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Kitagawa H, Munekage M, Seo S, Hanazaki K. Artificial pancreas: the past and the future. J Artif Organs 2025:10.1007/s10047-025-01510-1. [PMID: 40415035 DOI: 10.1007/s10047-025-01510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Accepted: 05/05/2025] [Indexed: 05/27/2025]
Abstract
In glucose management using continuous insulin infusion, artificial pancreas systems prevent blood glucose fluctuations and severe hypoglycemia using insulin pumps and continuous glucose monitoring. Advances in both insulin pumps and continuous glucose monitoring have enabled the transition from sensor augmented pump therapy, where insulin delivery is manually adjusted, to hybrid closed-loop insulin pump therapy, which automatically adjusts basal insulin infusion. Furthermore, fully automated insulin delivery systems that adjust insulin based on variations due to meals and exercise are now possible. These systems have been primarily applied to patients with type 1 diabetes but are now expanding to all insulin-dependent patients. Wearable artificial pancreas systems measure glucose levels in subcutaneous tissue fluid, while bedside artificial pancreas systems measure glucose levels in venous blood, making them suitable for managing the highly variable blood glucose levels of perioperative and critically ill patients. Future developments are anticipated to integrate the benefits of both wearable and bedside systems.
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Affiliation(s)
- Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan.
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Kochi Medical School Hospital, Kohasu, Okocho, Nankoku, Kochi, 7838505, Japan
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2
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Bismuth E, Joubert M, Renard E, Tubiana-Rufi N, Chaillous L, Bonnemaison E, Hanaire H, Coutant R, Schaepelynck P, Beltrand J, Reznik Y, Authier F, Borot S, Brunot S, Calvez C, Charpentier G, Dalla-Vale F, Delawoevre A, Delemer B, Desserprix A, Durain D, Fendri S, Franc S, Godot C, Gouet D, Guenego A, Guerci B, Guilhem I, Jeandidier N, Lablanche S, Le Tallec C, Malwe M, Meyer L, Morin C, Penfornis A, Picard S, Riveline JP, Rossignol V, Smati S, Sola-Gazagnes A, Thivolet C, Villard O, Benhamou PY. Practical implementation of automated insulin delivery systems in 2025: A French position statement update. DIABETES & METABOLISM 2025; 51:101637. [PMID: 40073966 DOI: 10.1016/j.diabet.2025.101637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025]
Abstract
The advent of automated insulin delivery (AID) systems in 2020 marked a disruptive event in managing type 1 diabetes, benefiting children and adults alike. By 2024, advances in real-world data and research motivated an update to the French consensus on AID systems to expand accessibility, refine guidelines, and optimize patient follow-up. AID systems have consistently improved glycemic control by reducing HbA1c, increasing time-in-range (TIR), and minimizing hypoglycemia, with significant benefits even for specific populations such as individuals with poor glycemic control, brittle diabetes, children, very young children, pregnant women, those with insulin resistance or gastroparesis, or after bariatric surgery. Recent studies support the broadening of AID indications for these special situations, also demonstrating safe transitions directly from multiple daily injections. A careful selection of the most appropriate system for these special situations is essential to achieve optimal personalization for each patient. Training healthcare professionals and patients remains essential for optimizing AID usage. Updated guidelines emphasize multidisciplinary education, telemonitoring, and individualized follow-up to ensure safety and efficacy. The potential of fully automated systems and adjunctive therapies, such as GLP-1 receptor agonists, is being explored alongside promising evidence that AID systems improve glycemic control in type 2 diabetes without increasing hypoglycemia. The future of AID systems lies in innovation and expanding their applicability across diverse patient populations.
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Affiliation(s)
- E Bismuth
- Endocrinologie et Diabétologie pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris, Paris, France
| | - M Joubert
- Université de Caen et Endocrinologie-Diabétologie, CHU Côte de Nacre, Caen, France.
| | - E Renard
- Endocrinologie-Diabétologie, CHU Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - N Tubiana-Rufi
- Endocrinologie et Diabétologie pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris, Paris, France
| | - L Chaillous
- Endocrinologie-Diabétologie-Nutrition, Institut du Thorax, CHU Nantes, France
| | - E Bonnemaison
- Clinique Saint Jean - Saint Jean de Vedas - Montpellier Métropole, France
| | - H Hanaire
- Diabétologie - Maladies Métaboliques - Nutrition, CHU Toulouse, Université de Toulouse, Toulouse, France
| | - R Coutant
- Endocrinologie et Diabétologie pédiatrique, CHU Angers, France
| | - P Schaepelynck
- service de diabétologie, Hôpital Européen, Marseille, France
| | - J Beltrand
- APHP Centre, Université de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Y Reznik
- Université de Caen et Endocrinologie-Diabétologie, CHU Côte de Nacre, Caen, France
| | - F Authier
- Diététicienne, DIAB-eCare, Centre du diabète des Hospices Civils de Lyon, France
| | - S Borot
- Université Franche-Comté et Endocrinologie-Nutrition-Diabétologie, CHU Besançon, France
| | - S Brunot
- IDE DIAB-eCARE, Centre du diabète des Hospices Civils de Lyon, France
| | - C Calvez
- IPA, Endocrinologie Diabétologie, Hôpital Cochin, APHP, Paris, France
| | | | - F Dalla-Vale
- Endocrinologie et Diabétologie pédiatrique, CHU, Montpellier, France
| | - A Delawoevre
- IPA-puéricultrice Hôpital d'enfants CHRU Nancy, France
| | - B Delemer
- Endocrinologie-Diabétologie, CHU Reims, et Présidente du CNP d'Endocrinologie-Diabétologie, France
| | - A Desserprix
- IDE I-ETP, Hôtel Dieu Le Creusot, Groupe SOS Santé, France
| | - D Durain
- Cadre de Santé Endocrinologie et Diabétologie, CHRU Nancy, France
| | - S Fendri
- Endocrinologie et Diabétologie, CHU, Amiens, France
| | - S Franc
- Diabétologie, CH Sud Francilien, CERITD, Bioparc Genopole, Université Paris-Saclay, Evry, France
| | - C Godot
- Diabétologie pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - D Gouet
- Diabétologie, CHR, Hôpital Saint Louis, La Rochelle, France, et Collège des Diabétologues et Endocrinologues des Hôpitaux Généraux (Codehg) , France
| | - A Guenego
- Endocrinologie-Diabétologie-Nutrition, CHU, Rennes, France
| | - B Guerci
- Université de Lorraine et Endocrinologie-Diabétologie-Maladies Métaboliques et Nutrition, CHU Nancy, France
| | - I Guilhem
- Endocrinologie-Diabétologie-Nutrition, CHU Rennes, France
| | - N Jeandidier
- Université de Strasbourg et Endocrinologie-Diabétologie-Nutrition, Hôpitaux Universitaires de Strasbourg, France
| | - S Lablanche
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, France
| | - C Le Tallec
- Diabetologie pédiatrique Enfance Adolescence Diabète Toulouse, France
