51
|
Garcia-Tirado J, Farhy L, Nass R, Kollar L, Clancy-Oliveri M, Basu R, Kovatchev B, Basu A. Automated Insulin Delivery with SGLT2i Combination Therapy in Type 1 Diabetes. Diabetes Technol Ther 2022; 24:461-470. [PMID: 35255229 PMCID: PMC9464084 DOI: 10.1089/dia.2021.0542] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as adjunct therapy to insulin in type 1 diabetes (T1D) has been previously studied. In this study, we present data from the first free-living trial combining low-dose SGLT2i with commercial automated insulin delivery (AID) or predictive low glucose suspend (PLGS) systems. Methods: In an 8-week, randomized, controlled crossover trial, adults with T1D received 5 mg/day empagliflozin (EMPA) or no drug (NOEMPA) as adjunct to insulin therapy. Participants were also randomized to sequential orders of AID (Control-IQ) and PLGS (Basal-IQ) systems for 4 and 2 weeks, respectively. The primary endpoint was percent time-in-range (TIR) 70-180 mg/dL during daytime (7:00-23:00 h) while on AID (NCT04201496). Findings: A total of 39 subjects were enrolled, 35 were randomized, 34 (EMPA; n = 18 and NOEMPA n = 16) were analyzed according to the intention-to-treat principle, and 32 (EMPA; n = 16 and NOEMPA n = 16) completed the trial. On AID, EMPA versus NOEMPA had higher daytime TIR 81% versus 71% with a mean estimated difference of +9.9% (confidence interval [95% CI] 0.6-19.1); p = 0.04. On PLGS, the EMPA versus NOEMPA daytime TIR was 80% versus 63%, mean estimated difference of +16.5% (95% CI 7.3-25.7); p < 0.001. One subject on SGLT2i and AID had one episode of diabetic ketoacidosis with nonfunctioning insulin pump infusion site occlusion contributory. Interpretation: In an 8-week outpatient study, addition of 5 mg daily empagliflozin to commercially available AID or PLGS systems significantly improved daytime glucose control in individuals with T1D, without increased hypoglycemia risk. However, the risk of ketosis and ketoacidosis remains. Therefore, future studies with SGLT2i will need modifications to closed-loop control algorithms to enhance safety.
Collapse
Affiliation(s)
- Jose Garcia-Tirado
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Leon Farhy
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Ralf Nass
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Laura Kollar
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Mary Clancy-Oliveri
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Rita Basu
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Ananda Basu
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Address correspondence to: Ananda Basu, MD, Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| |
Collapse
|
52
|
Domingo-Lopez DA, Lattanzi G, H. J. Schreiber L, Wallace EJ, Wylie R, O'Sullivan J, Dolan EB, Duffy GP. Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus. Adv Drug Deliv Rev 2022; 185:114280. [PMID: 35405298 DOI: 10.1016/j.addr.2022.114280] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/21/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus refers to a group of metabolic disorders which affect how the body uses glucose impacting approximately 9% of the population worldwide. This review covers the most recent technological advances envisioned to control and/or reverse Type 1 diabetes mellitus (T1DM), many of which will also prove effective in treating the other forms of diabetes mellitus. Current standard therapy for T1DM involves multiple daily glucose measurements and insulin injections. Advances in glucose monitors, hormone delivery systems, and control algorithms generate more autonomous and personalised treatments through hybrid and fully automated closed-loop systems, which significantly reduce hypo- and hyperglycaemic episodes and their subsequent complications. Bi-hormonal systems that co-deliver glucagon or amylin with insulin aim to reduce hypoglycaemic events or increase time spent in target glycaemic range, respectively. Stimuli responsive materials for the controlled delivery of insulin or glucagon are a promising alternative to glucose monitors and insulin pumps. By their self-regulated mechanism, these "smart" drugs modulate their potency, pharmacokinetics and dosing depending on patients' glucose levels. Islet transplantation is a potential cure for T1DM as it restores endogenous insulin and glucagon production, but its use is not yet widespread due to limited islet sources and risks of chronic immunosuppression. New encapsulation strategies that promote angiogenesis and oxygen delivery while protecting islets from recipients' immune response may overcome current limiting factors.
Collapse
|
53
|
Luo X, Yu Q, Liu Y, Gai W, Ye L, Yang L, Cui Y. Closed-Loop Diabetes Minipatch Based on a Biosensor and an Electroosmotic Pump on Hollow Biodegradable Microneedles. ACS Sens 2022; 7:1347-1360. [PMID: 35442623 DOI: 10.1021/acssensors.1c02337] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Developing a miniaturized, low-cost, and smart closed-loop system for diabetes could significantly improve life quality and benefit millions of people. Conventional closed-loop devices are large in size and exorbitant. Here, we unprecedentedly demonstrate an electrically controlled flexible closed-loop patch for continuous diabetes management by integrating hollow biodegradable microneedles with a biosensing device and an electroosmotic pump. The hollow microneedles were fabricated using a combination of soft lithography and micromachining. The outer layer of the microneedles was functionalized to serve as a biosensing device for the in situ sensitive and accurate monitoring of interstitial glucose. The inner layer of the microneedles was integrated with a flexible electroosmotic pump to deliver insulin, and the delivery rate was electrically controlled by the glucose level from the biosensing device. The closed-loop system successfully stabilized the blood glucose levels of diabetic rats in a normal and safe range. The system is painless, miniaturized, cost-effective, and flexible. It is anticipated that it could open up exciting new avenues for fundamental studies of new closed-loop devices as well as practical applications for diabetes management.
Collapse
Affiliation(s)
- Xiaojin Luo
- School of Materials Science and Engineering, Peking University, Beijing 100871, P. R. China
| | - Qi Yu
- Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, P. R. China
| | - Yiqun Liu
- School of Materials Science and Engineering, Peking University, Beijing 100871, P. R. China
| | - Weixin Gai
- School of Integrated Circuits, Peking University, Beijing 100871, P. R. China
| | - Le Ye
- School of Integrated Circuits, Peking University, Beijing 100871, P. R. China
| | - Li Yang
- Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, P. R. China
| | - Yue Cui
- School of Materials Science and Engineering, Peking University, Beijing 100871, P. R. China
| |
Collapse
|
54
|
Haidar A, Lovblom LE, Cardinez N, Gouchie-Provencher N, Orszag A, Tsoukas MA, Falappa CM, Jafar A, Ghanbari M, Eldelekli D, Rutkowski J, Yale JF, Perkins BA. Empagliflozin add-on therapy to closed-loop insulin delivery in type 1 diabetes: a 2 × 2 factorial randomized crossover trial. Nat Med 2022; 28:1269-1276. [PMID: 35551290 DOI: 10.1038/s41591-022-01805-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
There is a need to optimize closed-loop automated insulin delivery in type 1 diabetes. We assessed the glycemic efficacy and safety of empagliflozin 25 mg d-1 as add-on therapy to insulin delivery with a closed-loop system. We performed a 2 × 2 factorial randomized, placebo-controlled, crossover two-center trial in adults, assessing 4 weeks of closed-loop delivery versus sensor-augmented pump (SAP) therapy and empagliflozin versus placebo. The primary outcome was time spent in the glucose target range (3.9-10.0 mmol l-1). Primary comparisons were empagliflozin versus placebo in each of closed-loop or SAP therapy; the remaining comparisons were conditional on its significance. Twenty-four of 27 randomized participants were included in the final analysis. Compared to placebo, empagliflozin improved time in target range with closed-loop therapy by 7.2% and in SAP therapy by 11.4%. Closed-loop therapy plus empagliflozin improved time in target range compared to SAP therapy plus empagliflozin by 6.1% but by 17.5% for the combination of closed-loop therapy and empagliflozin compared to SAP therapy plus placebo. While no diabetic ketoacidosis or severe hypoglycemia occurred during any intervention, uncomplicated ketosis events were more common on empagliflozin. Empagliflozin 25 mg d-1 added to automated insulin delivery improves glycemic control but increases ketone concentration and ketosis compared to placebo.
Collapse
Affiliation(s)
- Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada.,The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.,Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Leif Erik Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nancy Cardinez
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Andrej Orszag
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael A Tsoukas
- The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.,Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - C Marcelo Falappa
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adnan Jafar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Milad Ghanbari
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Devrim Eldelekli
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Joanna Rutkowski
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Jean-François Yale
- The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.,Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. .,Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
55
|
Abstract
Combining technologies including rapid insulin analogs, insulin pumps, continuous glucose monitors, and control algorithms has allowed for the creation of automated insulin delivery (AID) systems. These systems have proven to be the most effective technology for optimizing metabolic control and could hold the key to broadly achieving goal-level glycemic control for people with type 1 diabetes. The use of AID has exploded in the past several years with several options available in the United States and even more in Europe. In this article, we review the largest studies involving these AID systems, and then examine future directions for AID with an emphasis on usability.
Collapse
Affiliation(s)
- Gregory P. Forlenza
- School of Medicine, Barbara Davis Center, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Rayhan A. Lal
- Department of Medicine & Pediatrics, Divisions of Endocrinology Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| |
Collapse
|
56
|
Benhamou PY, Lablanche S, Vambergue A, Pou S, Madrolle S, Romero-Ugalde H, Franc S, Charpentier G. The beneficial effects of closed-loop insulin delivery in patients with highly unstable type 1 diabetes eligible for islet transplantation are maintained over 6 months: An extension study of the DBLHU-WP10 trial. Diabetes Obes Metab 2022; 24:956-961. [PMID: 35099098 DOI: 10.1111/dom.14654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | | | | | | | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| |
Collapse
|
57
|
A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc). Nat Commun 2022; 13:2229. [PMID: 35484106 PMCID: PMC9050729 DOI: 10.1038/s41467-022-29488-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/18/2022] [Indexed: 02/02/2023] Open
Abstract
Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2-12] per patient/year, 1[0-5] at 12 months and 0[0-2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 [-3.37,-0.560], p = 0.01) and reduced scores for diabetes distress (-6.70[-12.50,-0.89], p = 0.02); depression (-1.86[-3.30, -0.43], p = 0.01) and anxiety (-1.89[-3.32, -0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.
