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Yogev D, Goldberg T, Arami A, Tejman-Yarden S, Winkler TE, Maoz BM. Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges. APL Bioeng 2023; 7:031506. [PMID: 37781727 PMCID: PMC10539032 DOI: 10.1063/5.0152290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.
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Affiliation(s)
| | | | | | | | | | - Ben M. Maoz
- Authors to whom correspondence should be addressed: and
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Rachmiel M, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Jacobi-Polishook T, Ben Ari T, Abiri S, Landau Z, Pinhas-Hamiel O. MiniMed 780G Advanced Hybrid Closed-Loop System Outcomes According to Pubertal Status: Awesome Study Group Real-Life Experience. Diabetes Technol Ther 2023; 25:643-651. [PMID: 37219952 DOI: 10.1089/dia.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background and Aims: Achieving good glycemic control is a major challenge for adolescents with type 1 diabetes (TID). The introduction of the MiniMed 780G system, an advanced hybrid closed-loop (AHCL) that enables an automatic correction of insulin, gave hope for improved glycemic outcomes in adolescents. We assessed specific characteristics associated with glycemic measures in youth with T1D switching to Minimed 780G. Methods: This retrospective observational real-life multicenter study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 22 patients (59% females, median age 13.9 interquartile range [IQR 11,18] years), from a high socioeconomic background. CGM metrics were recorded for 2-week periods before AHCL, after 1, 3, 6 months, and at the end of follow-up (median 10.9 [IQR 5.4, 17.4] months). Delta-variables (Δ) were calculated as the difference between the end of follow-up and baseline. Results: Time in range (TIR)70-180mg/dL increased from 65% [52, 72] to 75% [63, 80], P = 0.008, from baseline to end of follow-up. Time above range>180mg/dL decreased from 28% [20, 46] to 22% [14, 35], P = 0.047. Advanced pubertal stage was correlated with less improvement in ΔTAR>180mg/dL, r = 0.47, P = 0.05, and less CGM usage r = -0.57, P = 0.05. A longer disease duration was associated with less improvement in ΔTAR180-250mg/dL, r = 0.48, P = 0.05. Lower pump site change frequency was associated with higher glucose management indicator, r = 0.5, P = 0.03, and lower TIR70-180mg/dL r = -0.52, P = 0.08. Conclusion: The use of AHCL enabled improvements in TIR70-180mg/dL in youth with T1D. More advanced pubertal stages, longer disease duration, and less compliance were associated with less improvement, stressing the need for continuous support, and re-education in this age group.
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Affiliation(s)
- Marianna Rachmiel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Beer Yaakov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Avivit Brener
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noah Levek
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Talia Jacobi-Polishook
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Beer Yaakov, Israel
| | - Tal Ben Ari
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Shirli Abiri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Zohar Landau
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
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Cordero TL, Dai Z, Arrieta A, Niu F, Vella M, Shin J, Rhinehart AS, McVean J, Lee SW, Slover RH, Forlenza GP, Shulman DI, Pop-Busui R, Thrasher JR, Kipnes MS, Christiansen MP, Buckingham BA, Pihoker C, Sherr JL, Kaiserman KB, Vigersky RA. Glycemic Outcomes During Early Use of the MiniMed™ 780G Advanced Hybrid Closed-Loop System with Guardian™ 4 Sensor. Diabetes Technol Ther 2023; 25:652-658. [PMID: 37252734 PMCID: PMC10460682 DOI: 10.1089/dia.2023.0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Safety and significant improvement in overall glycated hemoglobin (A1C) and percentage of time spent in (TIR), below (TBR), and above (TAR) glucose range were demonstrated in the pivotal trial of adolescents and adults using the MiniMed™ advanced hybrid closed-loop (AHCL) system with the adjunctive, calibration-required Guardian™ Sensor 3. The present study evaluated early outcomes of continued access study (CAS) participants who transitioned from the pivotal trial investigational system to the approved MiniMed™ 780G system with the non-adjunctive, calibration-free Guardian™ 4 Sensor (MM780G+G4S). Study data were presented alongside those of real-world MM780G+G4S users from Europe, the Middle East, and Africa. Methods: The CAS participants (N = 109, aged 7-17 years and N = 67, aged >17 years) used the MM780G+G4S for 3 months and data of real-world MM780G+G4S system users (N = 10,204 aged ≤15 years and N = 26,099 aged >15 years) were uploaded from September 22, 2021 to December 02, 2022. At least 10 days of real-world continuous glucose monitoring (CGM) data were required for analyses. Glycemic metrics, delivered insulin and system use/interactions underwent descriptive analyses. Results: Time in AHCL and CGM use were >90% for all groups. AHCL exits averaged 0.1/day and there were few blood glucose measurements (BGMs) (0.8/day-1.0/day). Adults in both cohorts met most consensus recommendations for glycemic targets. Pediatric groups met recommendations for %TIR and %TBR, although not those for mean glucose variability and %TAR, possibly due to low use of recommended glucose target (100 mg/dL) and active insulin time (2 h) settings (28.4% in the CAS cohort and 9.4% in the real-world cohort). The CAS pediatric and adult A1C were 7.2% ± 0.7% and 6.8% ± 0.7%, respectively, and there were no serious adverse events. Conclusions: Early clinical use of the MM780G+G4S was safe and involved minimal BGMs and AHCL exits. Consistent with real-world pediatric and adult use, outcomes were associated with achievement of recommended glycemic targets. Clinical Trial Registration number: NCT03959423.