| | - M Malwe
- IPA, AMTIM, Montpellier et Institut St Pierre, Palavas-les-flots, France
| | - L Meyer
- Endocrinologie Diabétologie, Hôpitaux Universitaires de Strasbourg, France
| | - C Morin
- Diabétologie Pédiatrique, CHU Hôpital des Enfants, Toulouse, France
| | - A Penfornis
- Université Paris-Saclay et Endocrinologie-Diabétologie et Maladies Métaboliques, CH Sud Francilien, Corbeil-Essonnes, France
| | - S Picard
- Cabinet d'Endocrino-Diabétologie, Point Médical, Dijon, France
| | - J P Riveline
- Centre Universitaire du Diabète, Hôpital Lariboisière, APHP, Paris, France
| | - V Rossignol
- Diététicienne, Diabétologie - Maladies Métaboliques - Nutrition, CHU Toulouse, France
| | - S Smati
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU Nantes, France
| | - A Sola-Gazagnes
- Endocrinologie-Diabétologie, Hôpital Cochin, APHP, Paris, France
| | - C Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon, France
| | - O Villard
- Endocrinologie-Diabétologie, CHU de Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - P Y Benhamou
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, France
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Fisker S, Christensen M, Bach E, Bibby BM, Hansen KW. Long-Term Performance of Two Systems for Automated Insulin Delivery in Adults With Type 1 Diabetes: An Observational Study. Endocrinol Diabetes Metab 2025; 8:e70043. [PMID: 40198839 PMCID: PMC11977919 DOI: 10.1002/edm2.70043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 04/10/2025] Open
Abstract
AIMS To compare glycaemic outcomes for two automated insulin delivery (AID) systems, the Tandem Control IQ (CIQ) and the MiniMed 780G (MM780G). MATERIAL AND METHODS In this observational study, we evaluated 60 days of glycaemic data from 139 persons with type 1 diabetes (CIQ: 79 persons, MM780G: 60 persons), who had an active glucose sensor time ≥ 85%. RESULTS The time with AID was median 620 (IQR, 439-755) days for CIQ users and 509 (429-744) days for MM780G users (p = 0.26). The last HbA1c before initiation of AID was 59.7 mmol/mol in CIQ and 60.1 mmol/mol in MM780G (p = 0.88). The time with an active glucose sensor was higher for CIQ than MM780G (median 98.5 (97.4-98.0)% vs. 96.5 (94.9-97.0)%, p < 0.001). Time in range (TIR, glucose 3.9-10.0 mmol/L) was lower in CIQ than MM780G (mean 68.9% ± 11.4% vs. 73.7% ± 12.0%, p = 0.02) as was time in tight range (TITR) (glucose 3.9-7.8 mmol/L) (43.0% ± 12.2% vs. 48.4% ± 12.7%, p = 0.01). The difference in TIR (4.2 (95% CI 1.0-7.5)%, p = 0.01) and TITR (5.0 (1.4-8.6)%, p < 0.01) remained statistically significant in a multiple regression model controlling for various baseline variables. Time with an absolute rate of glucose change > 1.5 mmol/L/15 min was higher in CIQ than MM780G (9.4 (IQR, 7.2-13.3)% vs. 7.4 (5.2-10.4)%, p < 0.001). CONCLUSIONS The CIQ system had a higher active glucose sensor time but a lower TIR, TITR, and a higher time with a rapid glucose rate of change than the MM780G system.
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Affiliation(s)
- Sanne Fisker
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Mia Christensen
- Medical Diagnostic CenterSilkeborg Regional HospitalSilkeborgDenmark
| | - Ermina Bach
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Medical Diagnostic CenterViborg Regional HospitalViborgDenmark
| | - Bo Martin Bibby
- Section for Biostatistics, Department of Public HealthAarhus UniversityAarhusDenmark
| | - Klavs Würgler Hansen
- Medical Diagnostic CenterSilkeborg Regional HospitalSilkeborgDenmark
- Department of Internal MedicineAarhus UniversityAarhusDenmark
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De Meulemeester J, Keymeulen B, De Block C, Van Huffel L, Taes Y, Ballaux D, Spincemaille K, Lapauw B, Vanhaverbeke G, Lowyck I, Vercammen C, Colin IM, Preumont V, Charleer S, Fieuws S, Mathieu C, Gillard P. One-year real-world benefits of Tandem Control-IQ technology on glucose management and person-reported outcomes in adults with type 1 diabetes: a prospective observational cohort study. Diabetologia 2025; 68:948-960. [PMID: 39934368 DOI: 10.1007/s00125-025-06366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 12/19/2024] [Indexed: 02/13/2025]
Abstract
AIMS/HYPOTHESIS This multicentre prospective observational cohort study aimed to evaluate real-world changes in glycaemic and person-reported outcomes after 1 year's use of Control-IQ technology in adults with type 1 diabetes. METHODS Adults who started with Control-IQ between December 2021 and December 2022 were consecutively recruited in 13 Belgian diabetes centres. Data were collected at start and after 4, 8 and 12 months. The primary endpoint was the evolution of time in range (TIR; glucose levels of 3.9-10.0 mmol/l). Data are reported as mean ± SD or least-squares mean (95% CI). RESULTS A total of 473 adults were included, with a mean age of 38.5 ± 13.1 years and of whom 57.3% were female. TIR increased from 58.8% (95% CI 56.7, 60.9) at start to 70.9% (69.1, 72.8) at 12 months (p<0.001). HbA1c decreased from 57.3 mmol/mol (56.1, 58.5) (7.4% [7.3, 7.5]) to 49.5 mmol/mol (48.5, 50.6) (6.7% [6.6, 6.8]) and time <3.9 mmol/l from 4.2% (3.9, 4.6) to 1.9% (1.8, 2.1) (all p<0.001). Participants scored better on the Hypoglycaemia Fear Survey version 2 worry (22.5 [21.3, 23.7] vs 18.1 points [17.0, 19.3]), the Problem Areas in Diabetes - Short Form (7.2 [6.7, 7.8] vs 6.1 points [5.5, 6.7]), and the Diabetes Treatment Satisfaction Questionnaire status (25.5 [24.8, 26.2] vs 31.0 points [30.4, 31.6]) (all p<0.001). The number of self-reported severe hypoglycaemia events (37.5 [21.3, 65.9] vs 15.7 [9.7, 25.3] events per 100 person-years, p=0.002) and work absenteeism days (116.3 [42.8, 315.5] vs 69.3 [25.4, 189.2] days per 100 person-years, p=0.034) decreased. CONCLUSIONS/INTERPRETATION One-year use of Control-IQ was associated with better glucose management, improved diabetes-related quality of life, more treatment satisfaction, less severe hypoglycaemia and less work absenteeism in adults with type 1 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT04414280.
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Affiliation(s)
| | - Bart Keymeulen
- Department of Diabetology and Endocrinology, University Hospital Brussels - Vrije Universiteit Brussel, Jette, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology & Metabolism, University Hospital Antwerp - University of Antwerp, Edegem, Belgium
| | - Liesbeth Van Huffel
- Department of Endocrinology, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Youri Taes
- Department of Endocrinology, AZ Sint-Jan Brugge, Brugge, Belgium
| | | | | | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Ine Lowyck
- Department of Endocrinology, Hospital Oost-Limburg, Genk, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Ides M Colin
- Service d'Endocrino-Diabétologie, CHU HELORA sites Constantinople/Warquignies, Mons, Belgium
| | - Vanessa Preumont
- Department of Endocrinology, Cliniques Universitaires St Luc, Brussel, Belgium
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, University of Leuven and University of Hasselt, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven - KU Leuven, Leuven, Belgium.