Collapse
|
58
|
Paldus B, Morrison D, Lee M, Zaharieva DP, Riddell MC, O'Neal DN. Strengths and Challenges of Closed-Loop Insulin Delivery During Exercise in People With Type 1 Diabetes: Potential Future Directions. J Diabetes Sci Technol 2022:19322968221088327. [PMID: 35466723 DOI: 10.1177/19322968221088327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exercise has many physical and psychological benefits and is recommended for people with type 1 diabetes; however, there are many barriers to exercise, including glycemic instability and fear of hypoglycemia. Closed-loop (CL) systems have shown benefit in the overall glycemic management of type 1 diabetes, including improving HbA1c levels and reducing the incidence of nocturnal hypoglycemia; however, these systems are challenged by the rapidly changing insulin needs with exercise. This commentary focuses on the principles, strengths, and challenges of CL in the management of exercise, and discusses potential approaches, including the use of additional physiological signals, to address their shortcomings in the pursuit of fully automated CL systems.
Collapse
Affiliation(s)
- Barbora Paldus
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Dale Morrison
- Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Melissa Lee
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, CA, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia
| |
Collapse
|
59
|
Berget C, Sherr JL, DeSalvo DJ, Kingman RS, Stone SL, Brown SA, Nguyen A, Barrett L, Ly TT, Forlenza GP. Clinical Implementation of the Omnipod 5 Automated Insulin Delivery System: Key Considerations for Training and Onboarding People With Diabetes. Clin Diabetes 2022; 40:168-184. [PMID: 35669307 PMCID: PMC9160549 DOI: 10.2337/cd21-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Automated insulin delivery (AID) systems, which connect an insulin pump, continuous glucose monitoring system, and software algorithm to automate insulin delivery based on real-time glycemic data, hold promise for improving outcomes and reducing therapeutic burden for people with diabetes. This article reviews the features of the Omnipod 5 Automated Insulin Delivery System and how it compares to other AID systems available on or currently under review for the U.S. market. It also provides practical guidance for clinicians on how to effectively train and onboard people with diabetes on the Omnipod 5 System, including how to personalize therapy and optimize glycemia. Many people with diabetes receive their diabetes care in primary care settings rather than in a diabetes specialty clinic. Therefore, it is important that primary care providers have access to resources to support the adoption of AID technologies such as the Omnipod 5 System.
Collapse
Affiliation(s)
- Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Jennifer L. Sherr
- Section of Pediatric Endocrinology, Yale School of Medicine, New Haven, CT
| | - Daniel J. DeSalvo
- Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Houston, TX
| | - Ryan S. Kingman
- Department of Pediatric Endocrinology, Stanford School of Medicine, Palo Alto, CA
| | | | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | | | | | - Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| |
Collapse
|
60
|
Jiao X, Shen Y, Chen Y. Better TIR, HbA1c, and less hypoglycemia in closed-loop insulin system in patients with type 1 diabetes: a meta-analysis. BMJ Open Diabetes Res Care 2022; 10:10/2/e002633. [PMID: 35450868 PMCID: PMC9024214 DOI: 10.1136/bmjdrc-2021-002633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/03/2022] [Indexed: 12/18/2022] Open
Abstract
The study aimed to evaluate the effectiveness and safety of long-term use of closed-loop insulin system (CLS) in non-pregnant patients with type 1 diabetes mellitus (T1DM) using systematic review and meta-analysis. A literature search was performed using MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs) on long-term use (not less than 8 weeks) of CLS in patients with T1DM were selected. Meta-analysis was performed with RevMan V.5.3.5 to compare CLS with controls (continuous subcutaneous insulin infusion with blinded continuous glucose monitoring or unblinded sensor-augmented pump therapy or multiple daily injections or predictive low-glucose suspend system) in adults and children with type 1 diabetes. Research quality evaluation was conducted using the Cochrane risk of bias tool. Eleven RCTs (817 patients) that satisfied the eligibility criteria were included in the meta-analysis. Compared with controls, the CLS group had a favorable effect on the proportion of time with sensor glucose level in 3.9-10 mmol/L (10.32%, 8.70% to 11.95%), above 10 mmol/L (-8.89%, -10.57% to -7.22%), or below 3.9 mmol/L (-1.09%, -1.54% to -0.64%) over 24 hours. The CLS group also had lower glycated hemoglobin levels (-0.30%, -0.41% to -0.19%), and glucose variability, coefficient of variation of glucose, and SD were lower by 1.41 (-2.38 to -0.44, p=0.004) and 6.37 mg/dL (-9.19 mg/dL to -3.55 mg/dL, p<0.00001). There were no significant differences between the CLS and the control group in terms of daily insulin dose, quality of life assessment, and satisfaction with diabetes treatment. CLS is a better solution than control treatment in optimizing blood glucose management in patients with T1DM. CLS could become a common means of treating T1DM in clinical practice.
Collapse
Affiliation(s)
- Xiaojuan Jiao
- Department of Endocrinology and Metabolism, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yifa Chen
- Department of Endocrinology and Metabolism, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| |
Collapse
|
61
|
Petrovski G, Al Khalaf F, Campbell J, Day E, Almajaly D, Hussain K, Pasha M, Umer F, Hamdan M, Khalifa A. Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI). BMC Endocr Disord 2022; 22:80. [PMID: 35351095 PMCID: PMC8962027 DOI: 10.1186/s12902-022-00996-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The objective of this study was to evaluate the glycemic outcomes in children and adolescents with Type 1 Diabetes (T1D) previously treated with Multiple Daily Injections (MDI) using a structured initiation protocol for the Advanced Hybrid Closed Loop (AHCL) Minimed 780G insulin pump system. METHODS In this prospective open label single-arm, single-center, clinical investigation, we recruited children and adolescents (aged 7-17 years) with T1D on MDI therapy and HbA1c below 12.5%. All participants followed a 10-day structured initiation protocol which included 4 steps: step 1: AHCL system assessment; step 2: AHCL system training; step 3: Sensor augmented pump therapy (SAP) for 3 days; step 4: AHCL system use for 12 weeks, successfully completing the training from MDI to AHCL in 10 days. The primary outcome of the study was the change in the time spent in the target in range (TIR) of 70-180 mg/dl and HbA1c from baseline (MDI + CGM, 1 week) to study phase (AHCL, 12 weeks). The paired student t-test was used for statistical analysis and a value < 0.05 was considered statistically significant. RESULTS Thirty-four participants were recruited and all completed the 12 weeks study. TIR increased from 42.1 ± 18.7% at baseline to 78.8 ± 6.1% in the study phase (p < 0.001). HbA1c decreased from 8.6 ± 1.7% (70 ± 18.6 mmol/mol) at baseline, to 6.5 ± 0.7% (48 ± 7.7 mmol/mol) at the end of the study (p = 0.001). No episodes of severe hypoglycemia or DKA were reported. CONCLUSION Children and adolescents with T1D on MDI therapy who initiated the AHCL system following a 10-days structured protocol achieved the internationally recommended goals of glycemic control with TIR > 70% and a HbA1c of < 7%.
Collapse
Affiliation(s)
- Goran Petrovski
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar.
| | - Fawziya Al Khalaf
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Judith Campbell
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Emma Day
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Douha Almajaly
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Khalid Hussain
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Maheen Pasha
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Fareeda Umer
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Manar Hamdan
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Amel Khalifa
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| |
Collapse
|
62
|
Forlenza GP, Vigers T, Berget C, Messer LH, Lal RA, Basina M, Maahs DM, Hood K, Buckingham B, Wilson DM, Wadwa RP, Driscoll KA, Pyle L. Predicting Success with a First-Generation Hybrid Closed-Loop Artificial Pancreas System Among Children, Adolescents, and Young Adults with Type 1 Diabetes: A Model Development and Validation Study. Diabetes Technol Ther 2022; 24:157-166. [PMID: 34780306 PMCID: PMC8971998 DOI: 10.1089/dia.2021.0326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Hybrid Closed-Loop (HCL) systems aid individuals with type 1 diabetes in improving glycemic control; however, sustained use over time has not been consistent for all users. This study developed and validated prognostic models for successful 12-month use of the first commercial HCL system based on baseline and 1- or 3-month data. Methods and Materials: Data from participants at the Barbara Davis Center (N = 85) who began use of the MiniMed 670G HCL were used to develop prognostic models using logistic regression and Lasso model selection. Candidate factors included sex, age, duration of diabetes, baseline hemoglobin A1c (HbA1c), race, ethnicity, insurance status, history of insulin pump and continuous glucose monitor use, 1- or 3-month Auto Mode use, boluses per day, and time in range (TIR; 70-180 mg/dL), and scores on behavioral questionnaires. Successful use of HCL was predefined as Auto Mode use ≥60%. The 3-month model was then externally validated against a sample from Stanford University (N = 55). Results: Factors in the final model included baseline HbA1c, sex, ethnicity, 1- or 3-month Auto Mode use, Boluses per Day, and TIR. The 1- and 3-month prognostic models had very good predictive ability with area under the curve values of 0.894 and 0.900, respectively. External validity was acceptable with an area under the curve of 0.717. Conclusions: Our prognostic models use clinically accessible baseline and early device-use factors to identify risk for failure to succeed with 670G HCL technology. These models may be useful to develop targeted interventions to promote success with new technologies.