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Affiliation(s)
| | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Fang Niu
- Medtronic, Northridge, California, USA
| | | | - John Shin
- Medtronic, Northridge, California, USA
| | | | | | - Scott W. Lee
- Department of Endocrinology, Loma Linda University, Loma Linda, California, USA
| | - Robert H. Slover
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Gregory P. Forlenza
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Dorothy I. Shulman
- University of South Florida Diabetes and Endocrinology, Department of Pediatrics, Tampa, Florida, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - James R. Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Mark S. Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | | | - Bruce A. Buckingham
- Stanford University School of Medicine, Department of Pediatric Endocrinology, Stanford, California, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Franceschi R, Mozzillo E, Di Candia F, Maines E, Leonardi L, Girardi M, Fedi L, Rosanio FM, Marcovecchio ML. A systematic review on the impact of commercially available hybrid closed loop systems on psychological outcomes in youths with type 1 diabetes and their parents. Diabet Med 2023; 40:e15099. [PMID: 37029751 DOI: 10.1111/dme.15099] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/09/2023]
Abstract
AIM To systematically assess the impact of commercially available hybrid closed loop (HCL) systems on psychological outcomes in youths with type 1 diabetes and their parents. METHODS We performed a systematic review including studies published in the last 10 years. PICOS framework was used in the selection process, and evidence was assessed using the GRADE system. RESULTS A total of 215 studies were identified after duplicate removal, and 31 studies were included in this systematic review: 20 on first-generation HCL and 11 on second-generation HCL systems. According to studies with moderate- to high-level quality of evidence, HCL systems led to better, or in some studies, unchanged psychological outcomes such as distress and burden related to diabetes management, fear of hypoglycemia, quality of life, satisfaction; instead, quality of sleep was perceived as improved, although results were not confirmed in studies using actigraphy. From semi-structured interviews, answers were more homogeneous, and participants reported a positive experience and attitude towards HCL technology, which was felt to be easy to use and apt to achieve glycemic targets. CONCLUSIONS Evidence confirms the importance of evaluating the psychosocial needs of youths with diabetes and their families when starting HCL systems and during follow-up, and to set realistic expectations of what can be achieved along with awareness of the limitations of the systems, and educate and motivate families to overcome barriers.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department S. Chiara General Hospital of Trento, APSS, Trento, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department S. Chiara General Hospital of Trento, APSS, Trento, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department S. Chiara General Hospital of Trento, APSS, Trento, Italy
| | - Martina Girardi
- Pediatric Diabetology Unit, Pediatric Department S. Chiara General Hospital of Trento, APSS, Trento, Italy
| | - Ludovica Fedi
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - M Loredana Marcovecchio
- Department of Pediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lomax KE, Taplin CE, Abraham MB, Smith GJ, Haynes A, Zomer E, Ellis KL, Clapin H, Zoungas S, Jenkins AJ, Harrington J, de Bock MI, Jones TW, Davis EA. Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models. Front Endocrinol (Lausanne) 2023; 14:1178958. [PMID: 37670884 PMCID: PMC10476216 DOI: 10.3389/fendo.2023.1178958] [Citation(s) in RCA: 1] [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] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Technology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through private health insurance, self-funding or philanthropy. The study aim was to investigate the use of diabetes technology across different socioeconomic groups in Australian youth with T1D, in the setting of two contrasting funding models. Methods A cross-sectional evaluation of 4957 youth with T1D aged <18 years in the national registry was performed to determine technology use. The Index of Relative Socio-Economic Disadvantage (IRSD) derived from Australian census data is an area-based measure of socioeconomic status (SES). Lower quintiles represent greater disadvantage. IRSD based on most recent postcode of residence was used as a marker of SES. A multivariable generalised linear model adjusting for age, diabetes duration, sex, remoteness classification, and location within Australia was used to determine the association between SES and device use. Results CGM use was lower in IRSD quintile 1 in comparison to quintiles 2 to 5 (p<0.001) where uptake across the quintiles was similar. A higher percentage of pump use was observed in the least disadvantaged IRSD quintiles. Compared to the most disadvantaged quintile 1, pump use progressively increased by 16% (95% CI: 4% to 31%) in quintile 2, 19% (6% to 33%) in quintile 3, 35% (21% to 50%) in quintile 4 and 51% (36% to 67%) in the least disadvantaged quintile 5. Conclusion In this large national dataset, use of diabetes technologies was found to differ across socioeconomic groups. For nationally subsidised CGM, use was similar across socioeconomic groups with the exception of the most disadvantaged quintile, an important finding requiring further investigation into barriers to CGM use within a nationally subsidised model. User pays funding models for pump therapy result in lower use with socioeconomic disadvantage, highlighting inequities in this funding approach. For the full benefits of diabetes technology to be realised, equitable access to pump therapy needs to be a health policy priority.