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Liarakos AL, Crabtree TSJ, Hussain S, Patel R, Gazis A, Mendis B, Herring R, Kennedy A, Black N, Ryder REJ, Wilmot EG. Long-Term Improvements in Glycemia and User-Reported Outcomes Associated with Open-Source Automated Insulin Delivery Systems in Adults with Type 1 Diabetes in the United Kingdom: A Real-World Observational Study. Diabetes Technol Ther 2025; 27:283-291. [PMID: 39866104 DOI: 10.1089/dia.2024.0556] [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] [Indexed: 01/28/2025]
Abstract
Objective: To evaluate real-world outcomes in adults with type 1 diabetes initiating open-source automated insulin delivery systems (OS-AID). Methods: Adults with type 1 diabetes who commenced OS-AID, between May 2016 and April 2021, across 12 centers in the United Kingdom were included. Anonymized clinical data, collected during routine clinical care between December 2019 and November 2023, were submitted to a secure web-based tool within the National Health Service network. Outcomes included change in hemoglobin A1c (HbA1c), sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), user opinion of OS-AID, and event rates (hospital admissions, paramedic callouts, severe hypoglycemia, and adverse events) between baseline and follow-up. Results: In total, 81 OS-AID users were included (51.9% male; 90.1% White British; mean age 41.4 years; median diabetes duration 25 years [IQR 17-32]). Over a mean follow-up of 1.7 years, HbA1c reduced by 0.8% (9 mmol/mol) (7.3 ± 1.1% vs. 6.5 ± 0.7%; P < 0.001), and the percentage of individuals achieving HbA1c ≤ 7.0% (53 mmol/mol) increased from 48.6% to 75.7% (P < 0.001). Diabetes-related distress score reduced by 0.9 (95% confidence interval [CI] -0.3, -1.5; P = 0.006), and Gold score reduced by 0.7 (95% CI -0.1, -1.3; P = 0.022). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) reduced (27.8% at baseline vs. 8.3% at follow-up; P = 0.039). Of those asked, all participants stated that OS-AID had a positive impact on quality of life. The number of hospital admissions was low. Conclusions: The use of OS-AID is associated with long-term improvements in HbA1c, hypoglycemia awareness, and diabetes-related distress in type 1 diabetes. These benefits were achieved without increased rates of hospital admissions, diabetic ketoacidosis, or severe hypoglycemia.
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Affiliation(s)
- Alexandros L Liarakos
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Thomas S J Crabtree
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, United Kingdom
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, United Kingdom
| | - Rachel Patel
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Anastasios Gazis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | - Buddhike Mendis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | - Roselle Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Surrey, United Kingdom
| | - Adele Kennedy
- Northern Heath and Social Care Trust, Antrim Area Hospital, Antrim, Northern Ireland
| | - Neil Black
- Western Health and Social Care Trust, Altnagelvin Area Hospital, Londonderry, Northern Ireland
| | - Robert E J Ryder
- Department of Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, United Kingdom
| | - Emma G Wilmot
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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de Torres-Sánchez A, Ampudia-Blasco FJ, Murillo S, Bellido V, Amor AJ, Mezquita-Raya P. Proposed Practical Guidelines to Improve Glycaemic Management by Reducing Glycaemic Variability in People with Type 1 Diabetes Mellitus. Diabetes Ther 2025; 16:569-589. [PMID: 40019699 PMCID: PMC11926304 DOI: 10.1007/s13300-025-01703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 01/30/2025] [Indexed: 03/01/2025] Open
Abstract
INTRODUCTION For decades, glycaemic variability (GV) was ignored in clinical practice because its precise assessment was challenging and there were no specific recommendations to reduce it. However, the current widespread use of continuous glucose monitoring (CGM) systems has changed this situation. Associations between high GV and risk of hypoglycaemia, onset of macro- and microvascular complications and mortality have been described in type 1 diabetes (T1D). It is therefore important to identify the causes of excessive glycaemic excursions and make recommendations for people with T1D to achieve better glycaemic management by minimising GV in both the short term and the long term. METHODS To achieve these aims, a panel comprising four endocrinologists, one diabetes nurse educator and one nutritionist worked together to reach a consensus on the detection of triggers of GV and propose clinical guidelines to reduce GV and improve glycaemic management by reducing the risk of hypoglycaemias. RESULTS AND CONCLUSIONS In total, four different areas of interest were identified, in which the insufficient education and/or training of people with T1D could lead to higher GV: physical activity; dietary habits; insulin therapy, especially when pump-based systems are not used; and other causes of GV increase. Practical, easy-to-follow recommendations to reduce GV in daily activities were then issued, with the aim of enabling people with T1D to reduce either hypoglycaemia or hyperglycaemia episodes. By doing this, their quality of life may be improved, and progression of chronic complications may be prevented or delayed.
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Affiliation(s)
| | - Francisco J Ampudia-Blasco
- Department of Medicine, Medicine Faculty, University of Valencia (UV), Valencia, Spain.
- Department of Endocrinology and Nutrition, Clinic University Hospital of Valencia, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain.
- INCLIVA Biomedical Research Institute, Valencia, Spain.
- Biomedical Research Networking Center for Diabetes and Associated Metabolic Diseases (CIBERDEM), Biomedical Research Networking Center (CIBER) of Diabetes and Associated Metabolic Diseases, Madrid, Spain.
| | - Serafín Murillo
- Department of Endocrinology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Pedro Mezquita-Raya
- Department of Endocrinology and Nutrition, Hospital Universitario Torrecárdenas, Almería, Spain
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Dlugatch R, Rankin D, Evans M, Oliver N, Ng SM, Lawton J. Understanding inequities in access to diabetes technologies in children and young people with type 1 diabetes: Qualitative study of healthcare professionals' perspectives and views. Diabet Med 2025; 42:e15486. [PMID: 39611761 PMCID: PMC11929559 DOI: 10.1111/dme.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/25/2024] [Accepted: 09/30/2024] [Indexed: 11/30/2024]
Abstract
AIMS We explored healthcare professionals' perceptions and understandings of the factors and considerations underlying inequities in technology access in children and young people (CYP) with type 1 diabetes. METHODS We interviewed (n = 29) healthcare professionals working in paediatric diabetes in England recruited from (n = 15) purposively selected sites. We analysed data thematically. RESULTS Interviewees highlighted multiple, often overlapping barriers to accessing technology faced by CYP with type 1 diabetes from deprived and/or ethnic minority backgrounds. They described the impacts of deprivation on technology uptake, together with the complex social, ethnic and cultural factors that could also reinforce disparities in technology access. Interviewees further highlighted staffing shortfalls as a significant barrier to supporting CYP to use technology, especially those from under-represented groups who they perceived as requiring more staff time to be trained to use technology. While interviewees suggested that unconscious bias has become less prominent, they reported being less likely to recommend technology (especially pumps) to CYP/caregivers who they feared would not use it safely and effectively (e.g. those with low literacy levels). Interviewees also highlighted geographical variability in the technology commissioning process (a 'postcode lottery'). CONCLUSIONS Our findings suggest that without targeted interventions, technology inequities may continue to persist amongst CYP from the most and least deprived areas and from white and ethnic minority groups in the United Kingdom. Additionally, our findings suggest that closing the technology gap will require large-scale governmental and health policies aimed at fostering socioeconomic, ethnic and cultural equality alongside targeted measures to improve technology accessibility.