Collapse
Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Address correspondence to: Gregory P. Forlenza, MD, Associate Professor of Pediatrics, Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus,, 1775 Aurora Court, MS A140, Aurora, CO 80045, USA
| | - Tim Vigers
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Laurel H. Messer
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Rayhan A. Lal
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Marina Basina
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - David M. Maahs
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Korey Hood
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Bruce Buckingham
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Darrell M. Wilson
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Laura Pyle
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| |
Collapse
|
63
|
Nimri R, Phillip M, Kovatchev B. Decision Support Systems and Closed-Loop. Diabetes Technol Ther 2022; 24:S58-S75. [PMID: 35475696 DOI: 10.1089/dia.2022.2504] [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: 11/12/2022]
Affiliation(s)
- Revital Nimri
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Kovatchev
- University of Virginia Center for Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
64
|
Kariyawasam D, Morin C, Casteels K, Le Tallec C, Sfez A, Godot C, Huneker E, Garrec N, Benhamou PY, Polak M, Charpentier G, Franc S, Beltrand J. Hybrid closed-loop insulin delivery versus sensor-augmented pump therapy in children aged 6–12 years: a randomised, controlled, cross-over, non-inferiority trial. Lancet Digit Health 2022; 4:e158-e168. [DOI: 10.1016/s2589-7500(21)00271-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
|
65
|
El Fatouhi D, Héritier H, Allémann C, Malisoux L, Laouali N, Riveline JP, Salathé M, Fagherazzi G. Associations Between Device-Measured Physical Activity and Glycemic Control and Variability Indices Under Free-Living Conditions. Diabetes Technol Ther 2022; 24:167-177. [PMID: 34648353 PMCID: PMC8971971 DOI: 10.1089/dia.2021.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Disturbances of glycemic control and large glycemic variability have been associated with increased risk of type 2 diabetes in the general population as well as complications in people with diabetes. Long-term health benefits of physical activity are well documented but less is known about the timing of potential short-term effects on glycemic control and variability in free-living conditions. Materials and Methods: We analyzed data from 85 participants without diabetes from the Food & You digital cohort. During a 2-week follow-up, device-based daily step count was studied in relationship to glycemic control and variability indices using generalized estimating equations. Glycemic indices, evaluated using flash glucose monitoring devices (FreeStyle Libre), included minimum, maximum, mean, standard deviation, and coefficient of variation of daily glucose values, the glucose management indicator, and the approximate area under the sensor glucose curve. Results: We observed that every 1000 steps/day increase in daily step count was associated with a 0.3588 mg/dL (95% confidence interval [CI]: -0.6931 to -0.0245), a 0.0917 mg/dL (95% CI: -0.1793 to -0.0042), and a 0.0022% (95% CI: -0.0043 to -0.0001) decrease in the maximum glucose values, mean glucose, and in the glucose management indicator of the following day, respectively. We did not find any association between daily step count and glycemic indices from the same day. Conclusions: Increasing physical activity level was linked to blunted glycemic excursions during the next day. Because health-related benefits of physical activity can be long to observe, such short-term physiological benefits could serve as personalized feedback to motivate individuals to engage in healthy behaviors.
Collapse
Affiliation(s)
- Douae El Fatouhi
- “Exposome, Heredity, Cancer, and Health” Team, Center of Research in Epidemiology and Population Health (CESP), Inserm U1018, Paris-Saclay University, UVSQ, Gustave Roussy, Espace Maurice Tubiana, Villejuif, France
- Address correspondence to: Douae El Fatouhi, MSc, “Exposome, Heredity, Cancer, and Health” Team, Center of Research in Epidemiology and Population Health (CESP), Inserm U1018, Paris-Saclay University, UVSQ, Gustave Roussy, Espace Maurice Tubiana, 114 rue Edouard Vaillant, Villejuif Cedex 94805, France
| | - Harris Héritier
- Digital Epidemiology Laboratory, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Chloé Allémann
- Digital Epidemiology Laboratory, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Laurent Malisoux
- Physical Activity, Sport and Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Nasser Laouali
- “Exposome, Heredity, Cancer, and Health” Team, Center of Research in Epidemiology and Population Health (CESP), Inserm U1018, Paris-Saclay University, UVSQ, Gustave Roussy, Espace Maurice Tubiana, Villejuif, France
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Lariboisière Hospital, Paris, France
- Inserm U1138, Immunity and Metabolism in Diabetes (ImMeDiab Team), Centre de Recherches des Cordeliers, Paris, France
| | - Marcel Salathé
- Digital Epidemiology Laboratory, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| |
Collapse
|
66
|
Ware J, Hovorka R. Recent advances in closed-loop insulin delivery. Metabolism 2022; 127:154953. [PMID: 34890648 PMCID: PMC8792215 DOI: 10.1016/j.metabol.2021.154953] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/05/2021] [Accepted: 11/24/2021] [Indexed: 02/03/2023]
Abstract
Since the discovery of insulin 100 years ago, we have seen considerable advances across diabetes therapies. The more recent advent of glucose-responsive automated insulin delivery has started to revolutionise the management of type 1 diabetes in children and adults. Evolution of closed-loop insulin delivery from research to clinical practice has been rapid, and multiple systems are now commercially available. In this review, we summarise key evidence on currently available closed-loop systems and those in development. We comment on dual-hormone and do-it-yourself systems, as well as reviewing clinical evidence in special populations such as very young children, older adults and in pregnancy. We identify future directions for research and barriers to closed-loop adoption, including how these might be addressed to ensure equitable access to this novel therapy.
Collapse
Affiliation(s)
- Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
67
|
Abstract
Hybrid closed-loop therapy is an emerging technology transforming the management of type 1 diabetes (T1D). Research studies demonstrate glycemic and quality of life benefits of hybrid closed-loop therapy for people with T1D. Translating these outcomes into standard clinical practice is critical for reimbursement and improving access to this technology.High-quality training is essential for achieving optimal outcomes with hybrid closed-loop therapy. Basic diabetes skills and tasks are as important, or even more important, with closed-loop therapy than with standard insulin therapy and need to be reiterated. Establishing expectations of hybrid closed-loop therapy clearly at the outset promotes long-term usage and optimal outcomes.We share key aspects of training and support for users of commercially available hybrid closed-loop systems and consider who may benefit from this technology.
Collapse
Affiliation(s)
- Charlotte K. Boughton
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
- Charlotte K. Boughton, MBBS, PhD, University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - Sara Hartnell
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
| | - Janet M. Allen
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Julia Fuchs
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| |
Collapse
|
68
|
Biester T, Tauschmann M, Chobot A, Kordonouri O, Danne T, Kapellen T, Dovc K. The automated pancreas: A review of technologies and clinical practice. Diabetes Obes Metab 2022; 24 Suppl 1:43-57. [PMID: 34658126 DOI: 10.1111/dom.14576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
Insulin pumps and glucose sensors are effective in improving diabetes therapy and reducing acute complications. The combination of both devices using an algorithm-driven interoperable controller makes automated insulin delivery (AID) systems possible. Many AID systems have been tested in clinical trials and have proven safety and effectiveness. However, currently, none of these systems are available for routine use in children younger than 6 years in Europe. For continued use, both users and prescribers must have sound knowledge of the features of the individual AID systems. Presently, all systems require various user interactions (e.g. meal announcements) because fully automated systems are not yet developed. Open-source systems are non-regulated variants to circumvent existing regulatory conditions. There are risks here for both users and prescribers. To evaluate AID therapy, the metric data of the glucose sensors, 'time in target range' and 'glucose management index', are novel recognized and suitable parameters allowing a consultation based on real glucose and insulin pump download data from the daily life of people with diabetes. Read out via cloud-based software or automatic download of such individual treatment data provides the ideal technical basis for shared decision-making through telemedicine, which must be further evaluated for general use.
Collapse
Affiliation(s)
- Torben Biester
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Martin Tauschmann
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Olga Kordonouri
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Thomas Danne
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Thomas Kapellen
- Department of Pediatrics, MEDIAN Clinic for Children 'Am Nicolausholz' Bad Kösen, Naumburg, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
69
|
Nielsen P, Sahay S. A critical review of the role of technology and context in digital health research. Digit Health 2022; 8:20552076221109554. [PMID: 35769359 PMCID: PMC9234838 DOI: 10.1177/20552076221109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Digital health represents a research field dedicated to realising digital
technologies’ potential and developing knowledge about their feasibility and
impacts. Yet, drawing on a critical review of the articles in the most prominent
multidisciplinary digital health journals, this paper argues that the digital
health field has not profoundly engaged with its core subject, namely
technology. The features of digital technologies remain in the background, and
research is disconnected from the complexities of healthcare settings, including
multiple technologies, established practices and people. Instead, the
overarching focus in the digital health literature is the processing
capabilities of digital technologies and their posited impacts. This paper
proposes a research direction in digital health where technology and the context
of use take a more prominent role. It argues that realising the potential of
digital health requires intensive investigation drawing on different
disciplines, grounded on understanding healthcare processes, related
informational needs and the concrete features of digital technologies.
Collapse
Affiliation(s)
- Petter Nielsen
- Department of Informatics, University of Oslo, Norway
- Petter Nielsen, Department of Informatics,
University of Oslo, Norway.
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway
| |
Collapse
|
70
|
von dem Berge T, Biester S, Biester T, Buchmann AK, Datz N, Grosser U, Kapitzke K, Klusmeier B, Remus K, Reschke F, Tiedemann I, Weiskorn J, Würsig M, Thomas A, Kordonouri O, Danne T. Empfehlungen zur Diabetes-Behandlung mit automatischen Insulin-Dosierungssystemen. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1652-9011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ZusammenfassungDas Prinzip der automatischen Insulindosierung, kurz „AID“ genannt, zeigt in Zulassungsstudien und Real-World-Erfahrungen ausgezeichnete Behandlungsergebnisse. Beim AID wird eine Insulinpumpe mit einem System zur kontinuierlichen Glukosemessung zusammengeschaltet, während ein Rechenprogramm, der sogenannte Algorithmus, die Steuerung der Insulingabe nach Bedarf übernimmt. Idealerweise wäre das System ein geschlossener Kreis, bei dem die Menschen mit Diabetes keine Eingabe mehr machen müssten. Jedoch sind bei den heute verfügbaren Systemen verschiedene Grundeinstellungen und Eingaben erforderlich (insbesondere von Kohlenhydratmengen der Mahlzeiten oder körperlicher Aktivität), die sich von den bisherigen Empfehlungen der sensorunterstützten Pumpentherapie in einzelnen Aspekten unterscheiden. So werden die traditionellen Konzepte von „Basal“ und „Bolus“ mit AID weniger nützlich, da der Algorithmus beide Arten der Insulinabgabe verwendet, um die Glukosewerte dem eingestellten Zielwert zu nähern. Daher sollte bei diesen Systemen statt der Erfassung von „Basal“ und „Bolus“, zwischen einer „nutzerinitiierten“ und einer „automatischen“ Insulindosis unterschieden werden. Gemeinsame Therapieprinzipien der verschiedenen AID-Systeme umfassen die passgenaue Einstellung des Kohlenhydratverhältnisses, die Bedeutung des Timings der vom Anwender initiierten Insulinbolusgaben vor der Mahlzeit, den korrekten Umgang mit einem verzögerten oder versäumten Mahlzeitenbolus, neue Prinzipien im Umgang mit Sport oder Alkoholgenuss sowie den rechtzeitigen Umstieg von AID zu manuellem Modus bei Auftreten erhöhter Ketonwerte. Das Team vom Diabetes-Zentrum AUF DER BULT in Hannover hat aus eigenen Studienerfahrungen und der zugrunde liegenden internationalen Literatur praktische Empfehlungen zur Anwendung und Schulung der gegenwärtig und demnächst in Deutschland kommerziell erhältlichen Systeme zusammengestellt. Für den Erfolg der AID-Behandlung scheint das richtige Erwartungsmanagement sowohl beim Behandlungsteam und als auch beim Anwender von großer Bedeutung zu sein.
