1
|
Mingorance Delgado A, Lucas F. The Tandem Control-IQ advanced hybrid system improves glycemic control in children under 18 years of age with type 1 diabetes and night rest in caregivers. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:27-35. [PMID: 37598004 DOI: 10.1016/j.endien.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/12/2022] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To determine the impact of switching from the predictive low glucose suspend (PLGS) system to the advanced hybrid Tandem Control-IQ system on glucometrics and glycosylated haemoglobin (HbA1c) at one year. To assess the impact on the quality of life perceived by parents. METHOD Prospective study in 71 patients aged 6-18 years with type 1 diabetes (DM1), in treatment with PLGS, who switched to an advanced hybrid system. Glucometric data were collected before the change, at 4 and 8 weeks, and at one year of use; HbA1c before the change and after one year. The Diabetes Impact and Devices Satisfaction (DIDS) questionnaire was used at weeks 4 and 8. RESULTS An increase in time in range (TIR) was observed with a median of 76% (P<.001) at 4 weeks, which was maintained after one year (+8% in the total group). Overall, 73.24% of patients achieved a TIR above 70%. The subgroup with an initial TIR of less than 56% increased it by 14.4%. After one year there was a 0.3% reduction in HbA1c. Level 1 hypoglycaemia, level 1 and level 2 hyperglycaemia, mean glucose (GM) and coefficient of variation (CV) decreased. Auto mode stayed on 97% of the time and no dropouts occurred. Caregivers had a perception of better glycaemic control and less need to monitor blood glucose variations during the night. None of them would switch back to the previous system and they feel safe with the new system. CONCLUSIONS The Tandem Control-IQ advanced hybrid system was shown to be effective one year after its implementation with improvement in all glucometric parameters and HbA1c, as well as night-time rest in caregivers.
Collapse
Affiliation(s)
- Andrés Mingorance Delgado
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) - Diabetes y enfermedades metabólicas asociadas, Alicante, Spain; Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | - Fernando Lucas
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) - Diabetes y enfermedades metabólicas asociadas, Alicante, Spain; Unidad de Diabetes, Servicio de Endocrinología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| |
Collapse
|
2
|
Mingorance Delgado A, Lucas F. El sistema híbrido avanzado Tandem Control-IQ mejora el control glucémico en menores de 18 años con diabetes tipo 1 y el descanso nocturno de los cuidadores. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
3
|
Gandhi GY, Mooradian AD. Clinical Considerations for Insulin Therapy in Older Adults with Type 1 Diabetes. Drugs Aging 2021; 39:23-37. [PMID: 34664212 DOI: 10.1007/s40266-021-00900-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes represents an autoimmune condition with a strong inherited background, and its incidence is increasing worldwide. About 25% of such cases are diagnosed in adulthood, some even as late as the ninth decade of life. The number of older adults with type 1 diabetes is increasing due to improvements in care and decreased mortality rate. However, there is a lack of clinical trials in people older than 70 years of age with type 1 diabetes complicated with comorbidities, frailty, and dependency. The management of type 1 diabetes and the goals of therapy should be individualized based on the patient's health status and life expectancy. In healthier older adults, insulin treatment regimens (multiple daily insulin injections or insulin pump therapy) that approximate the normal physiology of insulin secretion should be used to achieve lower glycemic goals, while reducing the risk of hypoglycemia with frequent glucose monitoring (preferably using continuous glucose monitoring systems). For frail individuals with poor health, simpler insulin regimens and less stringent glycemic targets would be more appropriate. Poor cognition, vision and hearing, impaired mobility, depression, and chronic pain can interfere with complex insulin regimens. In these individuals, the principal goals of therapy are to reduce the acute effects of hyperglycemia, minimize hypoglycemia risk, and optimize quality of life. The newer insulin preparations and technological advances in insulin delivery and blood glucose monitoring have enhanced the management of type 1 diabetes in all age groups.