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Affiliation(s)
- Rachel Dlugatch
- Usher Institute, Medical SchoolUniversity of EdinburghEdinburghUK
| | - David Rankin
- Usher Institute, Medical SchoolUniversity of EdinburghEdinburghUK
| | - Mark Evans
- Institute of Metabolic Science and Department of MedicineUniversity of CambridgeCambridgeUK
| | | | - Sze May Ng
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkUK
- Department of Women's and Children's HealthUniversity of LiverpoolLiverpoolUK
- Paediatric Department, Mersey and West Lancashire Teaching HospitalsOrmskirkUK
| | - Julia Lawton
- Usher Institute, Medical SchoolUniversity of EdinburghEdinburghUK
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Azova S, Laffel L, Lennerz BS, Petty CR, Wolfsdorf J, Rhodes ET, Garvey K. Sociodemographic inequities and use of hybrid closed-loop systems associated with obesity in youth with type 1 diabetes. Diabetes Res Clin Pract 2025; 221:112041. [PMID: 39933614 PMCID: PMC11913344 DOI: 10.1016/j.diabres.2025.112041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/03/2025] [Accepted: 02/05/2025] [Indexed: 02/13/2025]
Abstract
AIMS This study aimed to describe changes over time in rates of overweight and obesity and to identify factors associated with obesity in youth with type 1 diabetes. METHODS We analyzed data from 7360 diabetes medical visits among 2242 youth with type 1 diabetes for ≥1 year followed at a pediatric, tertiary care, academic medical center between 2018 and 2023. Multivariable generalized estimating equations (GEE) analysis and conditional logistic regression (CLR), where each patient had both control (not obesity) and case (obesity) status, were conducted. RESULTS Adjusted annual percentages of patients with obesity increased from 13.8 % in 2018 to 18.2 % in 2023 (P = 0.006); rates of overweight did not differ significantly over time. In multivariable GEE analysis, public insurance (P = 0.026), lower Child Opportunity Index score (P = 0.027), and use of hybridclosed-loop (HCL) systems (P = 0.023) were associated with obesity. In CLR, use of continuous glucose monitor and HCL systems and the sum of their effects (P = 0.002) were associated with obesity. CONCLUSIONS This study revealed increasing rates of obesity in children with type 1 diabetes and identified sociodemographic and diabetes care-related factors associated with obesity, highlighting targets for intervention to decrease future risk of cardiovascular complications.
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Affiliation(s)
- Svetlana Azova
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Lori Laffel
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, United States
| | - Belinda S Lennerz
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Carter R Petty
- Biostatistics and Research Design Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Joseph Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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9
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Cayetano-Jiménez IU, López-Jiménez NP, Bustamante-Bello R. Demystifying Infusion Pumps: Design of a Cost-Effective Platform for Education and Innovation. J Diabetes Sci Technol 2025:19322968251316580. [PMID: 39902656 PMCID: PMC11795575 DOI: 10.1177/19322968251316580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
INTRODUCTION This article presents a cost-effective, modular infusion platform to help diabetes specialists customize and understand infusion pump mechanics and control principles. Traditional insulin pumps are costly and inflexible, limiting accessibility, and particularly in low-resource settings. Inspired by open-source initiatives like OpenAPS, this platform engages specialists in device operation and customization, offering practical insights into infusion technology. METHOD An initial survey assessed technological literacy, customization interests, and feature preferences among Mexican diabetes specialists, followed by a hands-on engagement session with the platform's hardware. Core components are described and chosen for reliability, affordability, and integration ease. A follow-up survey evaluated specialists' confidence and interest in device customization, gathering feedback on usability and design. RESULTS Survey data showed strong specialist interest in understanding device mechanics and high confidence in customization after hands-on engagement. Most specialists found the hardware layout conducive to experimentation, with significant interest in closed-loop capabilities. Key valued features included safety, affordability, ease of use, customization, and integration of diverse continuous glucose monitors, with added suggestions for potential clinical certification, cost-effective supplies, and artificial intelligence integration. CONCLUSION This platform offers a promising educational and developmental tool in diabetes management, bridging clinical application, and customization. Its low-cost, modular design provides a feasible solution for low-resource settings, equipping specialists to tailor devices for specific patient needs. While the platform's educational potential is clear, further studies and validation are essential for a possible transition to a clinical-grade device. Continued development could democratize access to advanced diabetes technology, transforming specialist training, and patient care.
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10
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Laffel LM, Sherr JL, Liu J, Wolf WA, Bispham J, Chapman KS, Finan D, Titievsky L, Liu T, Hagan K, Gaglia J, Chandarana K, Pettus J, Bergenstal R. Limitations in Achieving Glycemic Targets From CGM Data and Persistence of Severe Hypoglycemia in Adults With Type 1 Diabetes Regardless of Insulin Delivery Method. Diabetes Care 2025; 48:273-278. [PMID: 39699995 PMCID: PMC11770157 DOI: 10.2337/dc24-1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/07/2024] [Indexed: 12/21/2024]
Abstract
OBJECTIVE We captured continuous glucose monitoring (CGM) metrics from a large online survey of adults with type 1 diabetes to determine how glycemic outcomes varied by insulin delivery form. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes from the T1D Exchange Registry/online communities completed the survey and contributed retrospective CGM data for up to 1 year. Self-reported glycemic outcomes and CGM measures were described overall and by insulin delivery method. RESULTS The 926 participants completed the survey and provided CGM data. Mean ± SD age was 41.9 ± 15.7 years, and 50.8% reported using automated insulin delivery (AID). While AID users spent more time in range, 27.9% did not achieve time in range targets, 15.5% reported severe hypoglycemic events (SHEs), and 16.0% had CGM-detected level 2 hypoglycemic events. CONCLUSIONS Despite use of diabetes technologies, many individuals are unable to achieve glycemic targets and experience severe hypoglycemia, highlighting the need for novel treatments.
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Affiliation(s)
- Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | - Tina Liu
- Vertex Pharmaceuticals, Boston, MA
| | | | - Jason Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
- Vertex Pharmaceuticals, Boston, MA
| | | | | | - Richard Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN
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11
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Banerjee A, Brackenridge A. Managing diabetic chronic kidney disease in pregnancy: Current clinical practice and uncertainties. Diabet Med 2025; 42:e15460. [PMID: 39568375 DOI: 10.1111/dme.15460] [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: 08/01/2024] [Accepted: 10/17/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Pre-gestational diabetes occurs in approximately 1% of pregnancies in the UK and increases the risk of adverse maternal and fetal outcomes. More women with type 2 than type 1 diabetes are now becoming pregnant and tend to have higher rates of obesity and other multi-morbidities. Chronic kidney disease (CKD) affects approximately 5%-10% of pregnant women with type 1 diabetes and about 2%-3% with type 2 diabetes. Diabetic chronic kidney disease (DCKD) increases the risk of preeclampsia, preterm birth, Caesarean section, small for gestational age (SGA) infant and infant admission to neonatal intensive care unit (NICU), and risks are higher compared to those with diabetes without CKD and those with CKD from other causes. Definitions of CKD in pregnancy are not standardised, and studies are generally small, observational, heterogenous, mainly include women with type 1 diabetes and often predate modern diabetes management such as continuous glucose monitoring and insulin pumps. Therefore, there is a lack of robust data to guide practice and clinical guidelines offer conflicting advice, without precise detail. AIMS We present our approach to caring for women with diabetes and CKD in pregnancy based on available guidelines and clinical experience. DISCUSSION AND CONCLUSION Our practice is to aim for intensive targets for blood pressure and glycaemic control pre and during pregnancy, lower than suggested in many guidelines. The importance of multidisciplinary team work and patient centred care is emphasised. Using standardised prospective data collection to better understand the prevalence and outcomes of diabetes and CKD in contemporary pregnancy populations, is recommended to drive future improvements in care.