Collapse
Affiliation(s)
- Thekla von dem Berge
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Sarah Biester
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Torben Biester
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Anne-Kathrin Buchmann
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Nicolin Datz
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Ute Grosser
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Kerstin Kapitzke
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Britta Klusmeier
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Kerstin Remus
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Felix Reschke
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Inken Tiedemann
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Jantje Weiskorn
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Martina Würsig
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | | | - Olga Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Thomas Danne
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| |
Collapse
|
71
|
Thabit H, Lal R, Leelarathna L. Automated insulin dosing systems: Advances after a century of insulin. Diabet Med 2021; 38:e14695. [PMID: 34547133 PMCID: PMC8763058 DOI: 10.1111/dme.14695] [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: 07/11/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
The daily complexities of insulin therapy and glucose variability in type 1 diabetes still pose significant challenges, despite advancements in modern insulin analogues. Minimising hypoglycaemia and optimising time spent within target glucose range are recommended to reduce the risk of diabetes-related complications and distress. Access to structured education and adjuvant diabetes technologies, such as insulin pumps and glucose sensors, are recommended by National Institute for Health and Care Excellence (NICE) to enable people with type 1 diabetes achieve their glycaemic goals. One hundred years after the discovery of insulin, automated insulin dosing (AID, a.k.a. closed loop or artificial pancreas) systems are a reality with a number of systems available and being used in usual clinical practice. Evidence from randomised clinical trials and real-world prospective studies support efficacy, effectiveness and safety of AID systems. Qualitative evaluations reveal treatment satisfaction and positive effects on quality of life. Current insulin-only AID systems still require carbohydrate and activity announcement (hybrid closed loop) due to the inherent pharmacokinetic limitations of rapid-acting insulin analogies. Ultra-rapid acting insulin and adjunctive use of other therapies (e.g. glucagon, pramlitide) are being evaluated to achieve full closed loop. Open-source AID (OS-AID) systems have been developed by the diabetes community, driven by a desire for safety and to accelerate technological advancement. In addition to effectiveness and safety, real-world prospective studies suggest that OS-AID systems fulfil unmet needs of commercially approved systems. The development, ongoing challenges and expectations of AID are outlined in this review.
Collapse
Affiliation(s)
- Hood Thabit
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine & Paediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
72
|
Abstract
Automated insulin delivery (AID) is the most recent advance in type 1 diabetes (T1D) management. It has the potential to achieve glycemic targets without disabling hypoglycemia, to improve quality of life and reduce diabetes distress and burden associated with self-management. Several AID systems are currently licensed for use by people with T1D in Europe, United States, and the rest of the world. Despite AID becoming a reality in routine clinical practice over the last few years, the commercially hybrid AID and other systems, are still far from a fully optimized automated diabetes management tool. Implementation of AID systems requires education and support of healthcare professionals taking care of people with T1D, as well as users and their families. There is much to do to increase usability, portability, convenience and to reduce the burden associated with the use of the systems. Co-design, involvement of people with lived experience of T1D and robust qualitative assessment is critical to improving the real-world use of AID systems, especially for those who may have greater need. In addition to this, information regarding the psychosocial impact of the use of AID systems in real life is needed. The first commercially available AID systems are not the end of the development journey but are the first step in learning how to optimally automate insulin delivery in a way that is equitably accessible and effective for people living with T1D.
Collapse
Affiliation(s)
- Marga Giménez
- Diabetes Unit, Endocrinology and
Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
- CIBERDEM, Centro de Investigación
Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut
d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and
Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
- CIBERDEM, Centro de Investigación
Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut
d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nick Oliver
- Department of Metabolism,
Digestion and Reproduction, Faculty of Medicine, Imperial College London,
London, UK
| |
Collapse
|
73
|
Moon SJ, Jung I, Park CY. Current Advances of Artificial Pancreas Systems: A Comprehensive Review of the Clinical Evidence. Diabetes Metab J 2021; 45:813-839. [PMID: 34847641 PMCID: PMC8640161 DOI: 10.4093/dmj.2021.0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
Since Banting and Best isolated insulin in the 1920s, dramatic progress has been made in the treatment of type 1 diabetes mellitus (T1DM). However, dose titration and timely injection to maintain optimal glycemic control are often challenging for T1DM patients and their families because they require frequent blood glucose checks. In recent years, technological advances in insulin pumps and continuous glucose monitoring systems have created paradigm shifts in T1DM care that are being extended to develop artificial pancreas systems (APSs). Numerous studies that demonstrate the superiority of glycemic control offered by APSs over those offered by conventional treatment are still being published, and rapid commercialization and use in actual practice have already begun. Given this rapid development, keeping up with the latest knowledge in an organized way is confusing for both patients and medical staff. Herein, we explore the history, clinical evidence, and current state of APSs, focusing on various development groups and the commercialization status. We also discuss APS development in groups outside the usual T1DM patients and the administration of adjunct agents, such as amylin analogues, in APSs.
Collapse
Affiliation(s)
- Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
74
|
Abstract
In this review, we bring our personal experiences to showcase insulin from its breakthrough discovery as a life-saving drug 100 years ago to its uncovering as the autoantigen and potential cause of type 1 diabetes and eventually as an opportunity to prevent autoimmune diabetes. The work covers the birth of insulin to treat patients, which is now 100 years ago, the development of human insulin, insulin analogues, devices, and the way into automated insulin delivery, the realization that insulin is the primary autoimmune target of type 1 diabetes in children, novel approaches of immunotherapy using insulin for immune tolerance induction, the possible limitations of insulin immunotherapy, and an outlook how modern vaccines could remove the need for another 100 years of insulin therapy.
Collapse
|
75
|
Abstract
Advances in glucose monitoring and insulin delivery technologies have led to the development of innovative self-management tools, such as continuous glucose monitoring, automated insulin delivery systems, and smart connected insulin pens. Although the clinical advantages of today's emerging diabetes technologies are well documented, the cost of integrating these tools into clinical practice must be considered to sustain the financial viability of both public and private insurers. Most clinicians are unfamiliar with the process the commercial insurers follow when making these decisions. This article reviews the key factors the insurers consider when determining eligibility criteria.
Collapse
Affiliation(s)
- Tim Nolan
- TEN Healthcare Strategies, Newtown, Pennsylvania, USA
| | - Marie Frazzitta
- Abbott Diabetes Care, Department of Medical Affairs, Alameda, California, USA
| |
Collapse
|
76
|
Bailey TS, Alva S. Landscape of Continuous Glucose Monitoring (CGM) and Integrated CGM: Accuracy Considerations. Diabetes Technol Ther 2021; 23:S5-S11. [PMID: 34546084 DOI: 10.1089/dia.2021.0236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Continuous glucose monitoring devices have significantly improved in many respects compared with earlier versions. As sensor accuracy improved, U.S. Food and Drug Administration approved a nonadjunctive indication for use that no longer required confirmatory blood glucose monitoring. This article discusses the performance characteristics and regulatory classifications for the current systems that are relevant to informed clinical decision-making.
Collapse
|
77
|
Abstract
Background: The t:slim X2™ insulin pump with Control-IQ® technology from Tandem Diabetes Care is an advanced hybrid closed-loop system that was first commercialized in the United States in January 2020. Longitudinal glycemic outcomes associated with real-world use of this system have yet to be reported. Methods: A retrospective analysis of Control-IQ technology users who uploaded data to Tandem's t:connect® web application as of February 11, 2021 was performed. Users age ≥6 years, with >2 weeks of continuous glucose monitoring (CGM) data pre- and >12 months post-Control-IQ technology initiation were included in the analysis. Results: In total 9451 users met the inclusion criteria, 83% had type 1 diabetes, and the rest had type 2 or other forms of diabetes. The mean age was 42.6 ± 20.8 years, and 52% were female. Median percent time in automation was 94.2% [interquartile range, IQR: 90.1%-96.4%] for the entire 12-month duration of observation, with no significant changes over time. Of these users, 9010 (96.8%) had ≥75% of their CGM data available, that is, sufficient data for reliable computation of CGM-based glycemic outcomes. At baseline, median percent time in range (70-180 mg/dL) was 63.6 (IQR: 49.9%-75.6%) and increased to 73.6% (IQR: 64.4%-81.8%) for the 12 months of Control-IQ technology use with no significant changes over time. Median percent time <70 mg/dL remained consistent at ∼1% (IQR: 0.5%-1.9%). Conclusion: In this real-world use analysis, Control-IQ technology retained, and to some extent exceeded, the results obtained in randomized controlled trials, showing glycemic improvements in a broad age range of people with different types of diabetes.
Collapse
Affiliation(s)
- Marc D. Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Address correspondence to: Marc Breton, PhD, Center for Diabetes Technology, University of Virginia, 560 Ray C Hunt Drive, Charlottesville, VA 22903, USA
| | - Boris P. Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
78
|
Franc S, Benhamou P, Borot S, Chaillous L, Delemer B, Doron M, Guerci B, Hanaire H, Huneker E, Jeandidier N, Amadou C, Renard E, Reznik Y, Schaepelynck P, Simon C, Thivolet C, Thomas C, Hannaert P, Charpentier G. No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed-loop system for 12 weeks: A post hoc secondary analysis of the multicentre, randomized controlled Diabeloop WP7 trial. Diabetes Obes Metab 2021; 23:2170-2176. [PMID: 34009725 PMCID: PMC8453744 DOI: 10.1111/dom.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022]
Abstract
A post hoc analysis of the Diabeloop WP7 multicentre, randomized controlled trial was performed to investigate the efficacy of the Diabeloop Generation-1 (DBLG1) closed-loop system in controlling the hypoglycaemia induced by physical activity (PA) in real-life conditions. Glycaemic outcomes were compared between days with and without PA in 56 patients with type 1 diabetes (T1D) using DBLG1 for 12 weeks. After the patient announces a PA, DBLG1 reduces insulin delivery and, if necessary, calculates the amount of preventive carbohydrates (CHO). Daily time spent in the interstitial glucose range less than 70 mg/dL was not significantly different between days with and without PA (2.0% ± 1.5% vs. 2.2% ± 1.1%), regardless of the intensity or duration of the PA. Preventive CHO intake recommended by the system was significantly higher in days with PA (41.1 ± 35.5 vs. 21.8 ± 28.5 g/day; P < .0001), and insulin delivery was significantly lower (31.5 ± 10.5 vs. 34.0 ± 10.5 U/day; P < .0001). The time spent in hyperglycaemia and the glycaemic variation coefficient increased significantly on days with PA. In real-life conditions, the use of DBLG1 avoids PA-induced hypoglycaemia. Insulin adjustments and preventive CHO recommendation may explain this therapeutic benefit.