Collapse
Affiliation(s)
- Gunjan Y Gandhi
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA
| | - Arshag D Mooradian
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA.
| |
Collapse
|
4
|
Intelligent automated drug administration and therapy: future of healthcare. Drug Deliv Transl Res 2021; 11:1878-1902. [PMID: 33447941 DOI: 10.1007/s13346-020-00876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
In the twenty-first century, the collaboration of control engineering and the healthcare sector has matured to some extent; however, the future will have promising opportunities, vast applications, and some challenges. Due to advancements in processing speed, the closed-loop administration of drugs has gained popularity for critically ill patients in intensive care units and routine life such as personalized drug delivery or implantable therapeutic devices. For developing a closed-loop drug delivery system, the control system works with a group of technologies like sensors, micromachining, wireless technologies, and pharmaceuticals. Recently, the integration of artificial intelligence techniques such as fuzzy logic, neural network, and reinforcement learning with the closed-loop drug delivery systems has brought their applications closer to fully intelligent automatic healthcare systems. This review's main objectives are to discuss the current developments, possibilities, and future visions in closed-loop drug delivery systems, for providing treatment to patients suffering from chronic diseases. It summarizes the present insight of closed-loop drug delivery/therapy for diabetes, gastrointestinal tract disease, cancer, anesthesia administration, cardiac ailments, and neurological disorders, from a perspective to show the research in the area of control theory.
Collapse
|
5
|
Liu H, Shan X, Yu J, Li X, Hu L. Recent Advances in Inhaled Formulations and Pulmonary Insulin Delivery Systems. Curr Pharm Biotechnol 2020; 21:180-193. [PMID: 31612824 DOI: 10.2174/1389201020666191011152248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023]
Abstract
Insulin (INS) therapy played a great role in patients with type 1 and type 2 diabetes to regulate
blood glucose levels. Although hypodermic injection was commonly used for insulin delivery, it
had some disadvantages such as pain, needle phobia and the risk of infection. Therefore, pulmonary
insulin delivery had been developed as an alternative method to overcome the therapeutic challenges in
recent years since pulmonary insulin administration showed great improvements in rapid action and
circumvention of first-pass hepatic metabolism. This review described the most recent developments in
pulmonary insulin administration. Firstly, the structure and physiology of the lung cavity were introduced.
Next, the advantages and disadvantages of pulmonary administration were discussed. Then
some new dosage forms for pulmonary insulin were investigated including carriers based on surfactants
and carriers based on polymers. Finally, innovate insulin inhalers and formulations were also described.
Collapse
Affiliation(s)
- Haofan Liu
- Department of Pharmacy, Affiliated Hospital of Hebei University, Baoding, China
| | - Xiaosong Shan
- Department of Pharmacy, Affiliated Hospital of Hebei University, Baoding, China
| | - Jiaojiao Yu
- Department of Pharmacy, Affiliated Hospital of Hebei University, Baoding, China
| | - Xin Li
- School of Pharmaceutical Sciences, Key Laboratory of Pharmaceutical Quality Control of Hebei Province, Hebei University, Baoding, China
| | - Liandong Hu
- Department of Pharmacy, Affiliated Hospital of Hebei University, Baoding, China
| |
Collapse
|
6
|
Yang G, Wang Q, Gao Y, Yang C, Hu L. Combination of coating and injectable hydrogel depot to improve the sustained delivery of insulin. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Abstract
Controlling glycemia in diabetes remains key to prevent complications in this condition. However, glucose levels can undergo large fluctuations secondary to daily activities, consequently creating management difficulties. The current review summarizes the basics of glucose management in diabetes by addressing the main glycemic parameters. The advantages and limitation of HbA1c, the gold standard measure of glucose control, are discussed together with the clinical importance of hypoglycemia and glycemic variability. The review subsequently moves focus to glucose monitoring techniques in diabetes, assessing advantages and limitations. Monitoring glucose levels is crucial for effective and safe adjustment of hypoglycemic therapy, particularly in insulin users. Self-monitoring of blood glucose (SMBG), based on capillary glucose testing, remains one of the most widely used methods to monitor glucose levels, given the relative accuracy, familiarity, and manageable costs. However, patient inconvenience and the sporadic nature of SMBG limit clinical effectiveness of this approach. In contrast, continuous glucose monitoring (CGM) provides a more comprehensive picture of glucose levels, but these systems are expensive and require constant calibration which, together with concerns over accuracy of earlier devices, restrict CGM use to special groups of patients. The newer flash continuous glucose monitoring (FCGM) system, which is more affordable than conventional CGM devices and does not require calibration, offers an alternative glucose monitoring strategy that comprehensively analyzes glucose profile while sparing patients the inconvenience of capillary glucose testing for therapy adjustment or CGM calibration. The fast development of new CGM devices will gradually displace SMBG as the main glucose testing method. Avoiding the inconvenience of SMBG and optimizing glycemia through alternative glucose testing strategies will help to reduce the risk of complications and improve quality of life in patients with diabetes.