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Affiliation(s)
- Kate E Lomax
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
| | - Grant J Smith
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katrina L Ellis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
| | - Helen Clapin
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alicia J Jenkins
- Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jenny Harrington
- Division of Endocrinology, Women's and Children's Health Network, North Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
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Lendínez‐Jurado A, Gómez‐Perea A, Ariza‐Jiménez AB, Tapia‐Ceballos L, Becerra‐Paz I, Martos‐Lirio MF, Moreno‐Jabato F, Leiva‐Gea I. Impact on glucometric variables and quality of life of the advanced hybrid closed-loop system in pediatric and adolescent type 1 diabetes. J Diabetes 2023; 15:699-708. [PMID: 37337407 PMCID: PMC10415871 DOI: 10.1111/1753-0407.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In recent years, technological advances in the field of diabetes have revolutionized the management, prognosis, and quality of life of diabetes patients and their environment. The aim of our study was to evaluate the impact of implementing the MiniMed 780G closed-loop system in a pediatric and adolescent population previously treated with a continuous subcutaneous insulin infusion pump and intermittent glucose monitoring. METHODS Data were collected from 28 patients with type 1 diabetes aged 6 to 17 years, with a follow-up of 6 months. We included both glucometric and quality of life variables, as well as quality of life in primary caregivers. Metabolic control variables were assessed at baseline (before system change) and at different cutoff points after initiation of the closed-loop system (48 hours, 7 days, 14 days, 21 days, 1 month, 3 months, 6 months). RESULTS Time in range 70-180 mg/dL increased from 59.44% at baseline to 74.29% in the first 48 hours after automation of the new system, and this improvement was maintained at the other cutoff points, as was time in hyperglycemia 180-250 mg/dL (24.44% at baseline to 18.96% at 48 hours) and >250 mg/dL (11.71% at baseline to 3.82% at 48 hours). CONCLUSIONS Our study showed an improvement in time in range and in all time spent in hyperglycemia from the first 48 hours after the automation of the system, which was maintained at 6 months.
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Affiliation(s)
- Alfonso Lendínez‐Jurado
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
| | - Ana Gómez‐Perea
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Ana B. Ariza‐Jiménez
- Department of Pediatric EndocrinologyReina Sofia University HospitalCórdobaSpain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de CórdobaCórdobaSpain
| | - Leopoldo Tapia‐Ceballos
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Icía Becerra‐Paz
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
| | - María F. Martos‐Lirio
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
| | - Fernando Moreno‐Jabato
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
- Servicio de Supercomputación y Departamento de Arquitectura de ComputadoresUniversidad de MálagaMálagaSpain
| | - Isabel Leiva‐Gea
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
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Lakshman R, Boughton C, Hovorka R. The changing landscape of automated insulin delivery in the management of type 1 diabetes. Endocr Connect 2023; 12:e230132. [PMID: 37289734 PMCID: PMC10448576 DOI: 10.1530/ec-23-0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 06/10/2023]
Abstract
Automated insulin delivery systems, also known as closed-loop or 'artificial pancreas' systems, are transforming the management of type 1 diabetes. These systems consist of an algorithm which responds to real-time glucose sensor levels by automatically modulating insulin delivery through an insulin pump. We review the rapidly changing landscape of automated insulin-delivery systems over recent decades, from initial prototypes to the different hybrid closed-loop systems commercially available today. We discuss the growing body of clinical trials and real-world evidence demonstrating their glycaemic and psychosocial benefits. We also address future directions in automated insulin delivery such as dual-hormone systems and adjunct therapy as well as the challenges around ensuring equitable access to closed-loop technology.
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Affiliation(s)
- Rama Lakshman
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Boughton
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
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Newman C, Hartnell S, Wilinska M, Alwan H, Hovorka R. Real-World Evidence of the Cambridge Hybrid Closed-Loop App With a Novel Real-Time Continuous Glucose Monitoring System. J Diabetes Sci Technol 2023:19322968231187915. [PMID: 37503893 DOI: 10.1177/19322968231187915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
We evaluated the performance of the interoperable Cambridge hybrid closed-loop app with FreeStyle Libre 3 glucose sensor, and YpsoPump insulin pump in a real-world setting. Data from 100 users (63 adults [mean ± SD age 41.9 ± 14.0 years], 15 children [8.6 ± 5.2 years)] and 22 users of unreported age) for a period of 28 days were analyzed. Time in range (3.91- 10.0mmol/L) was 72.6 ± 11.1% overall. Time below range (<3.9mmol/L) was 3.1% (1.4-5.1) (median [interquartile range]). Auto-mode was active for 95.8% (91.8-97.9) of time. This real-world analysis suggests that the performance of Cambridge hybrid closed-loop app with this glucose sensor is comparable to other commercially available hybrid closed-loop systems.