Collapse
Affiliation(s)
- Sylvia Franc
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | | | - Sophie Borot
- Department of Endocrinology, Metabolism, Diabetes and NutritionCentre Hospitalier Universitaire Jean MinjozBesançonFrance
| | | | - Brigitte Delemer
- Department of Endocrinology, Diabetes and NutritionReims University HospitalReimsFrance
| | - Maeva Doron
- Université Grenoble Alpes, Commissariat à l'Energie Atomique, Laboratoire d'électronique et de technologie de l'information, Département micro Technologies pour la Biologie et la SantéGrenobleFrance
| | - Bruno Guerci
- Endocrinology‐Diabetes Care UnitUniversity of LorraineVandoeuvre Lès NancyFrance
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and NutritionCHU Toulouse, University of ToulouseToulouseFrance
| | | | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and NutritionCHRU of Strasbourg (UDS)StrasbourgFrance
| | - Coralie Amadou
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- University Paris‐SaclayOrsayFrance
| | - Eric Renard
- Department of Endocrinology, Diabetes and NutritionMontpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of MontpellierMontpellierFrance
| | - Yves Reznik
- Department of EndocrinologyUniversity of Caen Côte de Nacre Regional Hospital CenterCaenFrance
| | - Pauline Schaepelynck
- Department of Nutrition‐Endocrinology‐Metabolic DisordersMarseille University Hospital, Sainte Marguerite HospitalMarseilleFrance
| | - Chantal Simon
- Department of Endocrinology, Diabetes and NutritionCentre Hospitalier Lyon SudLyonFrance
| | | | - Claire Thomas
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | - Patrick Hannaert
- School of Medicine and Pharmacy of PoitiersIschémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1082PoitiersFrance
| | - Guillaume Charpentier
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| |
Collapse
|
79
|
Hartnell S, Fuchs J, Boughton CK, Hovorka R. Closed‐loop technology: a practical guide. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sara Hartnell
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic Cambridge UK
| | - Julia Fuchs
- Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Hospital Cambridge UK
- Department of Paediatrics University of Cambridge Cambridge UK
| | - Charlotte K Boughton
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic Cambridge UK
- Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Hospital Cambridge UK
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Hospital Cambridge UK
- Department of Paediatrics University of Cambridge Cambridge UK
| |
Collapse
|
80
|
[Individualization of diabetes treatment by automated insulin delivery]. Monatsschr Kinderheilkd 2021; 169:902-911. [PMID: 34276070 PMCID: PMC8276231 DOI: 10.1007/s00112-021-01239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/02/2022]
Abstract
Insulinpumpen und Glucosesensoren haben sich in Registerdaten als effektiv in der Verbesserung der Diabetestherapie und Reduktion akuter Komplikationen gezeigt. In der pädiatrischen Diabetologie ist die Nutzung mindestens eines technischen Geräts Standard. Durch die Kombination beider Systeme ergibt sich Möglichkeit der automatischen Insulinabgabe („automated insulin delivery“, AID). Viele AID-Systeme sind in klinischen Studien getestet und haben sich als sicher und effektiv erwiesen. Die Versorgungsituation in Deutschland erlaubt es derzeit nur, Mitgliedern der gesetzlichen Krankenversicherungen ein bestimmtes System zu verordnen; dieses ist für Kinder, die jünger als 7 Jahre sind, nicht geeignet. Gründe liegen in gesetzlichen Hürden und mangelnder Zertifizierung durch die Hersteller. Die CE-Zertifikate können Probleme bei der Insulinverordnung mit sich bringen. „Open-source“-Systeme sind Varianten, mit denen bestehende Regularien umgangen werden können. Daraus ergeben sich sowohl für Nutzer wie auch für Verordner Risiken. Die dauerhafte Nutzung setzt sowohl auf Anwender- als auch auf Behandlerseite die fundierte Kenntnis der Eigenschaften der einzelnen AID-Systeme voraus. Eine vollständige Automatisierung funktioniert noch nicht. Zur Evaluation der AID-Therapie sind die metrischen Daten der Glucosesensoren, die „Zeit im Zielbereich“ und der „Glucose Management Indicator“ anerkannte und geeignete Parameter, da sie eine Beratung auf Basis der reellen Daten aus dem Alltag der Menschen mit Diabetes zulassen. Da alle Glucosesensoren über Cloud-basierte Software ausgelesen werden oder die Daten automatisch aus einem telefonverbundenen Empfangsgerät beziehen, ist die ideale technische Grundlage für eine telemedizinische Betreuung geschaffen, die noch der Ausgestaltung bedarf.
Collapse
|
81
|
Fink H, de Barros Fernandes NM, Weissmann J, Frey M. Extraction With Sweat-Sebum Emulsion as a New Test Method for Leachables in Patch-Based Medical Devices, Illustrated by Assessment of Isobornylacrylate (IBOA) in Diabetes Products. J Diabetes Sci Technol 2021; 15:792-800. [PMID: 32115999 PMCID: PMC8258535 DOI: 10.1177/1932296820908656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increasing offering of patch-based medical devices is accompanied by growing numbers of reported adverse skin reactions. Procedures for testing leachables according to ISO 10993 may not be optimal for lipophilic substances that can be mobilized on skin by sweat and sebum. We propose an improved extraction method for targeted analysis of leachables using low volumes of a sweat-sebum emulsion. The approach is illustrated by the analysis of isobornylacrylate (IBOA), a compound found in some devices and suspected for allergenic potential. METHOD Three patch-based products were tested: an implantable device for continuous glucose monitoring (CGM), an intermittently scanned CGM (isCGM) device, and a micro-insulin pump. Quantification of IBOA was performed by gas chromatography and allergenic potential of IBOA levels was assessed by the KeratinoSens cell assay. Different combinations were used for extraction solvent (isopropanol, 5% ethanol-water solution, and sweat-sebum emulsion), extraction volumes (complete immersion vs partial immersion in 2 mm of solvent), and extraction time (3, 5, and 14 days). RESULTS Isobornylacrylate was only found in the isCGM device. About 20 mg/L IBOA were eluted after 3 days in isopropanol but only about 1 mg/L in ethanol-water. Sweat-sebum emulsion dissolves IBOA better and gives a more stable solution than ethanol-water. Decomposition of IBOA solutions requires adjusted extraction timing or correction of results. In the sweat-sebum extract, IBOA levels were about 20 mg/L after 3 days and about 30 mg/L after 5 days, clearly above the threshold found in the KerationSens assay for keratinocyte activation (10 mg/L). CONCLUSION Extraction by low volumes of sweat-sebum emulsion can be a superior alternative for the targeted simulating-use assessment of leachables in patch-based medical devices.
Collapse
Affiliation(s)
- Herbert Fink
- Roche Diabetes Care GmbH, Mannheim, Germany
- Herbert Fink, Roche Diabetes Care GmbH, Sandhofer Str. 116, 68305 Mannheim, Baden-Württemberg, Germany.
| | | | | | - Manfred Frey
- Steinbeis Innovationszentrum für Zellkulturtechnik, Mannheim, Germany
| |
Collapse
|
82
|
Pease AJ, Andrikopoulos S, Abraham MB, Craig ME, Fenton B, Overland J, Price S, Simmons D, Ross GP. Utilisation, access and recommendations regarding technologies for people living with type 1 diabetes: consensus statement of the ADS/ADEA/APEG/ADIPS Working Group. Med J Aust 2021; 215:473-478. [PMID: 34148253 DOI: 10.5694/mja2.51118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Type 1 diabetes presents significant challenges for optimal management. Despite intensive glycaemic control being the standard of care for several decades, glycaemic targets are infrequently achieved and the burden of complications remains high. Therefore, the advancement of diabetes management technologies has a major role in reducing the clinical and economic impact of the disease on people living with type 1 diabetes and on health care systems. However, a national framework is needed to ensure equitable and sustainable implementation of these technologies as part of holistic care. MAIN RECOMMENDATIONS This consensus statement considers technologies for insulin delivery, glucose sensing and insulin dose advice that are commercially available in Australia. While international position statements have provided recommendations for technology implementation, the ADS/ADEA/APEG/ADIPS Working Group believes that focus needs to shift from strict trial-based glycaemic criteria towards engagement and individualised management goals that consider the broad spectrum of benefits offered by technologies. CHANGES IN MANAGEMENT AS RESULT OF THIS STATEMENT This Australian consensus statement from peak national bodies for the management of diabetes across the lifespan outlines a national framework for the optimal implementation of technologies for people with type 1 diabetes. The Working Group highlights issues regarding equity of access to technologies and services, scope of clinical practice, credentialling and accreditation requirements, regulatory issues with "do-it-yourself" technology, national benchmarking, safety reporting, and ongoing patient advocacy.