Collapse
Affiliation(s)
- Ramzi A Ajjan
- LIGHT Laboratories, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| |
Collapse
|
8
|
Affiliation(s)
- Revital Nimri
- 1 Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes , Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nathan Murray
- 2 William Sansum Diabetes Center , Santa Barbara, CA
| | | | | | - Eyal Dassau
- 2 William Sansum Diabetes Center , Santa Barbara, CA
- 3 Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University , Cambridge, MA
| |
Collapse
|
9
|
Sarode BR, Kover K, Tong PY, Zhang C, Friedman SH. Light Control of Insulin Release and Blood Glucose Using an Injectable Photoactivated Depot. Mol Pharm 2016; 13:3835-3841. [PMID: 27653828 PMCID: PMC5101575 DOI: 10.1021/acs.molpharmaceut.6b00633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
![]()
In this work we demonstrate
that blood glucose can be controlled
remotely through light stimulated release of insulin from an injected
cutaneous depot. Human insulin was tethered to an insoluble but injectable
polymer via a linker, which was based on the light cleavable di-methoxy
nitrophenyl ethyl (DMNPE) group. This material was injected
into the skin of streptozotocin-treated diabetic rats. We observed
insulin being released into the bloodstream after a 2 min trans-cutaneous
irradiation of this site by a compact LED light source. Control animals
treated with the same material, but in which light was blocked from
the site, showed no release of insulin into the bloodstream. We also
demonstrate that additional pulses of light from the light source
result in additional pulses of insulin being absorbed into circulation.
A significant reduction in blood glucose was then observed. Together,
these results demonstrate the feasibility of using light to allow
for the continuously variable control of insulin release. This in
turn has the potential to allow for the tight control of blood glucose
without the invasiveness of insulin pumps and cannulas.
Collapse
Affiliation(s)
- Bhagyesh R Sarode
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Karen Kover
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States.,Department of Medicine, School of Medicine, University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Pei Y Tong
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Chaoying Zhang
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Simon H Friedman
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| |
Collapse
|
10
|
Blauw H, Keith-Hynes P, Koops R, DeVries JH. A Review of Safety and Design Requirements of the Artificial Pancreas. Ann Biomed Eng 2016; 44:3158-3172. [PMID: 27352278 PMCID: PMC5093196 DOI: 10.1007/s10439-016-1679-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/13/2016] [Indexed: 01/03/2023]
Abstract
As clinical studies with artificial pancreas systems for automated blood glucose control in patients with type 1 diabetes move to unsupervised real-life settings, product development will be a focus of companies over the coming years. Directions or requirements regarding safety in the design of an artificial pancreas are, however, lacking. This review aims to provide an overview and discussion of safety and design requirements of the artificial pancreas. We performed a structured literature search based on three search components—type 1 diabetes, artificial pancreas, and safety or design—and extended the discussion with our own experiences in developing artificial pancreas systems. The main hazards of the artificial pancreas are over- and under-dosing of insulin and, in case of a bi-hormonal system, of glucagon or other hormones. For each component of an artificial pancreas and for the complete system we identified safety issues related to these hazards and proposed control measures. Prerequisites that enable the control algorithms to provide safe closed-loop control are accurate and reliable input of glucose values, assured hormone delivery and an efficient user interface. In addition, the system configuration has important implications for safety, as close cooperation and data exchange between the different components is essential.