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Affiliation(s)
- Anita Banerjee
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Women's Health Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College, London, UK
| | - Anna Brackenridge
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Halperin IJ, Wicklow B, Amed S, Chambers A, Courage C, Cummings E, Kirkland P, MacKay D, Nakhla M, Punthakee Z, Ryan PM, Sawatsky L, Senior PA, Sidhu BS, Weisman A. Glycemic Management Across the Lifespan for People With Type 1 Diabetes: A Clinical Practice Guideline. Can J Diabetes 2025; 49:5-18. [PMID: 40155190 DOI: 10.1016/j.jcjd.2025.01.001] [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: 04/01/2025]
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13
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Karges B, Rosenbauer J, Stahl-Pehe A, Flury M, Biester T, Tauschmann M, Lilienthal E, Hamann J, Galler A, Holl RW. Hybrid closed-loop insulin therapy and risk of severe hypoglycaemia and diabetic ketoacidosis in young people (aged 2-20 years) with type 1 diabetes: a population-based study. Lancet Diabetes Endocrinol 2025; 13:88-96. [PMID: 39701114 DOI: 10.1016/s2213-8587(24)00284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/03/2024] [Accepted: 09/03/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND The effect of closed-loop insulin delivery on the risk of acute diabetes complications in people with type 1 diabetes is unclear. We investigated whether the rates of severe hypoglycaemia and diabetic ketoacidosis are lower with hybrid closed-loop insulin therapy compared with sensor-augmented (open-loop) pump therapy in a large cohort of young people. METHODS In this population-based cohort study, we evaluated young people with type 1 diabetes from 250 diabetes centres in Germany, Austria, Switzerland, and Luxembourg participating in the Diabetes Prospective Follow-up (DPV) initiative. Included participants were aged 2-20 years, with diabetes duration of more than 1 year, and were treated between Jan 1, 2021, and Dec 31, 2023. The primary outcomes were the rates of severe hypoglycaemia and ketoacidosis in people using closed-loop therapy versus open-loop therapy. Key secondary outcomes were differences in HbA1c levels, percentage of time in glucose range of 3·9-10·0 mmol/L, and glycaemic variability. To account for relevant confounders, we applied propensity score inverse probability of treatment weighting considering several baseline characteristics. FINDINGS 13 922 young people (median age 13·2 years [IQR 10·0 to 16·0]; 51% male) in the DPV database met inclusion criteria and were included in the analysis. 7088 used closed-loop therapy and 6834 used open-loop therapy, with a median observation time of 1·6 years [IQR 1·1 to 2·4]. Individuals using closed-loop therapy had a higher rate of ketoacidosis (1·74 per 100 patient-years) than those using open-loop therapy (0·96 per 100 patient-years; incidence rate ratio 1·81 [1·37 to 2·40], p<0·0001) and there was no significant difference between groups in the rate of severe hypoglycaemia (5·59 per 100 patient-years vs 6·63 per 100 patient-years; incidence rate ratio 0·84 [95% CI 0·69 to 1·03], p=0·089). Individuals using closed-loop therapy had a lower rate of hypoglycaemic coma (0·62 per 100 patient-years) compared with individuals using open-loop therapy (0·91 per 100 patient-years; incidence rate ratio 0·68 [95% CI 0·48 to 0·97], p=0·034). Those in the closed-loop therapy group also had a lower HbA1c level (7·34% vs 7·50%; difference -0·16% [95% CI -0·20 to -0·13], p=0·0007), higher percentage of time in target glucose range of 3·9-10·0 mmol/L (64% vs 52%, difference 12% [10 to 14], p<0·0001), and less glycaemic variability (coefficient of variation 35·4% vs 38·3%; difference -2·9% [-3·3 to -2·5], p<0·0001) than those in the open-loop therapy group. The rate of ketoacidosis was particularly high in young people with HbA1c of 8·5% or higher in the closed-loop therapy group (5·25 per 100 patient-years) compared with the open-loop therapy group (1·53 per 100 patient-years; incidence rate ratio 3·43 [95% CI 1·69 to 6·97], p<0·0001). INTERPRETATION Hybrid closed-loop insulin delivery has no significant effect on the rate of severe hypoglycaemia, and is associated with an increased risk of diabetic ketoacidosis, but is associated with a reduced risk of hypoglycaemic coma and improved glycaemia. These findings indicate the need for additional educational measures for the use of closed-loop insulin delivery. FUNDING German Center for Diabetes Research, German Diabetes Society, and Robert Koch Institute.
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Affiliation(s)
- Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Monika Flury
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Torben Biester
- Auf der Bult Diabetes Centre for Children and Adolescents, Hannover, Germany
| | - Martin Tauschmann
- Medical University of Vienna, Department of Pediatrics, Vienna, Austria
| | - Eggert Lilienthal
- University Hospital St Josef Bochum, Department of Pediatrics, Bochum, Germany
| | | | - Angela Galler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Sozialpädiatrisches Zentrum, Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
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Craig ME. Technology for type 1 diabetes: what impact will it have? Lancet Diabetes Endocrinol 2025; 13:76-77. [PMID: 39701115 DOI: 10.1016/s2213-8587(24)00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 10/30/2024] [Indexed: 12/21/2024]
Affiliation(s)
- Maria E Craig
- Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
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15
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Tanenbaum ML, Commissariat PV, Wilmot EG, Lange K. Navigating the Unique Challenges of Automated Insulin Delivery Systems to Facilitate Effective Uptake, Onboarding, and Continued Use. J Diabetes Sci Technol 2025; 19:47-53. [PMID: 39212371 PMCID: PMC11571946 DOI: 10.1177/19322968241275963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advances in diabetes technologies have enabled automated insulin delivery (AID) systems, which have demonstrated benefits to glycemia, psychosocial outcomes, and quality of life for people with type 1 diabetes (T1D). Despite the many demonstrated benefits, AID systems come with their own unique challenges: continued user attention and effort, barriers to equitable access, personal costs vs benefits, and integration of the system into daily life. The purpose of this narrative review is to identify challenges and opportunities for supporting uptake and onboarding of AID systems to ultimately support sustained AID use. Setting realistic expectations, providing comprehensive training, developing willingness to adopt new treatments and workflows, upskilling of diabetes team members, and increasing flexibility of care to tailor care to individual needs, preferences, lifestyle, and personal goals will be most effective in facilitating effective, widespread, person-centered implementation of AID systems.
