels showed the greatest improvements in TIR and HbA1c. Conclusion: This pooled analysis of Control-IQ RCTs demonstrates the beneficial effect of Control-IQ in T1D across a broad spectrum of participant characteristics, including racial-ethnic minority, lower SES, lack of prestudy insulin pump experience, and high HbA1c levels. The greatest benefit was observed in participants with the worst baseline glycemic control in whom the auto-bolus feature of the Control-IQ algorithm appears to have substantial impact. Since no subgroups were identified that did not benefit from Control-IQ, hybrid-closed loop technology should be strongly considered for all youth and adults with T1D. Clinical Trials Registry: clinicaltrials.gov; NCT03563313, NCT03844789, and NCT04796779.
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Affiliation(s)
- Roy W. Beck
- JAEB Center for Health Research, Tampa, Florida, USA
| | | | - Marc D. Breton
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia, USA
| | - Sue A. Brown
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Craig Kollman
- JAEB Center for Health Research, Tampa, Florida, USA
| | - Boris Kovatchev
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia, USA
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Gómez AM, Henao D, Parra D, Kerguelen A, Jaramillo P, Gómez Y, Muñoz OM, Rondón M. Early and sustained increase in time in range 1 year after initiation of hybrid close loop therapy via telemedicine in type 1 diabetes patients. Acta Diabetol 2023; 60:943-949. [PMID: 37010594 PMCID: PMC10068726 DOI: 10.1007/s00592-023-02051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 02/07/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND AIMS Evidence supports the efficacy and safety of the Hybrid Close loop (HCL) system in patients with type 1 diabetes (T1D). However, limited data are available on the long-term outcomes of patients on HCL with telemedicine follow-up. METHODS A prospective observational cohort study including T1D patients, who were upgrading to HCL system. Virtual training and follow-up were done through telemedicine. CGM data were analyzed to compare the baseline time in range (TIR), time below range (TBR), glycemic variability and auto mode (AM), with measurements performed at 3, 6 and 12 months. RESULTS 134 patients were included with baseline A1c 7.6% ± 1.1. 40.5% had a severe hypoglycemia event in the last year. Baseline TIR, measured two weeks after starting AM was 78.6 ± 9.94%. No changes were evident at three (Mean difference - 0.15;CI-2.47,2.17;p = 0.96), six (MD-1.09;CI-3.42,1.24;p = 0.12) and 12 months (MD-1.30;CI-3.64,1.04;p = 0.08). No significant changes were found in TBR or glycemic variability throughout the follow-up. Use of AM was 85.6 ± 17.5% and percentage of use of sensor was 88.75 ± 9.5% at 12 months. No severe hypoglycemic (SH) events were reported. CONCLUSIONS HCL systems allow to improve TIR, TBR and glycemic variability safely, early and sustained up to 1 year of follow-up in patients with T1D and high risk of hypoglycemia followed through telemedicine.
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Affiliation(s)
- Ana M. Gómez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Diana Henao
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Darío Parra
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Alfonso Kerguelen
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Pablo Jaramillo
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Yaline Gómez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia
| | - Oscar Mauricio Muñoz
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Martin Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
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Delvecchio M, Galati A, Maffeis C, Passanisi S, Bonfanti R, Franceschi R, Tornese G, Calzi E, Zanfardino A, Bracciolini GP, Piccinno E. A retrospective analysis of 24-month real-world glucose control for children and adolescents with type 1 diabetes using the MiniMed™ 670G insulin pump. Diabetes Obes Metab 2023; 25:1101-1105. [PMID: 36507706 DOI: 10.1111/dom.14934] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Maurizio Delvecchio
- Metabolic Disease and Genetic Unit, "Giovanni XXIII" Children Hospital, AOU Policlinico di Bari, Bari, Italy
| | - Alessio Galati
- Metabolic Disease and Genetic Unit, "Giovanni XXIII" Children Hospital, AOU Policlinico di Bari, Bari, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Riccardo Bonfanti
- Pediatric Diabetes, San Raffaele Scientific Hospital and Vita Salute San Raffaele University, Milan, Italy
| | | | - Gianluca Tornese
- Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Calzi
- Pediatric Department, Maggiore Hospital of Crema, Crema, Italy
| | - Angela Zanfardino
- Regional Center for Pediatric Diabetes, Department of Pediatrics, University of the Study of Campania, Naples, Italy
| | | | - Elvira Piccinno
- Metabolic Disease and Genetic Unit, "Giovanni XXIII" Children Hospital, AOU Policlinico di Bari, Bari, Italy
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