Collapse
Affiliation(s)
- Helga Blauw
- Department of Endocrinology, Academic Medical Center, University of Amsterdam, P.O Box 22660, 1100 DD, Amsterdam, The Netherlands. .,Inreda Diabetic BV, Goor, The Netherlands.
| | - Patrick Keith-Hynes
- TypeZero Technologies, LLC, Charlottesville, VA, USA.,Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | | | - J Hans DeVries
- Department of Endocrinology, Academic Medical Center, University of Amsterdam, P.O Box 22660, 1100 DD, Amsterdam, The Netherlands
| |
Collapse
|
11
|
McAdams BH, Rizvi AA. An Overview of Insulin Pumps and Glucose Sensors for the Generalist. J Clin Med 2016; 5:jcm5010005. [PMID: 26742082 PMCID: PMC4730130 DOI: 10.3390/jcm5010005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/16/2015] [Accepted: 12/24/2015] [Indexed: 01/22/2023] Open
Abstract
Continuous subcutaneous insulin, or the insulin pump, has gained popularity and sophistication as a near-physiologic programmable method of insulin delivery that is flexible and lifestyle-friendly. The introduction of continuous monitoring with glucose sensors provides unprecedented access to, and prediction of, a patient’s blood glucose levels. Efforts are underway to integrate the two technologies, from “sensor-augmented” and “sensor-driven” pumps to a fully-automated and independent sensing-and-delivery system. Implantable pumps and an early-phase “bionic pancreas” are also in active development. Fine-tuned “pancreas replacement” promises to be one of the many avenues that offers hope for individuals suffering from diabetes. Although endocrinologists and diabetes specialists will continue to maintain expertise in this field, it behooves the primary care physician to have a working knowledge of insulin pumps and sensors to ensure optimal clinical care and decision-making for their patients.
Collapse
Affiliation(s)
- Brooke H McAdams
- Fellow in Endocrinology, University of South Carolina School of Medicine, Columbia, SC 29203, USA.
| | - Ali A Rizvi
- Medicine and Director, Endocrinology Division, University of South Carolina School of Medicine, Two Medical Park, Suite 502, Columbia, SC 29203, USA.
| |
Collapse
|
12
|
Brugués A, Bromuri S, Barry M, Del Toro ÓJ, Mazurkiewicz MR, Kardas P, Pegueroles J, Schumacher M. Processing Diabetes Mellitus Composite Events in MAGPIE. J Med Syst 2015; 40:44. [PMID: 26590982 DOI: 10.1007/s10916-015-0377-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
The focus of this research is in the definition of programmable expert Personal Health Systems (PHS) to monitor patients affected by chronic diseases using agent oriented programming and mobile computing to represent the interactions happening amongst the components of the system. The paper also discusses issues of knowledge representation within the medical domain when dealing with temporal patterns concerning the physiological values of the patient. In the presented agent based PHS the doctors can personalize for each patient monitoring rules that can be defined in a graphical way. Furthermore, to achieve better scalability, the computations for monitoring the patients are distributed among their devices rather than being performed in a centralized server. The system is evaluated using data of 21 diabetic patients to detect temporal patterns according to a set of monitoring rules defined. The system's scalability is evaluated by comparing it with a centralized approach. The evaluation concerning the detection of temporal patterns highlights the system's ability to monitor chronic patients affected by diabetes. Regarding the scalability, the results show the fact that an approach exploiting the use of mobile computing is more scalable than a centralized approach. Therefore, more likely to satisfy the needs of next generation PHSs. PHSs are becoming an adopted technology to deal with the surge of patients affected by chronic illnesses. This paper discusses architectural choices to make an agent based PHS more scalable by using a distributed mobile computing approach. It also discusses how to model the medical knowledge in the PHS in such a way that it is modifiable at run time. The evaluation highlights the necessity of distributing the reasoning to the mobile part of the system and that modifiable rules are able to deal with the change in lifestyle of the patients affected by chronic illnesses.