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Affiliation(s)
- Christine Newman
- Wolfson Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara Hartnell
- Wolfson Diabetes and Endocrinology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Malgorzata Wilinska
- Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Heba Alwan
- Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Bombaci B, Passanisi S, Valenzise M, Macrì F, Calderone M, Hasaj S, Zullo S, Salzano G, Lombardo F. Real-World Performance of First- Versus Second-Generation Automated Insulin Delivery Systems on a Pediatric Population With Type 1 Diabetes: A One-Year Observational Study. J Diabetes Sci Technol 2023:19322968231185115. [PMID: 37431949 DOI: 10.1177/19322968231185115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND The aim of this single-center observational study was to assess the real-world performance of first- and second-generation automated insulin delivery (AID) systems in a cohort of children and adolescents with type 1 diabetes over a one-year follow-up. METHODS Demographic, anamnestic, and clinical data of the study cohort were collected at the start of automatic mode. Data on continuous glucose monitoring metrics, system settings, insulin requirements, and anthropometric parameters at three different time points (start period, six months, 12 months) were retrospectively gathered and statistically analyzed. RESULTS Fifty-four individuals (55.6% of females) aged 7 to 18 years switching to AID therapy were included in the analysis. Two weeks after starting automatic mode, subjects using advanced hybrid closed-loop (AHCL) showed a better response than hybrid closed-loop (HCL) users in terms of time in range (P = .016), time above range 180 to 250 mg/dl (P = .022), sensor mean glucose (P = .047), and glycemia risk index (P = .012). After 12 months, AHCL group maintained better mean sensor glucose (P = .021) and glucose management indicator (P = .027). Noteworthy, both HCL and AHCL users achieved the recommended clinical targets over the entire study period. The second-generation AID system registered longer time spent with automatic mode activated and fewer shifts to manual mode at every time point (P < .001). CONCLUSIONS Both systems showed sustained and successful glycemic outcomes in the first year of use. However, AHCL users achieved tighter glycemic targets, without an increase of hypoglycemia risk. Improved usability of the device may also have contributed to optimal glycemic outcomes by ensuring better continuity of the automatic mode activation.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Fabio Macrì
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Marco Calderone
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Senad Hasaj
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Sofia Zullo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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Alwan H, Wilinska ME, Ruan Y, Da Silva J, Hovorka R. Real-World Evidence Analysis of a Hybrid Closed-Loop System. J Diabetes Sci Technol 2023:19322968231185348. [PMID: 37421250 DOI: 10.1177/19322968231185348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
BACKGROUND We analyzed real-world evidence to assess the performance of the mylife CamAPS FX hybrid closed-loop system. METHODS Users from 15 countries across different age groups who used the system between May 9, 2022, and December 3, 2022, and who had ≥30 days of continuous glucose monitor data, and ≥30% of closed-loop usage were included in the current analysis (N = 1805). RESULTS Time in range (3.9-10 mmol/L) was 72.6 ± 11.5% (mean ± SD) for all users and increased by age from 66.9 ± 11.7% for users ≤6 years old to 81.8 ± 8.7% for users ≥65 years. Time spent in hypoglycemia (<3.9 mmol/L) was 2.3% [1.3, 3.6] (median [interquartile range]). Mean glucose and glucose management indicator were 8.4 ± 1.1 mmol/L and 6.9%, respectively. Time using closed-loop was high at 94.7% [90.0, 96.9]. CONCLUSIONS Glycemic outcomes from the present real-world evidence are comparable to results obtained from previous randomized controlled studies and confirm the efficacy of this hybrid closed-loop system in real-world settings.
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Affiliation(s)
- Heba Alwan
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Yue Ruan
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Castañeda J, Arrieta A, van den Heuvel T, Cohen O. The significance of coefficient of variation as a measure of hypoglycaemia risk and glycaemic control in real world users of the automated insulin delivery MiniMed 780G system. Diabetes Obes Metab 2023. [PMID: 37246797 DOI: 10.1111/dom.15139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/30/2023]
Abstract
AIM Use of the MiniMed 780G system (MM780G) can result in a reduction in mean and standard deviation (SD) of sensor glucose (SG) values. We assessed the significance of the coefficient of variation (CV) as a measure of hypoglycaemia risk and glycaemic control. MATERIALS AND METHODS Data from 10 404 MM780G users were analysed using multivariable logistic regression to assess the contribution of CV to (a) hypoglycaemia risk, measured as not reaching target <1% for time below range (TBR), and (b) achieving targets of time-in-range (TIR) >70% and glucose management indicator <7%. CV was compared with SD and low blood glucose index. To assess the relevance of CV <36% as a therapeutic threshold, we identified the CV cut-off point that optimally discriminated users at risk of hypoglycaemia. RESULTS The contribution of CV was the smallest in terms of risk of hypoglycaemia (vs. low blood glucose index and SD) and TIR and glucose management indicator targets (vs. SD). In all cases the models with SD showed the best fit. A CV <43.4% (95% CI: 42.9-43.9) was the optimal cut-off point with a correct classification rate of 87.2% (vs. 72.9% for CV <36%). CONCLUSION For MM780G users, CV is a poor marker for hypoglycaemia risk and glycaemic control. We recommend using, for the former, TBR and whether the TBR target is met (and not using CV <36% as a therapeutic threshold for hypoglycaemia); for the latter, TIR, time above range, whether targets are met and a discrete description of mean SG and SD of SG values.
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Affiliation(s)
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Matejko B, Juza A, Kiec-Wilk B, Cyranka K, Krzyżowska S, Cohen O, Malecki MT, Klupa T. One-year follow-up of advance hybrid closed-loop system in adults with type 1 diabetes previously naive to diabetes technology: The effect of switching to a calibration-free sensor. Diabetes Technol Ther 2023. [PMID: 37184526 DOI: 10.1089/dia.2023.0059] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study was to observe the one-year clinical outcomes of people with type 1 diabetes (T1D) who switched from Multiple Daile Injection + Blood Glucose Meter to an advanced hybrid closed-loop (AHCL) system (Medtronic MiniMedTM 780G system (MM 780G). Additionally, the effect of changing at month 6 to a calibration free sensor (GuardianTM 4 Sensor (G4S) was evaluated. 18 participants (10 men, age 40.9±7.6 years) completed 1 year of MM 780G use. Time in range (70-180 mg/dL) (TIR) remained stable and ranged from 83.2% in month 9 to 84.8% in month 3. There was no difference between TIR at 3 months before switching vs 3 months after switching to G4S (p=0.614). AHCL system in adults significantly improves glycemic outcomes. This improved glycemic control was maintained over the 12 months. Switching to a calibration free sensor (G4S) did not affect outcomes but required less patient involvement.