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Affiliation(s)
- Molly L. Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Persis V. Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, USA
| | - Emma G. Wilmot
- Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, University of Nottingham, Nottingham, UK
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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16
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Renard E, Weinstock RS, Aleppo G, Bode BW, Brown SA, Castorino K, Hirsch IB, Kipnes MS, Laffel LM, Lal RA, Penfornis A, Riveline JP, Shah VN, Thivolet C, Ly TT. Efficacy and Safety of a Tubeless AID System Compared With Pump Therapy With CGM in the Treatment of Type 1 Diabetes in Adults With Suboptimal Glycemia: A Randomized, Parallel-Group Clinical Trial. Diabetes Care 2024; 47:2248-2257. [PMID: 39423118 PMCID: PMC11655411 DOI: 10.2337/dc24-1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 09/20/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVE To examine the efficacy and safety of the tubeless Omnipod 5 automated insulin delivery (AID) system compared with pump therapy with a continuous glucose monitor (CGM) in adults with type 1 diabetes with suboptimal glycemic outcomes. RESEARCH DESIGN AND METHODS In this 13-week multicenter, parallel-group, randomized controlled trial performed in the U.S. and France, adults aged 18-70 years with type 1 diabetes and HbA1c 7-11% (53-97 mmol/mol) were randomly assigned (2:1) to intervention (tubeless AID) or control (pump therapy with CGM) following a 2-week standard therapy period. The primary outcome was a treatment group comparison of time in range (TIR) (70-180 mg/dL) during the trial period. RESULTS A total of 194 participants were randomized, with 132 assigned to the intervention and 62 to the control. TIR during the trial was 4.2h/day higher in the intervention compared with the control group (mean difference 17.5% [95% CI 14.0%, 21.1%]; P < 0.0001). The intervention group had a greater reduction in HbA1c from baseline compared with the control group (mean ± SD -1.24 ± 0.75% [-13.6 ± 8.2 mmol/mol] vs. -0.68 ± 0.93% [-7.4 ± 10.2 mmol/mol], respectively; P < 0.0001), accompanied by a significantly lower time <70 mg/dL (1.18 ± 0.86% vs. 1.75 ± 1.68%; P = 0.005) and >180 mg/dL (37.6 ± 11.4% vs. 54.5 ± 15.4%; P < 0.0001). All primary and secondary outcomes were met. No instances of diabetes-related ketoacidosis or severe hypoglycemia occurred in the intervention group. CONCLUSIONS Use of the tubeless AID system led to improved glycemic outcomes compared with pump therapy with CGM among adults with type 1 diabetes, underscoring the clinical benefit of AID and bolstering recommendations to establish AID systems as preferred therapy for this population.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology and Diabetes, Montpellier University Hospital; INSERM CIC1411 Clinical Investigation Center, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Ruth S. Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | - Irl B. Hirsch
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Rayhan A. Lal
- School of Medicine, Stanford University, Stanford, CA
| | - Alfred Penfornis
- Hospital Center Sud Francilien, Paris-Saclay University, Corbeil-Essonnes, France
| | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
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Oliver N, Reddy M, Leelarathna L. Continuous glucose sensor accuracy: beyond the headline metric. Lancet Diabetes Endocrinol 2024; 12:934-938. [PMID: 39419044 DOI: 10.1016/s2213-8587(24)00245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 10/19/2024]
Abstract
The promotion of continuous glucose monitoring (CGM) to standard of care for type 1 diabetes and insulin-treated type 2 diabetes reflects a robust and wide evidence base for the technology's effectiveness supported by real-world efficacy data. Multiple CGM devices are available worldwide and are marketed, in part, based on accuracy data. In this Viewpoint, we argue that accuracy metrics are no longer a point of difference between CGM devices as almost all exceed an acceptable threshold. We also argue that domains of standardisation, clinical outcomes, and sustainability should now be given primacy as CGM devices seek to be implemented for new indications. These domains are key for the success of the next generation of CGM devices. Additionally, we discuss the need to address inequalities in accessing clinically impactful technologies.
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Affiliation(s)
- Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
| | - Monika Reddy
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Lala Leelarathna
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Liarakos AL, Crabtree TSJ, Wilmot EG. Patient-reported outcomes in studies of diabetes technology: What matters. Diabetes Obes Metab 2024; 26 Suppl 7:59-73. [PMID: 39215657 PMCID: PMC11646481 DOI: 10.1111/dom.15858] [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: 05/26/2024] [Revised: 07/20/2024] [Accepted: 07/20/2024] [Indexed: 09/04/2024]
Abstract
In recent years, diabetes technologies have revolutionized the care of people with type 1 diabetes (T1D). Emerging evidence suggests that people with type 2 diabetes (T2D) can experience similar benefits from these advances in technology. While glycaemic outcomes are often a primary focus, the lived experience of the person with diabetes is equally important. In this review, we describe the impact of diabetes technologies on patient-reported outcome measures (PROMs). We highlight that most of the published studies investigated PROMs as secondary outcomes. Continuous glucose monitoring systems may have an important role in improving PROMs in individuals with T1D, which may be driven by the prevention or proactive management of hypoglycaemia. In people with T2D, continuous glucose monitoring may also have an important role in improving PROMs, particularly in those treated with insulin therapy. The impact of insulin pumps on PROMs seems positive in T1D, while there is limited evidence in T2D. Studies of hybrid closed-loop therapies suggest increased treatment satisfaction, improved quality of life and decreased diabetes-related distress in T1D, but it is unclear whether these benefits are because of a 'class-effect' or individual systems. We conclude that PROMs deserve a more central role in trials and clinical practice, and we discuss directions for future research.
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Affiliation(s)
- Alexandros L. Liarakos
- Department of Diabetes and EndocrinologyUniversity Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby HospitalDerbyUK
- School of Medicine, Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Thomas S. J. Crabtree
- Department of Diabetes and EndocrinologyUniversity Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby HospitalDerbyUK
- School of Medicine, Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Emma G. Wilmot
- Department of Diabetes and EndocrinologyUniversity Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby HospitalDerbyUK
- School of Medicine, Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
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Efthymiadis A, Bastounis A, Liu L, Bourlaki M, Spinos D, Tsikopoulos K. The impact of closed-loop automated insulin delivery systems on hypoglycaemia awareness in people living with type 1 diabetes: A systematic review and meta-analysis. J Diabetes Metab Disord 2024; 23:2251-2261. [PMID: 39610490 PMCID: PMC11599659 DOI: 10.1007/s40200-024-01492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/17/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVES Impaired awareness of hyperglycaemia (IAH) affects approximately 20-40% of people living with type 1 diabetes (T1D), predisposing them to severe hypoglycaemia. This systematic review evaluated the efficacy of closed-loop automated insulin delivery systems (CL-AID) in restoring IAH compared with standard diabetes care, including other diabetes technologies. METHODS Six electronic databases were searched for published and unpublished observational and randomised-control studies (RCTs) from inception to 29th of May 2024. The results of observational studies and RCTs were meta-analysed separately to calculate the effect of CL-AID on IAH in people living with T1D. Quality assessment of studies was performed using the Joanna-Briggs appraisal tool for cohort studies and the Risk of Bias (Rob-2) tool for RCTs. RESULTS Meta-analysis of four prospective observations studies (n = 583) demonstrated a statistically significant improvement in hypoglycaemia awareness upon transition to a hybrid closed-loop (HCL) system compared with standard diabetes care in people with T1D, Clarke score mean difference (MD) of -0.45 (-0.69 to -0.22, p = 0.0001). However, this was less than 1 point, which is the minimum clinically important difference (MCID) of Clarke score. Meta-analysis of three RCTs (n = 55) comparing standard diabetes care did not demonstrate any statistically significant effect on hypoglycaemia awareness, Clarke score MD of -0.69 (-1.89 to 0.50, p = 0.26). CONCLUSIONS This systematic review demonstrated that transition from standard diabetes care to HCL has the potential to improve hypoglycaemia awareness in people with T1D and IAH, but this might not be of major clinical significance. Hence, psychoeducational interventions continue to be the cornerstone of IAH management. Novel therapeutic modalities, such as bi-hormonal automated delivery systems, need to be further explored to help restore hypoglycaemia awareness. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-024-01492-6.