Collapse
Affiliation(s)
- Albert Brugués
- University of Applied Sciences Western Switzerland (HES-SO), Techno-Pôle 3, 3960, Sierre, Switzerland. .,Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Campus Nord, Edif. C3, C. Jordi Girona, 1-3, 08034, Barcelona, Spain.
| | - Stefano Bromuri
- University of Applied Sciences Western Switzerland (HES-SO), Techno-Pôle 3, 3960, Sierre, Switzerland
| | - Michael Barry
- University of Applied Sciences Western Switzerland (HES-SO), Techno-Pôle 3, 3960, Sierre, Switzerland
| | - Óscar Jiménez Del Toro
- University of Applied Sciences Western Switzerland (HES-SO), Techno-Pôle 3, 3960, Sierre, Switzerland
| | - Maciej R Mazurkiewicz
- First Department of Family Medicine, Medical University of Lodz, ul.Narutowicza 60, Łódź, Poland
| | - Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz, ul.Narutowicza 60, Łódź, Poland
| | - Josep Pegueroles
- Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Campus Nord, Edif. C3, C. Jordi Girona, 1-3, 08034, Barcelona, Spain
| | - Michael Schumacher
- University of Applied Sciences Western Switzerland (HES-SO), Techno-Pôle 3, 3960, Sierre, Switzerland
| |
Collapse
|
13
|
Wen H, Jung H, Li X. Drug Delivery Approaches in Addressing Clinical Pharmacology-Related Issues: Opportunities and Challenges. AAPS JOURNAL 2015; 17:1327-40. [PMID: 26276218 DOI: 10.1208/s12248-015-9814-9] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/06/2015] [Indexed: 12/27/2022]
Abstract
Various drug delivery approaches can be used to maximize therapeutic efficacy and minimize side effects, by impacting absorption, distribution, metabolism, and elimination (ADME) of a drug compound. For those drugs with poor water solubility or low permeability, techniques such as amorphous solid dispersion, liposomes, and complexations have been used to improve their oral bioavailability. Modified release (MR) formulations have been widely used to improve patient compliance, as well as to reduce side effects, especially for those drugs with short half-lives or narrow therapeutic windows. More than ten drugs using sterile long-acting release (LAR) formulations with clear clinical benefit have been successfully marketed. Furthermore, drug delivery systems have been used in delaying drug clearance processes. Additionally, modifying the in vivo drug distribution using targeted delivery systems has significantly improved oncology treatments. All the drug delivery approaches have their advantages and limitations. For both brand and generic drugs, the achievement of consistent quality and therapeutic performance using drug delivery systems can also pose serious challenges in developing a drug for the market, which requires close collaboration among industry, academia, and regulatory agencies. With the advent of personalized medicines, there will be great opportunities and challenges in utilizing drug delivery systems to provide better products and services for patients.
Collapse
Affiliation(s)
- Hong Wen
- Office of Generic Drugs, CDER, FDA, Silver Spring, Maryland, 20993, USA.
| | - Huijeong Jung
- Office of Generic Drugs, CDER, FDA, Silver Spring, Maryland, 20993, USA
| | - Xuhong Li
- Office of Pharmaceutical Quality, CDER, FDA, Silver Spring, Maryland, 20993, USA
| |
Collapse
|
14
|
Giani E, Scaramuzza AE, Zuccotti GV. Impact of new technologies on diabetes care. World J Diabetes 2015; 6:999-1004. [PMID: 26240696 PMCID: PMC4515449 DOI: 10.4239/wjd.v6.i8.999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/31/2015] [Accepted: 07/02/2015] [Indexed: 02/05/2023] Open
Abstract
Technologies for diabetes management, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems, have improved remarkably over the last decades. These developments are impacting the capacity to achieve recommended hemoglobin A1c levels and assisting in preventing the development and progression of micro- and macro vascular complications. While improvements in metabolic control and decreases in risk of severe and moderate hypoglycemia have been described with use of these technologies, large epidemiological international studies show that many patients are still unable to meet their glycemic goals, even when these technologies are used. This editorial will review the impact of technology on glycemic control, hypoglycemia and quality of life in children and youth with type 1 diabetes. Technologies reviewed include CSII, CGM systems and sensor-augmented insulin pumps. In addition, the usefulness of advanced functions such as bolus profiles, bolus calculators and threshold-suspend features will be also discussed. Moreover, the current editorial will explore the challenges of using these technologies. Indeed, despite the evidence currently available of the potential benefits of using advanced technologies in diabetes management, many patients still report barriers to using them. Finally this article will highlight the importance of future studies tailored toward overcome these barriers to optimizing glycemic control and avoiding severe hypoglycemia.
Collapse
|