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Affiliation(s)
- Bartlomiej Matejko
- Jagiellonian University Medical College, 49573, Krakow, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Anna Juza
- Specialist Voivodship Hospital Frederic Chopin in Rzeszow, 206088, ul. Saska 61/6, Rzeszów, Poland, 35-615;
| | - Beata Kiec-Wilk
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Katarzyna Cyranka
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Sabina Krzyżowska
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Department of Metabolic Diseases, Krakow, Małopolskie, Poland;
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Toluchenaz, Tolochenaz, Switzerland, 46733;
| | - Maciej Tadeusz Malecki
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Tomasz Klupa
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
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Šumnik Z, Pavlíková M, Neuman V, Petruželková L, Konečná P, Venháčová P, Škvor J, Pomahačová R, Neumann D, Vosáhlo J, Strnadel J, Kocourková K, Obermannová B, Šantová A, Plachý L, Průhová S, Cinek O. Glycemic Control by Treatment Modalities: National Registry-Based Population Data in Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2023; 97:70-79. [PMID: 37100041 DOI: 10.1159/000530833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
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Affiliation(s)
- Zdenek Šumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Marketa Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Lenka Petruželková
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Petra Konečná
- Department of Pediatrics, University Hospital Brno, Brno, Czechia
| | - Petra Venháčová
- Department of Pediatrics, University Hospital Olomouc, Olomouc, Czechia
| | - Jaroslav Škvor
- Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, Czechia
| | - Renata Pomahačová
- Department of Pediatrics, University Hospital Pilsen, Pilsen, Czechia
| | - David Neumann
- Department of Pediatrics, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Vosáhlo
- Department of Pediatrics, 3rd Faculty of Medicine, Prague, Czechia
| | - Jiri Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Kamila Kocourková
- Department of Pediatrics, Hospital České Budějovice, České Budějovice, Czechia
| | - Barbora Obermannová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Alzbeta Šantová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
- 1st Faculty of Medicine, Prague, Czechia
| | - Lukas Plachý
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Stepanka Průhová
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
| | - Ondrej Cinek
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia
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Chmayssem A, Nadolska M, Tubbs E, Sadowska K, Vadgma P, Shitanda I, Tsujimura S, Lattach Y, Peacock M, Tingry S, Marinesco S, Mailley P, Lablanche S, Benhamou PY, Zebda A. Insight into continuous glucose monitoring: from medical basics to commercialized devices. Mikrochim Acta 2023; 190:177. [PMID: 37022500 DOI: 10.1007/s00604-023-05743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.
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Affiliation(s)
- Ayman Chmayssem
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France
| | - Małgorzata Nadolska
- Institute of Nanotechnology and Materials Engineering, Faculty of Applied Physics and Mathematics, Gdansk University of Technology, 80-233, Gdansk, Poland
| | - Emily Tubbs
- Univ. Grenoble Alpes, CEA, INSERM, IRIG, 38000, Grenoble, Biomics, France
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
| | - Kamila Sadowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland
| | - Pankaj Vadgma
- School of Engineering and Materials Science, Queen Mary University of London, Mile End, London, E1 4NS, UK
| | - Isao Shitanda
- Department of Pure and Applied Chemistry, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
- Research Institute for Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
| | - Seiya Tsujimura
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan
- Division of Material Science, Faculty of Pure and Applied Science, University of Tsukuba, 1-1-1, Tennodai, Ibaraki, Tsukuba, 305-5358, Japan
| | | | - Martin Peacock
- Zimmer and Peacock, Nedre Vei 8, Bldg 24, 3187, Horten, Norway
| | - Sophie Tingry
- Institut Européen Des Membranes, UMR 5635, IEM, Université Montpellier, ENSCM, CNRS, Montpellier, France
| | - Stéphane Marinesco
- Plate-Forme Technologique BELIV, Lyon Neuroscience Research Center, UMR5292, Inserm U1028, CNRS, Univ. Claude-Bernard-Lyon I, 69675, Lyon 08, France
| | - Pascal Mailley
- Univ. Grenoble Alpes, CEA, LETI, 38000, Grenoble, DTBS, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Pierre Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Abdelkader Zebda
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France.
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan.
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da Silva Cardoso J, Vieira PM, Vaz AC, Monteiro SS, Ribeiro L, Mendes C, Freitas J, Rocha C, Oliveira MJ, Borges T. Type 1 diabetes mellitus - Population characterization and metabolic control outcomes in a Portuguese patient sample. Prim Care Diabetes 2023; 17:175-179. [PMID: 36646543 DOI: 10.1016/j.pcd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
AIMS To characterize a cohort of T1D patients and to compare diabetes control between patients using different regimen of insulin therapy and glucose monitoring. METHODS Were included all T1D patients followed at the Pediatric Endocrinology Unit, between April 1st and June 30th, 2021. Several clinical and demographic variables were analyzed. RESULTS Our sample included 208 patients, 56.7 % males, mean age of 12.7 ± 4.6 years. The median HbA1c was 7.3 %. Most patients, 78.8% were treated with continuous subcutaneous insulin infusion (CSII) and 81.3 % used continuous glucose monitoring (CGM). CSII had a lower HbAc compared with multiple daily injections (MDI) users (7.1vs 8.1 %, p < 0.01). In the CSII group, those who used CGM had a lower HbAc (7.1 vs 7.5 %,p = 0.02). Analyzing the data of the ambulatory glucose report, the CSII users had a lower glucose management indicator, (7.2 % vs 7.6 %, p < 0.01), more time in range (58.0 % vs 52.4 %;p < 0.01) and less time above range > 250 mg/dL (12.4 % vs 20.5 %;p < 0.01) than MDI users. CONCLUSIONS The median HbA1c was 7.3% very close to the recommended target. In Portugal, pediatric patients can access a CSII provided by the national health service and a CGM system due to an elevated reimbursement of their cost. This healthy policy allows us to achieve better goals without the risk of hypoglycemia.