Collapse
Affiliation(s)
- Anthony J Pease
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | | | - Mary B Abraham
- Perth Children's Hospital, Perth, WA.,Children's Diabetes Centre, Telethon Kids Institute, Perth, WA
| | - Maria E Craig
- Children's Hospital at Westmead, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Brett Fenton
- Central Coast Local Health District, Gosford, NSW
| | - Jane Overland
- University of Sydney, Sydney, NSW.,Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, NSW
| | - Sarah Price
- Melbourne Health, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Glynis P Ross
- University of Sydney, Sydney, NSW.,Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, NSW
| |
Collapse
|
83
|
Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
Collapse
Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
| |
Collapse
|
84
|
Petruzelkova L, Jiranova P, Soupal J, Kozak M, Plachy L, Neuman V, Pruhova S, Obermannova B, Kolouskova S, Sumnik Z. Pre-school and school-aged children benefit from the switch from a sensor-augmented pump to an AndroidAPS hybrid closed loop: A retrospective analysis. Pediatr Diabetes 2021; 22:594-604. [PMID: 33576551 DOI: 10.1111/pedi.13190] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/18/2020] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Data on closed loop systems in young children with type 1 diabetes (T1D) are limited. We tested the efficacy and safety of an open-source, do-it-yourself automated insulin delivery system AndroidAPS in preschool and school-aged children. RESEARCH DESIGN AND METHODS This retrospective study analyzed diabetes control in 18 preschool (3-7 years) and 18 school-aged children (8-14 years) with T1D who switched from a sensor-augmented pump (SAP) to AndroidAPS. We compared the CGM parameters and HbA1c levels 3 months before and 6 months after the initiation of AndroidAPS therapy and evaluated frequency of severe adverse events during AndroidAPS use, the most frequent reasons for its interruption, and the experience and psychosocial benefits of AndroidAPS use. RESULTS General glycemic control was significantly improved after the switch from SAP to AndroidAPS. Time in range (TIR) increased in both preschool (70.8%-78.6%, p = 0.004) and school-aged children (77.2%-82.9%, p < 0.001), whereas HbA1c levels decreased (preschool children 53.8-48.5 mmol/mol, p < 0.001; school-aged children 52.6-45.1 mmol/mol, p = 0.001). Time spent in range of 3.0-3.8 mmol/L increased slightly in school children (2.6%-3.8%, p = 0.040), but not in preschool children (3.0%-3.0%, p = 0.913). Time spent at <3 mmol/L remained unchanged in both preschool (0.95%-0.67%, p = 0.432) and school-aged children (0.8%-0.8%, p = 1.000). No episodes of severe hypoglycemia or DKA and significant improvement of quality of life were reported by AndroidAPS users. CONCLUSIONS AndroidAPS seems effective for T1D control both in preschool and school-age children but further validation by prospective studies is necessary.
Collapse
Affiliation(s)
- Lenka Petruzelkova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavlina Jiranova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Soupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milos Kozak
- IT division, CLOSED LOOP Systems, Prague, Czech Republic
| | - Lukas Plachy
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stepanka Pruhova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Obermannova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stanislava Kolouskova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
85
|
Bisio A, Brown SA, McFadden R, Pajewski M, Yu PL, DeBoer M, Schoelwer MJ, Bonner HG, Wakeman CA, Cherñavvsky DR, Gonder-Frederick L. Sleep and diabetes-specific psycho-behavioral outcomes of a new automated insulin delivery system in young children with type 1 diabetes and their parents. Pediatr Diabetes 2021; 22:495-502. [PMID: 33289242 DOI: 10.1111/pedi.13164] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Data on the use of Control-IQ, the latest FDA-approved automated insulin delivery (AID) system for people with T1D 6 years of age or older is still scarce, particularly regarding nonglycemic outcomes. Children with T1D and their parents are at higher risk for sleep disturbances. This study assesses sleep, psycho-behavioral and glycemic outcomes of AID compared to sensor-augmented pump therapy (SAP) therapy in young children with T1D and their parents. METHODS Thirteen parents and their young children (ages 7-10) on insulin pump therapy were enrolled. Children completed an initial 4-week study with SAP using their own pump and a study CGM followed by a 4-week phase of AID. Sleep outcomes for parents and children were evaluated through actigraphy watches. Several questionnaires were administered at baseline and at the end of each study phase. CGM data were used to assess glycemic outcomes. RESULTS Actigraphy data did not show any significant change from SAP to AID, except a reduction of number of parental awakenings during the night (p = 0.036). Parents reported statistically significant improvements in Pittsburgh Sleep Quality Index total score (p = 0.009), Hypoglycemia Fear Survey total score (p = 0.011), diabetes-related distress (p = 0.032), and depression (p = 0.023). While on AID, time in range (70-180 mg/dL) significantly increased compared to SAP (p < 0.001), accompanied by a reduction in hyperglycemia (p = 0.001). CONCLUSIONS These results suggest that use of AID has a positive impact on glycemic outcomes in young children as well as sleep and diabetes-specific quality of life outcomes in their parents.
Collapse
Affiliation(s)
- Alessandro Bisio
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Sue A Brown
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.,Department of Medicine, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, Virginia, USA
| | - Ryan McFadden
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Pajewski
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Pearl L Yu
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA.,Sleep Disorder Center, University of Virginia, Charlottesville, Virginia, USA
| | - Mark DeBoer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.,Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Melissa J Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.,Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Heather G Bonner
- Sleep Disorder Center, University of Virginia, Charlottesville, Virginia, USA
| | - Christian A Wakeman
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel R Cherñavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.,Department of Psychiatry, University of Virginia, Charlottesville, Virginia, USA
| | - Linda Gonder-Frederick
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA.,Department of Psychiatry, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
86
|
Ehrmann D, Priesterroth L, Schmitt A, Kulzer B, Hermanns N. Associations of Time in Range and Other Continuous Glucose Monitoring-Derived Metrics With Well-Being and Patient-Reported Outcomes: Overview and Trends. Diabetes Spectr 2021; 34:149-155. [PMID: 34149255 PMCID: PMC8178712 DOI: 10.2337/ds20-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Time in glucose ranges is increasingly relevant for research and clinical practice. Whereas the clinical validity of these metrics has been demonstrated with regard to long-term complications, their associations with patient-reported outcomes such as well-being, diabetes distress, and fear of hypoglycemia remain an open research question. This article reviews existing evidence on links between times in glycemic ranges and patient-reported outcomes. It also describes a novel research approach of using ecological momentary assessment to analyze on a more granular level in real time possible associations of these parameters of glycemic control and patient-reported outcomes. Such an approach could further our understanding of how glucose and patient-reported outcomes may be interconnected.
Collapse
Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research, Muenchen-Neuherberg, Germany
| | - Lilli Priesterroth
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research, Muenchen-Neuherberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research, Muenchen-Neuherberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research, Muenchen-Neuherberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| |
Collapse
|
87
|
Abstract
Advances in diabetes technologies have enabled the development of automated closed-loop insulin delivery systems. Several hybrid closed-loop systems have been commercialised, reflecting rapid transition of this evolving technology from research into clinical practice, where it is gradually transforming the management of type 1 diabetes in children and adults. In this review we consider the supporting evidence in terms of glucose control and quality of life for presently available closed-loop systems and those in development, including dual-hormone closed-loop systems. We also comment on alternative 'do-it-yourself' closed-loop systems. We remark on issues associated with clinical adoption of these approaches, including training provision, and consider limitations of presently available closed-loop systems and areas for future enhancements to further improve outcomes and reduce the burden of diabetes management.
Collapse
Affiliation(s)
- Charlotte K Boughton
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| |
Collapse
|
88
|
Sverdlov O, Ryeznik Y, Wong WK. Opportunity for efficiency in clinical development: An overview of adaptive clinical trial designs and innovative machine learning tools, with examples from the cardiovascular field. Contemp Clin Trials 2021; 105:106397. [PMID: 33845209 DOI: 10.1016/j.cct.2021.106397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Modern data analysis tools and statistical modeling techniques are increasingly used in clinical research to improve diagnosis, estimate disease progression and predict treatment outcomes. What seems less emphasized is the importance of the study design, which can have a serious impact on the study cost, time and statistical efficiency. This paper provides an overview of different types of adaptive designs in clinical trials and their applications to cardiovascular trials. We highlight recent proliferation of work on adaptive designs over the past two decades, including some recent regulatory guidelines on complex trial designs and master protocols. We also describe the increasing role of machine learning and use of metaheuristics to construct increasingly complex adaptive designs or to identify interesting features for improved predictions and classifications.
Collapse
Affiliation(s)
- Oleksandr Sverdlov
- Early Development Biostatistics, Novartis Pharmaceuticals Corporation, USA.
| | - Yevgen Ryeznik
- Department of Pharmaceutical Biosciences, Uppsala University, Sweden
| | - Weng Kee Wong
- Department of Biostatistics, University of California Los Angeles, USA
| |
Collapse
|
89
|
1921-2021: From insulin discovery to islet transplantation in type 1 diabetes. ANNALES D'ENDOCRINOLOGIE 2021; 82:74-77. [PMID: 33839122 DOI: 10.1016/j.ando.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022]
Abstract
One century after the discovery of insulin, the French Health regulations have just authorized the reimbursement for islet transplantation. Intraportal islet allotransplantation from a pancreatic donor is indicated in patients with type 1 diabetes (T1D) complicated with lability or hypoglycemia unawareness, or in case of a functioning kidney graft; islet auto-transplantation may be indicated after pancreatic surgery.Compared with insulin even administered in closed-loop pumps, the specificity of islet allotransplantation is the restoration of C-peptide secretion. Long-term insulin-independence is observed when the engrafted islet mass is sufficient, at the cost of immunosuppression. Fewer low-glucose events and less glucose variability, are observed even with minimal functional islet graft, after islet transplantation as at onset of T1D, when a residual C-peptide secretion is maintained, an objective currently approached with less aggressive immuno-modulating therapies than in the past. Therefore, restoration or preservation of endogen insulin secretion is an important goal, allowing to maintain a long-term glucose balance with more than 70% of time in range 3.9-10mmol/L and less than 3% of time <3.9mmol/L, thus reducing the occurrence of diabetic complications. In the clinical setting, - the preservation of C-peptide at early stage of T1D, - the use of technological ressources (multi-injections, sensors, insulin pump, closed-loop systems) at later stages, - and islet transplantation when hypoglycemia awareness becomes impaired are complementary for a personalized care all along the life of T1D patients.
Collapse
|
90
|
Amadou C, Franc S, Benhamou PY, Lablanche S, Huneker E, Charpentier G, Penfornis A. Diabeloop DBLG1 Closed-Loop System Enables Patients With Type 1 Diabetes to Significantly Improve Their Glycemic Control in Real-Life Situations Without Serious Adverse Events: 6-Month Follow-up. Diabetes Care 2021; 44:844-846. [PMID: 33431420 DOI: 10.2337/dc20-1809] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze safety and efficacy of the Diabeloop Generation 1 (DBLG1) hybrid closed-loop artificial pancreas system in patients with type 1 diabetes in real-world conditions. RESEARCH DESIGN AND METHODS After a 1-week run-in period with their usual pump, 25 patients were provided the commercial DBLG1 system. The results are presented on time in range (TIR) and HbA1c over 6 months. RESULTS The mean (SD; range) age of patients was 43 (13.8; 25-72) years. At baseline, the mean HbA1c and TIR 70-180 mg/dL were, respectively, 7.9% (0.93; 5.6-8.5%) [63 mmol/mol (10; 38-69 mmol/mol)] and 53% (16.4; 21-85%). One patient stopped using the system after 2 months. At 6 months, the mean HbA1c decreased to 7.1% [54 mmol/mol] (P < 0.001) and TIR 70-180 mg/dL increased to 69.7% (P < 0.0001). TIR <70 mg/dL decreased from 2.4 to 1.3% (P = 0.03), and TIR <54 mg/dL decreased from 0.32 to 0.24% (P = 0.42). No serious adverse event was reported during the study. CONCLUSIONS The ability of the DBLG1 system to significantly improve glycemic control in real-world conditions, without serious adverse events, was confirmed in this follow-up study.