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Affiliation(s)
- Agathoklis Efthymiadis
- Department of Diabetes & Endocrinology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, Harrow HA1 3UJ UK
| | - Anastasios Bastounis
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Linda Liu
- LNWH Library Service, London North West University Healthcare NHS Trust, Watford Road, London, Harrow HA1 3UJ UK
| | - Marianthi Bourlaki
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB UK
| | - Dimitrios Spinos
- Department of Otorhinolaryngology, Head and Neck Surgery, South Warwickshire University Hospitals NHS Trust, Lakin Rd, Warwick, CV345B UK
| | - Konstantinos Tsikopoulos
- Orthopaedic Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, 54124OX3 7LD Oxford, UK
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20
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Boughton CK, Hovorka R. The role of automated insulin delivery technology in diabetes. Diabetologia 2024; 67:2034-2044. [PMID: 38740602 PMCID: PMC11457686 DOI: 10.1007/s00125-024-06165-w] [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: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 05/16/2024]
Abstract
The role of automated insulin delivery systems in diabetes is expanding. Hybrid closed-loop systems are being used in routine clinical practice for treating people with type 1 diabetes. Encouragingly, real-world data reflects the performance and usability observed in clinical trials. We review the commercially available hybrid closed-loop systems, their distinctive features and the associated real-world data. We also consider emerging indications for closed-loop systems, including the treatment of type 2 diabetes where variability of day-to-day insulin requirements is high, and other challenging applications for this technology. We discuss issues around access and implementation of closed-loop technology, and consider the limitations of present closed-loop systems, as well as innovative approaches that are being evaluated to improve their performance.
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Affiliation(s)
- Charlotte K Boughton
- Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| | - Roman Hovorka
- Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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21
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Liarakos AL, Lim JZM, Leelarathna L, Wilmot EG. The use of technology in type 2 diabetes and prediabetes: a narrative review. Diabetologia 2024; 67:2059-2074. [PMID: 38951212 PMCID: PMC11446986 DOI: 10.1007/s00125-024-06203-7] [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: 03/05/2024] [Accepted: 05/09/2024] [Indexed: 07/03/2024]
Abstract
The increasing incidence of type 2 diabetes, which represents 90% of diabetes cases globally, is a major public health concern. Improved glucose management reduces the risk of vascular complications and mortality; however, only a small proportion of the type 2 diabetes population have blood glucose levels within the recommended treatment targets. In recent years, diabetes technologies have revolutionised the care of people with type 1 diabetes, and it is becoming increasingly evident that people with type 2 diabetes can also benefit from these advances. In this review, we describe the current knowledge regarding the role of technologies for people living with type 2 diabetes and the evidence supporting their use in clinical practice. We conclude that continuous glucose monitoring systems deliver glycaemic benefits for individuals with type 2 diabetes, whether treated with insulin or non-insulin therapy; further data are required to evaluate the role of these systems in those with prediabetes (defined as impaired glucose tolerance and/or impaired fasting glucose and/or HbA1c levels between 39 mmol/mol [5.7%] and 47 mmol/mol [6.4%]). The use of insulin pumps seems to be safe and effective in people with type 2 diabetes, especially in those with an HbA1c significantly above target. Initial results from studies exploring the impact of closed-loop systems in type 2 diabetes are promising. We discuss directions for future research to fully understand the potential benefits of integrating evidence-based technology into care for people living with type 2 diabetes and prediabetes.
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Affiliation(s)
- Alexandros L Liarakos
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jonathan Z M Lim
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Lalantha Leelarathna
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
- Department of Diabetes, Imperial College Healthcare NHS Trust, London, UK
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Emma G Wilmot
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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22
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McLean A, Maple-Brown L, Murphy HR. Technology advances in diabetes pregnancy: right technology, right person, right time. Diabetologia 2024; 67:2103-2113. [PMID: 38967667 PMCID: PMC11447080 DOI: 10.1007/s00125-024-06216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
This review outlines some of the extraordinary recent advances in diabetes technology, which are transforming the management of type 1 diabetes before, during and after pregnancy. It highlights recent improvements associated with use of continuous glucose monitoring (CGM) but acknowledges that neither CGM nor insulin pump therapy are adequate for achieving the pregnancy glucose targets. Furthermore, even hybrid closed-loop (HCL) systems that are clinically effective outside of pregnancy may not confer additional benefits throughout pregnancy. To date, there is only one HCL system, the CamAPS FX, with a strong evidence base for use during pregnancy, suggesting that the pregnancy benefits are HCL system specific. This is in stark contrast to HCL system use outside of pregnancy, where benefits are HCL category specific. The CamAPS FX HCL system has a rapidly adaptive algorithm and lower glucose targets with benefits across all maternal glucose categories, meaning that it is applicable for all women with type 1 diabetes, before and during pregnancy. For women of reproductive years living with type 2 diabetes, the relative merits of using non-insulin pharmacotherapies vs diabetes technology (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) are unknown. Despite the urgent unmet need and potential benefits, studies of pharmacotherapy and technology use are extremely limited in pregnant women with type 2 diabetes.
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Affiliation(s)
- Anna McLean
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Endocrinology Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK.
- Norfolk and Norwich NHS Foundation Trust, Diabetes and Antenatal Care, Norwich, UK.
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23
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Mallik R, Kar P, Mulder H, Krook A. The future is here: an overview of technology in diabetes. Diabetologia 2024; 67:2019-2026. [PMID: 39212678 DOI: 10.1007/s00125-024-06235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Ritwika Mallik
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Partha Kar
- Portsmouth Hospitals University NHS Trust, NHS England, Portsmouth, UK.
| | - Hindrik Mulder
- Unit of Molecular Metabolism, Lund University Diabetes Centre, Malmö, Sweden
| | - Anna Krook
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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24
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Yang Q, Zeng B, Hao J, Yang Q, Sun F. Real-world glycaemic outcomes of automated insulin delivery in type 1 diabetes: A meta-analysis. Diabetes Obes Metab 2024; 26:3753-3763. [PMID: 38888056 DOI: 10.1111/dom.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
AIM To evaluate the real-world effectiveness of automated insulin delivery (AID) systems in patients with type 1 diabetes (T1D). MATERIALS AND METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for studies published up until 2 March 2024. We included pragmatic randomized controlled trials (RCTs), cohort studies, and before-after studies that compared AID systems with conventional insulin therapy in real-world settings and reported continuous glucose monitoring outcomes. Percent time in range (TIR; 3.9-10 mmol/L), time below range (TBR; <3.9 mmol/L), time above range (TAR; >10 mmol/L), and glycated haemoglobin (HbA1c) level were extracted. Data were summarized as mean differences (MDs) with 95% confidence interval. RESULTS A total of 23 before-after studies (101 704 participants) were included in the meta-analysis. AID systems were associated with an increased percentage of TIR (11.61%, 10.47 to 12.76; p < 0.001). The favourable effect of AID systems was consistently observed when used continuously for 6 (11.76%) or 12 months (11.33%), and in both children (12.16%) and adults (11.04%). AID systems also showed favourable effects on TBR (-0.53%, -0.63 to -0.42), TAR (-9.65%, -10.63 to -8.67) and HbA1c level (-0.42%, -0.47 to -0.37) when compared with previous treatments. CONCLUSIONS Similar improvements in glycaemic parameters were observed in real-world settings in RCTs using AID systems in T1D. AID systems benefit both children and adults by increasing TIR for both short- and long-term interventions.