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Affiliation(s)
- Juliana da Silva Cardoso
- Pediatric Department, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Paula Manuel Vieira
- Pediatric Department, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Carvalho Vaz
- Unidade Local de Saúde do Alto Minho, Pediatric Department, Viana do Castelo, Portugal
| | - Sílvia Santos Monteiro
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Ribeiro
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Mendes
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Freitas
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carla Rocha
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Oliveira
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Teresa Borges
- Pediatric Endocrinology Unit, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto, Porto, Portugal
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Bassi M, Franzone D, Dufour F, Strati MF, Scalas M, Tantari G, Aloi C, Salina A, d’Annunzio G, Maghnie M, Minuto N. Automated Insulin Delivery (AID) Systems: Use and Efficacy in Children and Adults with Type 1 Diabetes and Other Forms of Diabetes in Europe in Early 2023. Life (Basel) 2023; 13:783. [PMID: 36983941 PMCID: PMC10053516 DOI: 10.3390/life13030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Type 1 diabetes (T1D) patients' lifestyle and prognosis has remarkably changed over the years, especially after the introduction of insulin pumps, in particular advanced hybrid closed loop systems (AHCL). Emerging data in literature continuously confirm the improvement of glycemic control thanks to the technological evolution taking place in this disease. As stated in previous literature, T1D patients are seen to be more satisfied thanks to the use of these devices that ameliorate not only their health but their daily life routine as well. Limited findings regarding the use of new devices in different age groups and types of patients is their major limit. This review aims to highlight the main characteristics of each Automated Insulin Delivery (AID) system available for patients affected by Type 1 Diabetes Mellitus. Our main goal was to particularly focus on these systems' efficacy and use in different age groups and populations (i.e., children, pregnant women). Recent studies are emerging that demonstrate their efficacy and safety in younger patients and other forms of diabetes.
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Affiliation(s)
- Marta Bassi
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Daniele Franzone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Francesca Dufour
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Marta Scalas
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Giacomo Tantari
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Concetta Aloi
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Salina
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Mohamad Maghnie
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
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Petrovski G, Campbell J, Pasha M, Day E, Hussain K, Khalifa A, van den Heuvel T. Simplified Meal Announcement Versus Precise Carbohydrate Counting in Adolescents With Type 1 Diabetes Using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control. Diabetes Care 2023; 46:544-550. [PMID: 36598841 PMCID: PMC10148675 DOI: 10.2337/dc22-1692] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/03/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We aimed to compare glucose control in adolescents with type 1 diabetes (T1D) using the MiniMed 780G system who used simplified meal announcement with those who used precise carbohydrate counting. RESEARCH DESIGN AND METHODS This randomized controlled trial included 34 participants (age 12-18 years) with T1D who were on multiple daily injections or insulin pump and were scheduled to start using the MiniMed 780G system at Sidra Medicine in Qatar. After a 7-day run-in period, participants were randomly assigned to the fix group (simplified meal announcement by preset of three personalized fixed carbohydrate amounts) or the flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary end point. Secondary end points included HbA1c and other glycometrics. RESULTS During the 12-week study phase, TIR was 73.5 ± 6.7% in the fix and 80.3 ± 7.4% in the flex group, with a between-group difference of 6.8% in favor of flex (P = 0.043). Time >250 mg/dL was better in the flex group (P = 0.012), whereas HbA1c (P = 0.168), time below range (P = 0.283), and time between 180 and 250 mg/dL (P = 0.114) did not differ. CONCLUSIONS Adolescents using the MiniMed 780G system with a preset of three personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.
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Affiliation(s)
- Goran Petrovski
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Judith Campbell
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Maheen Pasha
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Emma Day
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
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Zanfardino A, Piscopo A, Gizzone P, Vitulano C, Di Gennaro F, Buccella G, Fabozzi I, Mainolfi G, Marongiu MB, Rollato AS, Testa V, Chianese A, Miraglia Del Giudice E, Troncone A, Iafusco D. Adolescents with type 1 diabetes vs. hybrid closed loop systems: a case series of patients' behaviour that challenges the algorithm. J Pediatr Endocrinol Metab 2023; 36:216-222. [PMID: 36511758 DOI: 10.1515/jpem-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Hybrid closed loop systems (HCL) improve the management of type 1 diabetes (T1DM). T1DM adolescent patients represent a risk category also if they are in an automated insulin infusion delivery therapy. CASE PRESENTATION We describe a series of four cases in which adolescent patients have adopted incorrect behaviours in the managing of HCL systems, challenging the algorithm skills. Two patients performed fabricated sensor calibrations. The other two did not perform pre-prandial insulin boluses correctly. Despite these behaviours, the algorithm corrected the glucose values in three out of four patients. Only in one case, where fabricated calibrations were too frequent, the automatic system failed to restore the glycemic balance. CONCLUSIONS Fabricated calibrations seem to be more important than uncorrected insulin boluses to challenge the HCL systems.