Collapse
Affiliation(s)
- Coralie Amadou
- Diabetes Department, Sud-Francilien Hospital, Corbeil-Essonnes, France .,Paris-Saclay University, Gif-sur-Yvette, France
| | - Sylvia Franc
- Diabetes Department, Sud-Francilien Hospital, Corbeil-Essonnes, France.,Center for Study and Research for the Intensification of Diabetes Treatment, Bioparc-Génopole, Évry, France.,Laboratoire de Biologie de l'Exercice pour la Performance et la Santé (LBEPS), Évry University, Institut de Recherches Biomédicales des Armées (IRBA), Université Paris Saclay, Évry, France
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | | | - Guillaume Charpentier
- Diabetes Department, Sud-Francilien Hospital, Corbeil-Essonnes, France.,Center for Study and Research for the Intensification of Diabetes Treatment, Bioparc-Génopole, Évry, France
| | | | | |
Collapse
|
91
|
Haidar A, Legault L, Raffray M, Gouchie-Provencher N, Jacobs PG, El-Fathi A, Rutkowski J, Messier V, Rabasa-Lhoret R. Comparison Between Closed-Loop Insulin Delivery System (the Artificial Pancreas) and Sensor-Augmented Pump Therapy: A Randomized-Controlled Crossover Trial. Diabetes Technol Ther 2021; 23:168-174. [PMID: 33050728 PMCID: PMC7906861 DOI: 10.1089/dia.2020.0365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Several studies have shown that closed-loop automated insulin delivery (the artificial pancreas) improves glucose control compared with sensor-augmented pump therapy. We aimed to confirm these findings using our automated insulin delivery system based on the iPancreas platform. Research Design and Methods: We conducted a two-center, randomized crossover trial comparing automated insulin delivery with sensor-augmented pump therapy in 36 adults with type 1 diabetes. Each intervention lasted 12 days in outpatient free-living conditions with no remote monitoring. The automated insulin delivery system used a model predictive control algorithm that was a less aggressive version of our earlier dosing algorithm to emphasize safety. The primary outcome was time in the range 3.9-10.0 mmol/L. Results: The automated insulin delivery system was operational 90.2% of the time. Compared with the sensor-augmented pump therapy, automated insulin delivery increased time in range (3.9-10.0 mmol/L) from 61% (interquartile range 53-74) to 69% (60-73; P = 0.006) and increased time in tight target range (3.9-7.8 mmol/L) from 37% (30-49) to 45% (35-51; P = 0.011). Automated insulin delivery also reduced time spent below 3.9 and 3.3 mmol/L from 3.5% (0.8-5.4) to 1.6% (1.1-2.7; P = 0.0021) and from 0.9% (0.2-2.1) to 0.5% (0.2-1.1; P = 0.0122), respectively. Time spent below 2.8 mmol/L was 0.2% (0.0-0.6) with sensor-augmented pump therapy and 0.1% (0.0-0.4; P = 0.155) with automated insulin delivery. Conclusions: Our study confirms findings that automated insulin delivery improves glucose control compared with sensor-augmented pump therapy. ClinicalTrials.gov no. NCT02846831.
Collapse
Affiliation(s)
- Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Canada
- Centre for Translational Biology, Research Institute of McGill University Health Centre, Montréal, Canada
| | - Laurent Legault
- Department of Pediatrics, Division of Endocrinology and Metabolism, McGill University Health Centre, Montréal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montréal, Canada
| | - Marie Raffray
- Metabolic Diseases Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Nikita Gouchie-Provencher
- Centre for Translational Biology, Research Institute of McGill University Health Centre, Montréal, Canada
| | - Peter G. Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Anas El-Fathi
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Joanna Rutkowski
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Virginie Messier
- Metabolic Diseases Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Rémi Rabasa-Lhoret
- Metabolic Diseases Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Montreal Diabetes Research Center and Endocrinology Division, Montréal, Canada
- Address correspondence to: Rémi Rabasa-Lhoret, MD, PhD, Metabolic Diseases Research Unit, Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal (Québec) Canada H2W 1R7
| |
Collapse
|
92
|
Dovc K, Battelino T. Time in range centered diabetes care. Clin Pediatr Endocrinol 2021; 30:1-10. [PMID: 33446946 PMCID: PMC7783127 DOI: 10.1297/cpe.30.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Optimal glycemic control remains challenging and elusive for many people with diabetes. With the comprehensive clinical evidence on safety and efficiency in large populations, and with broader reimbursement, the adoption of continuous glucose monitoring (CGM) is rapidly increasing. Standardized visual reporting and interpretation of CGM data and clear and understandable clinical targets will help professionals and individuals with diabetes use diabetes technology more efficiently, and finally improve long-term outcomes with less everyday disease burden. For the majority of people with type 1 or type 2 diabetes, time in range (between 70 and 180 mg/dL, or 3.9 and 10 mmol/L) target of more than 70% is recommended, with each incremental increase of 5% towards this target being clinically meaningful. At the same time, the goal is to minimize glycemic excursions: a recommended target for a time below range (< 70 mg/dL or < 3.9 mmol/L) is less than 4%, and time above range (> 180 mg/dL or 10 mmol/L) less than 25%, with less stringent goals for older individuals or those at increased risk. These targets should be individualized: the personal use of CGM with the standardized data presentation provides all necessary means to accurately tailor diabetes management to the needs of each individual with diabetes.
Collapse
Affiliation(s)
- Klemen Dovc
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
93
|
Benhamou PY, Lablanche S, Vambergue A, Doron M, Franc S, Charpentier G. Patients with highly unstable type 1 diabetes eligible for islet transplantation can be managed with a closed-loop insulin delivery system: A series of N-of-1 randomized controlled trials. Diabetes Obes Metab 2021; 23:186-194. [PMID: 33001536 DOI: 10.1111/dom.14214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Abstract
AIM To compare the efficacy of the closed-loop Diabeloop for highly unstable diabetes (DBLHU) system with the open-loop predictive low glucose suspend (PLGS) system in patients with highly unstable type 1 diabetes (T1D) who experience acute metabolic events. METHODS DBLHU-WP10 was an interventional, controlled, randomized, open-label study that comprised two cycles of N-of-1 trials (2-of-1 trials). Each trial consisted of two crossover 4-week periods of treatment with either DBLHU or PLGS in randomized order. The primary outcome was the percentage of time spent in the 70-180 mg/dL glucose range (time in range [TIR]). RESULTS Five out of seven randomized patients completed the aggregated 2-of-1 trials. TIR was significantly higher with DBLHU (73.3% ± 1.7%) compared with PLGS (43.5% ± 1.7%; P < .0001). The percentage of time below 70 mg/dL was significantly lower with DBLHU (0.9% ± 0.4%) versus PLGS (3.7% ± 0.4%; P < .0001). DBLHU was also significantly superior to PLGS in reducing hyperglycaemic excursions and improving almost all other secondary outcomes, including glucose variability and satisfaction score. No adverse event could be related to the experimental treatment. CONCLUSIONS DBLHU was superior to PLGS in improving the metabolic control of patients with highly unstable T1D who require an islet or pancreas transplant but who either have a contraindication or refuse to consent.
Collapse
Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | - Maeva Doron
- University Grenoble Alpes, CEA, LETI, Grenoble, France
| | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| |
Collapse
|
94
|
Malandrucco I, Russo B, Picconi F, Menduni M, Frontoni S. Glycemic Status Assessment by the Latest Glucose Monitoring Technologies. Int J Mol Sci 2020; 21:E8243. [PMID: 33153229 PMCID: PMC7663245 DOI: 10.3390/ijms21218243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
The advanced and performing technologies of glucose monitoring systems provide a large amount of glucose data that needs to be properly read and interpreted by the diabetology team in order to make therapeutic decisions as close as possible to the patient's metabolic needs. For this purpose, new parameters have been developed, to allow a more integrated reading and interpretation of data by clinical professionals. The new challenge for the diabetes community consists of promoting an integrated and homogeneous reading, as well as interpretation of glucose monitoring data also by the patient himself. The purpose of this review is to offer an overview of the glycemic status assessment, opened by the current data management provided by latest glucose monitoring technologies. Furthermore, the applicability and personalization of the different glycemic monitoring devices used in specific insulin-treated diabetes mellitus patient populations will be evaluated.
Collapse
Affiliation(s)
- Ilaria Malandrucco
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Benedetta Russo
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Marika Menduni
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| |
Collapse
|
95
|
Tubiana-Rufi N, Schaepelynck P, Franc S, Chaillous L, Joubert M, Renard E, Reznik Y, Abettan C, Bismuth E, Beltrand J, Bonnemaison E, Borot S, Charpentier G, Delemer B, Desserprix A, Durain D, Farret A, Filhol N, Guerci B, Guilhem I, Guillot C, Jeandidier N, Lablanche S, Leroy R, Melki V, Munch M, Penfornis A, Picard S, Place J, Riveline JP, Serusclat P, Sola-Gazagnes A, Thivolet C, Hanaire H, Benhamou PY. Practical implementation of automated closed-loop insulin delivery: A French position statement. DIABETES & METABOLISM 2020; 47:101206. [PMID: 33152550 DOI: 10.1016/j.diabet.2020.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023]
Abstract
Automated closed-loop (CL) insulin therapy has come of age. This major technological advance is expected to significantly improve the quality of care for adults, adolescents and children with type 1 diabetes. To improve access to this innovation for both patients and healthcare professionals (HCPs), and to promote adherence to its requirements in terms of safety, regulations, ethics and practice, the French Diabetes Society (SFD) brought together a French Working Group of experts to discuss the current practical consensus. The result is the present statement describing the indications for CL therapy with emphasis on the idea that treatment expectations must be clearly defined in advance. Specifications for expert care centres in charge of initiating the treatment were also proposed. Great importance was also attached to the crucial place of high-quality training for patients and healthcare professionals. Long-term follow-up should collect not only metabolic and clinical results, but also indicators related to psychosocial and human factors. Overall, this national consensus statement aims to promote the introduction of marketed CL devices into standard clinical practice.