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Affiliation(s)
- Qin Yang
- Department of Cardiology, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Baoqi Zeng
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Emergency, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Jiayi Hao
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
- Xinjiang Medical University, Xinjiang, China
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25
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Umpierrez GE, Davis GM, ElSayed NA, Fadini GP, Galindo RJ, Hirsch IB, Klonoff DC, McCoy RG, Misra S, Gabbay RA, Bannuru RR, Dhatariya KK. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report. Diabetes Care 2024; 47:1257-1275. [PMID: 39052901 PMCID: PMC11272983 DOI: 10.2337/dci24-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 07/27/2024]
Abstract
The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE), and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes health care professionals and individuals with diabetes.
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Affiliation(s)
- Guillermo E. Umpierrez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Georgia M. Davis
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Nuha A. ElSayed
- American Diabetes Association, Arlington, VA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Gian Paolo Fadini
- Department of Medicine, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Rodolfo J. Galindo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Irl B. Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA
| | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- University of Maryland Institute for Health Computing, Bethesda, MD
| | - Shivani Misra
- Division of Metabolism, Digestion & Reproduction, Imperial College London, U.K
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, U.K
| | - Robert A. Gabbay
- American Diabetes Association, Arlington, VA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Ketan K. Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, U.K
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, U.K
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26
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Umpierrez GE, Davis GM, ElSayed NA, Fadini GP, Galindo RJ, Hirsch IB, Klonoff DC, McCoy RG, Misra S, Gabbay RA, Bannuru RR, Dhatariya KK. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia 2024; 67:1455-1479. [PMID: 38907161 PMCID: PMC11343900 DOI: 10.1007/s00125-024-06183-8] [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: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 06/23/2024]
Abstract
The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE) and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycaemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment and prevention of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes healthcare professionals and individuals with diabetes.
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Affiliation(s)
- Guillermo E Umpierrez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Georgia M Davis
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nuha A ElSayed
- American Diabetes Association, Arlington, VA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gian Paolo Fadini
- Department of Medicine, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Rodolfo J Galindo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Rozalina G McCoy
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland Institute for Health Computing, Bethesda, MD, USA
| | - Shivani Misra
- Division of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Robert A Gabbay
- American Diabetes Association, Arlington, VA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Ketan K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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27
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Forlenza GP, DeSalvo DJ, Aleppo G, Wilmot EG, Berget C, Huyett LM, Hadjiyianni I, Méndez JJ, Conroy LR, Ly TT, Sherr JL. Real-World Evidence of Omnipod ® 5 Automated Insulin Delivery System Use in 69,902 People with Type 1 Diabetes. Diabetes Technol Ther 2024; 26:514-525. [PMID: 38375861 DOI: 10.1089/dia.2023.0578] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: The Omnipod® 5 Automated Insulin Delivery System was associated with favorable glycemic outcomes for people with type 1 diabetes (T1D) in two pivotal clinical trials. Real-world evidence is needed to explore effectiveness in nonstudy conditions. Methods: A retrospective analysis of the United States Omnipod 5 System users (aged ≥2 years) with T1D and sufficient data (≥90 days of data; ≥75% of days with ≥220 continuous glucose monitor readings/day) available in Insulet Corporation's device and person-reported datasets as of July 2023 was performed. Target glucose setting usage (i.e., 110-150 mg/dL in 10 mg/dL increments) was summarized and glycemic outcomes were examined. Subgroup analyses of those using the lowest average glucose target (110 mg/dL) and stratification by baseline characteristics (e.g., age, prior therapy, health insurance coverage) were conducted. Results: In total, 69,902 users were included. Multiple and higher glucose targets were more commonly used in younger age groups. Median percentage of time in range (TIR; 70-180 mg/dL) was 68.8%, 61.3%, and 53.6% for users with average glucose targets of 110, 120, and 130-150 mg/dL, respectively, with minimal time <70 mg/dL (all median <1.13%). Among those with an average glucose target of 110 mg/dL (n = 37,640), median TIR was 65.0% in children and adolescents (2-17 years) and 69.9% in adults (≥18 years). Subgroup analyses of users transitioning from Omnipod DASH or multiple daily injections and of Medicaid/Medicare users demonstrated favorable glycemic outcomes among these groups. Conclusion: These glycemic outcomes from a large and diverse sample of nearly 70,000 children and adults demonstrate effective use of the Omnipod 5 System under real-world conditions.
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Affiliation(s)
- Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel J DeSalvo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma G Wilmot
- Translational Medical Sciences, University of Nottingham, School of Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Cari Berget
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | - Trang T Ly
- Insulet Corporation, Acton, Massachusetts, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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28
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Rodríguez-Muñoz A, Picón-César MJ, Tinahones FJ, Martínez-Montoro JI. Type 1 diabetes-related distress: Current implications in care. Eur J Intern Med 2024; 125:19-27. [PMID: 38609810 DOI: 10.1016/j.ejim.2024.03.030] [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: 09/19/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
Type 1 diabetes (T1D) is a complex chronic disease associated with major health and economic consequences, also involving important issues in the psychosocial sphere. In this regard, T1D-related distress, defined as the emotional burden of living with T1D, has emerged as a specific entity related to the disease. Diabetes distress (DD) is an overlooked but prevalent condition in people living with T1D, and has significant implications in both glycemic control and mental health in this population. Although overlapping symptoms may be found between DD and mental health disorders, specific approaches should be performed for the diagnosis of this problem. In recent years, different DD-targeted interventions have been postulated, including behavioral and psychosocial strategies. Moreover, new technologies in this field may be helpful to address DD in people living with T1D. In this article, we summarize the current knowledge on T1D-related distress, and we also discuss the current approaches and future perspectives in its management.
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Affiliation(s)
- Alba Rodríguez-Muñoz
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - María José Picón-César
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Medicine, University of Málaga, Málaga, Spain
| | - José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Medicine, University of Málaga, Málaga, Spain.
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29
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Beato-Víbora PI, Chico A, Moreno-Fernandez J, Bellido-Castañeda V, Nattero-Chávez L, Picón-César MJ, Martínez-Brocca MA, Giménez-Álvarez M, Aguilera-Hurtado E, Climent-Biescas E, Azriel-Mir S, Rebollo-Román Á, Yoldi-Vergara C, Pazos-Couselo M, Alonso-Carril N, Quirós C. A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting. Diabetes Care 2024; 47:216-224. [PMID: 37948469 PMCID: PMC11387664 DOI: 10.2337/dc23-1355] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.
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Affiliation(s)
| | - Ana Chico
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER-BBN, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carmen Quirós
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
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30
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Iacobucci G. Artificial pancreases for type 1 diabetes: Better access is "watershed moment"-but delivery is key. BMJ 2024; 384:q102. [PMID: 38262676 DOI: 10.1136/bmj.q102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
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