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Affiliation(s)
- Angela Zanfardino
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Alessia Piscopo
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Pietro Gizzone
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Caterina Vitulano
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Federica Di Gennaro
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Giulia Buccella
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Irma Fabozzi
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Gabriella Mainolfi
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Mariagrazia Bathilde Marongiu
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Assunta S Rollato
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Veronica Testa
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Antonietta Chianese
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
| | - Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Dario Iafusco
- Department of Pediatrics, Regional Center for Pediatric Diabetes, University of the Study of Campania, Naples, Italy
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Mameli C, Smylie GM, Galati A, Rapone B, Cardona-Hernandez R, Zuccotti G, Delvecchio M. Safety, metabolic and psychological outcomes of Medtronic MiniMed 670G in children, adolescents and young adults: a systematic review. Eur J Pediatr 2023; 182:1949-1963. [PMID: 36809498 PMCID: PMC9942055 DOI: 10.1007/s00431-023-04833-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/23/2023]
Abstract
Hybrid closed loop (HCL) systems are the combination of a pump for insulin delivery and a glucose sensor for continuous glucose monitoring. These systems are managed by an algorithm, which delivers insulin on the basis of the interstitial glucose levels. The MiniMed™ 670G system was the first HCL system available for clinical purpose. In this paper, we reviewed the literature about metabolic and psychological outcomes in children, adolescents and young adults with type 1 diabetes treated with MiniMed™ 670G. Only 30 papers responded to the inclusion criteria and thus were considered. All the papers show that the system is safe and effective in managing glucose control. Metabolic outcomes are available up to 12 months of follow-up; longer study period are lacking. This HCL system may improve HbA1c up to 7.1% and time in range up to 73%. The time spent in hypoglycaemia is almost neglectable. Better improvement in blood glucose control is observed in patients with higher HbA1c at HCL system start and larger daily use of auto-mode functionality. Conclusion: The Medtronic MiniMed™ 670G is safe and well accepted, without any increase in the burden for patients. Some papers report an improvement in the psychological outcomes, but other papers do not confirm this finding. So far, it significantly improves the management of diabetes mellitus in children, adolescents and young adults. Proper training and support by the diabetes team are mandatory. Studies for a period longer than 1 year would be appreciated to better understand the potentiality of this system. What is Known: • The Medtronic MiniMedTM 670G is a hybrid closed loop system which combines a continuous glucose monitoring sensor with an insulin pump. • It has been the first hybrid closed loop system available for clinical purpose. Adequate training and patients support play a key role in diabetes management. What is New: • The Medtronic MiniMedTM 670G may improve HbA1c and CGM metrics up to 1-year of follow-up, but the improvement appears lower than advanced hybrid closed loop systems. This system is effective to prevent hypoglycaemia. • The psychosocial effects remain less understood in terms of improvement of psychosocial outcomes. The system has been considered to provide flexibility and independence by the patients and their caregivers. The workload required to use this system is perceived as a burden by the patients who decrease the use of auto-mode functionality over time.
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Affiliation(s)
- Chiara Mameli
- grid.4708.b0000 0004 1757 2822Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Giulia Marie Smylie
- grid.4708.b0000 0004 1757 2822Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Alessio Galati
- Metabolic Disorders and Diabetes Unit, “Giovanni XXIII” Children’s Hospital, AOU Policlinico-Giovanni XXIII, Bari, Italy
| | - Biagio Rapone
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari “Aldo Moro, 70121 Bari, Italy
| | - Roque Cardona-Hernandez
- grid.411160.30000 0001 0663 8628Division of Pediatric Endocrinology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Gianvincenzo Zuccotti
- grid.4708.b0000 0004 1757 2822Department of Pediatrics, Buzzi Children’s Hospital, University of Milan, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Maurizio Delvecchio
- Metabolic Disorders and Diabetes Unit, "Giovanni XXIII" Children's Hospital, AOU Policlinico-Giovanni XXIII, Bari, Italy.
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Grassi B, Gómez AM, Calliari LE, Franco D, Raggio M, Riera F, Castro M, McVean J, van den Heuvel T, Arrieta A, Castañeda J, Cohen O. Real-world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system. Diabetes Obes Metab 2023; 25:1688-1697. [PMID: 36789699 DOI: 10.1111/dom.15023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
AIM We studied real-world performance of MiniMed (MM) 780G system users from Argentina, Brazil, Colombia and Chile (geographical analysis), and the effect of each technology iteration of the MM system on glycaemic control (technology iteration analysis). MATERIALS AND METHODS CareLink data from August 2020 to September 2022 were extracted. Endpoints included continuous glucose monitoring metrics. For the geographical analysis, aggregated endpoints for MM780G system users were calculated. For the technology iteration analysis, MM780G system user outcomes were compared with outcomes when the same individuals were still using the MM640G or MM670G system. RESULTS On average, 1025 MM780G system users from the geographical analysis were followed for 136 (SD 135) days, spent 91.5 (14.3)% in advanced hybrid closed loop, showed a glucose management indicator (GMI) of 6.7 (0.3)%, a time in range between 70 and 180 mg/dl (TIR) of 76.5 (9.0)%, and a time below range 70 mg/dl (TBR) of 2.7 (2.1)%. The percentage of users reaching targets of GMI <7%, TIR >70% and TBR <4% was 80.8%, 78.1% and 80.1%, respectively. The technology iteration analysis on users transitioning from MM640G to MM780G system (N = 381) showed 0.4% decrease in GMI (7.1% to 6.7%, p < .0001), 10.7% increase in TIR (65.9% to 76.6%, p < .0001), while TBR remained. The percentage of insulin delivered automatically increased as well (47.5%-57.7%, p < .0001). Users transitioning from MM670G system (N = 78) showed a similar but less pronounced pattern. CONCLUSIONS Real-world Latin American MM780G users on average showed good glucose control, achieving international targets. Glycaemic control increased with every technology iteration of the MM system, providing more automation each time.