Collapse
Affiliation(s)
- N Tubiana-Rufi
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - P Schaepelynck
- Nutrition-Endocrinologie-Maladies Métaboliques, pôle ENDO, Hôpital de la Conception, APHM, Marseille, France
| | - S Franc
- Diabétologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, CERITD, Bioparc Genopole Evry-Corbeil, LBEPS, Université Evry, IRBA, Université Paris Saclay, Evry, France
| | - L Chaillous
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - M Joubert
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - E Renard
- Endocrinologie, Diabète, Nutrition et CIC INSERM 1411, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - Y Reznik
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - C Abettan
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - E Bismuth
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - J Beltrand
- APHP Centre, Université de Paris, Hôpital Necker Enfants Malades, Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - E Bonnemaison
- Unité de Spécialités Pédiatriques, Hôpital Clocheville, CHRU de Tours, et SFEDP, France
| | - S Borot
- Université Franche-Comté et Endocrinologie, Nutrition et Diabétologie, CHU, Besançon, France
| | | | - B Delemer
- Endocrinologie Diabétologie, CHU, Reims, et Présidente du CNP d'Endocrinologie Diabétologie et Maladies Métaboliques, France
| | - A Desserprix
- IDE I-ETP, Hotel Dieu Le Creusot (71), Groupe SOS Santé et Vice-présidente de la SFD-Paramédical, France
| | - D Durain
- Cadre de Santé Endocrinologie et Diabétologie et ETP, CHRU, Nancy et SFD-Paramédical, France
| | - A Farret
- Endocrinologie, Diabète, Nutrition, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - N Filhol
- Endocrinologie et Diabétologie, Hôpital de la Conception, APHM, Marseille, France
| | - B Guerci
- Université de Lorraine et Endocrinologie Diabétologie Maladies Métaboliques et Nutrition, CHU, Nancy, France
| | - I Guilhem
- Endocrinologie-Diabétologie-Nutrition, CHU, Rennes, France
| | - C Guillot
- Sociologue responsable du Diabète LAB, FFD, Paris, 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
| | - R Leroy
- Cabinet libéral d'endocrinologie diabétologie, Lille, France
| | - V Melki
- Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - M Munch
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU Strasbourg, France
| | - A Penfornis
- Université Paris-Saclay et Endocrinologie, Diabétologie et Maladies Métaboliques, CHSF Corbeil-Essonnes, France
| | - S Picard
- Cabinet d'Endocrino-Diabétologie, Point Médical, Dijon et FENAREDIAM, France
| | - J Place
- Ingénieur d'Études, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - J P Riveline
- Centre Universitaire du Diabète, Hôpital Lariboisière, APHP, Paris, France
| | - P Serusclat
- Groupe Hospitalier Mutualiste Les Portes du Sud, Vénissieux, France
| | - A Sola-Gazagnes
- Endocrinologie Diabétologie, Hôpital Cochin, APHP, Paris, France
| | - C Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Président de la SFD, France
| | - H Hanaire
- Université de Toulouse et Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - P Y Benhamou
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Président du groupe de travail Télémédecine et Technologies Innovantes de la SFD, France.
| |
Collapse
|
96
|
Pease A, Zomer E, Liew D, Earnest A, Soldatos G, Ademi Z, Zoungas S. Cost-Effectiveness Analysis of a Hybrid Closed-Loop System Versus Multiple Daily Injections and Capillary Glucose Testing for Adults with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:812-821. [PMID: 32348159 DOI: 10.1089/dia.2020.0064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Hybrid closed-loop systems may offer improved HbA1c levels, more time-in-range, and less hypoglycemia than alternative treatment strategies. However, it is unclear if glycemic improvements offset this technology's higher acquisition costs. Among adults with type 1 diabetes in Australia, we sought to evaluate the cost-effectiveness of a hybrid closed-loop system in comparison with the current standard of care, comprising insulin injections and capillary glucose testing. Methods: Cost-effectiveness analysis was performed using decision analysis in combination with a Markov model to simulate disease progression in a cohort of adults with type 1 diabetes and compare the downstream health and economic consequences of hybrid closed-loop therapy versus current standard of care. Transition probabilities and utilities were sourced from published studies. Costs were considered from the perspective of the Australian health care system. A lifetime horizon was considered, with annual discount rates of 5% applied to future costs and outcomes. Uncertainty was assessed with probabilistic and deterministic sensitivity analyses. Results: Use of a hybrid closed-loop system resulted in an incremental cost-effectiveness ratio of Australian dollars (AUD) 37,767 per quality-adjusted life year (QALY) gained. This is below the traditionally cited willingness to pay a threshold of $50,000 per QALY gained in the Australian setting. Sensitivity analyses that varied baseline glycemic control, treatment effects, technology costs, age, discount rates, and time horizon indicated the results to be robust. Conclusions: For adults with type 1 diabetes, hybrid closed-loop therapy is likely to be cost-effective compared with multiple daily injections and capillary glucose testing in Australia.
Collapse
Affiliation(s)
- Anthony Pease
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Georgia Soldatos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| |
Collapse
|
97
|
Zheng F, Bonnet S, Villeneuve E, Doron M, Lepecq A, Forbes F. Unannounced Meal Detection for Artificial Pancreas Systems Using Extended Isolation Forest. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5892-5895. [PMID: 33019315 DOI: 10.1109/embc44109.2020.9176856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study aims at developing an unannounced meal detection method for artificial pancreas, based on a recent extension of Isolation Forest. The proposed method makes use of features accounting for individual Continuous Glucose Monitoring (CGM) profiles and benefits from a two-threshold decision rule detection. The advantage of using Extended Isolation Forest (EIF) instead of the standard one is supported by experiments on data from virtual diabetic patients, showing good detection accuracy with acceptable detection delays.
Collapse
|
98
|
Benhamou PY, Madrolle S, Lablanche S, Gallegos A, Tourki Y, Franc S, Doron M, Charpentier G. Comment on Leelarathna et al. Duration of Hybrid Closed-Loop Insulin Therapy to Achieve Representative Glycemic Outcomes in Adults With Type 1 Diabetes. Diabetes Care 2020;43:e38-e39. Diabetes Care 2020; 43:e167. [PMID: 32958628 PMCID: PMC7510045 DOI: 10.2337/dc20-1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Pierre Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | | | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| | - Maeva Doron
- Leti, CEA, Grenoble Alpes University, Grenoble, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| |
Collapse
|
99
|
Senior P, Lam A, Farnsworth K, Perkins B, Rabasa-Lhoret R. Assessment of Risks and Benefits of Beta Cell Replacement Versus Automated Insulin Delivery Systems for Type 1 Diabetes. Curr Diab Rep 2020; 20:52. [PMID: 32865637 DOI: 10.1007/s11892-020-01339-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Current approaches to insulin replacement in type 1 diabetes are unable to achieve optimal levels of glycemic control without substantial risk of hypoglycemia and substantial burden of self-management. Advances in biology and technology present beta cell replacement and automated insulin delivery as two alternative approaches. Here we discuss current and future prospects for the relative risks and benefits for biological and psychosocial outcomes from the perspective of researchers, clinicians, and persons living with diabetes. RECENT FINDINGS Beta cell replacement using pancreas or islet transplant can achieve insulin independence but requires immunosuppression. Although insulin independence may not be sustained, time in range of 80-90%, minimal glycemic variability and abolition of hypoglycemia is routine after islet transplantation. Clinical trials of potentially unlimited supply of stem cell-derived beta cells are showing promise. Automated insulin delivery (AID) systems can achieve 70-75% time in range, with reduced glycemic variability. Impatient with the pace of commercially available AID, users have developed their own algorithms which appear to be at least equivalent to systems developed within conventional regulatory frameworks. The importance of psychosocial factors and the preferences and values of persons living with diabetes are emerging as key elements on which therapies should be evaluated beyond their impact of biological outcomes. Biology or technology to deliver glucose dependent insulin secretion is associated with substantial improvements in glycemia and prevention of hypoglycemia while relieving much of the substantial burden of diabetes. Automated insulin delivery, currently, represents a more accessible bridge to a biologic cure that we expect future cellular therapies to deliver.
Collapse
Affiliation(s)
- Peter Senior
- Division of Endocrinology and Metabolism, University of Alberta, 9.114 CSB, Edmonton, AB, Canada.
- Innovations in Type 1 Diabetes, Diabetes Action Canada, Toronto, Canada.
| | - Anna Lam
- Division of Endocrinology and Metabolism, University of Alberta, 9.114 CSB, Edmonton, AB, Canada
| | - Kate Farnsworth
- Innovations in Type 1 Diabetes, Diabetes Action Canada, Toronto, Canada
| | - Bruce Perkins
- Innovations in Type 1 Diabetes, Diabetes Action Canada, Toronto, Canada
- Leadership Sinai Centre for Diabetes, University of Toronto, Toronto, ON, Canada
| | - Remi Rabasa-Lhoret
- Innovations in Type 1 Diabetes, Diabetes Action Canada, Toronto, Canada
- Institutes de Recherche Cliniques de Montreal, Montreal, QC, Canada
| |
Collapse
|
100
|
Villeneuve E, Lachal S, Desir C, Benhamou PY, Franc S, Charpentier G, Huneker E, Doron M. Increasing the safety of unannounced meal detection for artificial pancreas closed-loop with patient's hourly meal schedule. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5093-5096. [PMID: 33019132 DOI: 10.1109/embc44109.2020.9176470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The daily challenge for people with type 1 diabetes is maintaining glycaemia in the "normal" range after meals, by injecting themselves the correct amount of insulin. Artificial pancreas systems were developed to adjust insulin delivery based on real-time monitoring of glycaemia and meal patient's report. Meal reporting is a heavy burden for patients as it requires carbohydrate estimation several times per day. To improve patient's quality of life and treatment, several methods aim at detecting unannounced meals. While untreated meals lead to hyperglycaemia and in the long-term to comorbidities, treating falsely detected meals can cause hypoglycaemia and coma. In this paper, we propose to customise the meal detection to the patient's hourly meal probability in order to limit false detection of unannounced meals.
Collapse
|