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Affiliation(s)
- Bruno Grassi
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Maria Gómez
- Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario de San Ignacio, Bogotá, Colombia
| | | | - Denise Franco
- CPCLIN/DASA Clinical Research Centre, São Paulo, Brazil
| | | | | | | | | | | | - Arcelia Arrieta
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Ohad Cohen
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
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71
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Benhamou PY, Adenis A, Lebbad H, Tourki Y, Heredia MB, Gehr B, Franc S, Charpentier G. One-year real-world performance of the DBLG1 closed-loop system: Data from 3706 adult users with type 1 diabetes in Germany. Diabetes Obes Metab 2023; 25:1607-1613. [PMID: 36751978 DOI: 10.1111/dom.15008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
AIM The Diabeloop Generation 1 (DBLG1) system is an interoperable hybrid closed-loop solution that was commercialized in Germany in March 2021. We report the longitudinal glycaemic outcomes among the first 3706 users in a real-world setting. METHODS We performed a retrospective data collection of all consenting adult patients with type 1 diabetes who were equipped in Germany with the DBLG1 system before 30 April 2022, and with a minimum 14 days of closed-loop usage. RESULTS In total, 3706 users (41% women, age 45.1 ± 14.5 years) met the inclusion criteria, reaching a mean follow-up of 131.0 ± 85.1 days, an overall 485 600 days of continuous glucose monitoring data, and a median time spent in closed-loop of 95.0% (IQR 89.1-97.4). The median percentage time in range (70-180 mg/dl) was 72.1% (IQR 65.0-78.9); the time below 70 mg/dl was 0.9% (0.5-1.7), the time below 54 mg/dl was 0.1% (0.1-0.3), and the median Glucose Management Index was 7.0% (6.8-7.3). Exploratory analysis of a subset of 2460 patients in whom baseline glycated haemoglobin (HbA1c) was available [7.4% (IQR 6.9-8.0)] showed that the achieved mean time in range was influenced by baseline HbA1c, ranging from 65.8 ± 9.9% (A1c ≥8.5%) to 81.3 ± 6.8% (A1c <6.5%). CONCLUSION This large real-world analysis confirms the relevance of the DBLG1 automated insulin delivery solution for the achievement of standards of care in adult patients with type 1 diabetes.
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Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | | | | | | | | | - Bernhard Gehr
- Zentrum für Diabetes und Stoffwechselerkrankungen, m&i Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany
| | - 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
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72
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Pulkkinen MA, Varimo TJ, Hakonen ET, Harsunen MH, Hyvönen ME, Janér JN, Kiiveri SM, Laakkonen HM, Laakso SM, Wehkalampi K, Hero MT, Miettinen PJ, Tuomaala AK. MiniMed 780G™ in 2- to 6-Year-Old Children: Safety and Clinical Outcomes After the First 12 Weeks. Diabetes Technol Ther 2023; 25:100-107. [PMID: 36511831 DOI: 10.1089/dia.2022.0313] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The safety and impact of the advanced hybrid closed-loop (AHCL) system on glycemic outcome in 2- to 6-year-old children with type 1 diabetes and the diabetes distress of caregivers were evaluated. Research Design and Methods: This was an open-label prospective study (n = 35) with historical controls matched by treatment unit, diabetes duration, age, gender, and baseline treatment modality. The inclusion criteria were (1) type 1 diabetes diagnosis >6 months, (2) total daily dose of insulin ≥8 U/day, (3) HbA1c <10% (85 mmol/mol), and (4) capability to use insulin pump and continuous glucose monitoring. The MiniMed 780G™ AHCL in SmartGuard™ Mode was used for 12 weeks. Parental diabetes distress was evaluated with a validated Problem Areas In Diabetes-Parent, revised (PAID-PR) survey. Results: No events of diabetic ketoacidosis or severe hypoglycemia occurred. Between 0 and 12 weeks, HbA1c (mean change = -2.7 mmol/mol [standard deviation 5.7], P = 0.010), mean sensor glucose value (SG) (-0.8 mmol/L [1.0], P < 0.001), and time above range (TAR) (-8.6% [9.5], P < 0.001) decreased and time in range (TIR) (8.3% [9.3], P < 0.001) increased significantly, whereas no significant change in time below range (TBR) was observed. At the same time, PAID-PR score decreased from 37.5 (18.2) to 27.5 (14.8) (P = 0.006). Conclusions: MiniMed 780G™ AHCL is a safe system and 12-week use was associated with improvements in glycemic control in 2- to 6-year-old children with type 1 diabetes. In addition, AHCL is associated with a reduction in parental diabetes distress after 12-week use. ClinicalTrials.gov registration number: NCT04949022.
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Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero J Varimo
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina T Hakonen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Minna H Harsunen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mervi E Hyvönen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joakim N Janér
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanne M Kiiveri
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanne M Laakkonen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saila M Laakso
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karoliina Wehkalampi
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti T Hero
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Bassi M, Patti L, Silvestrini I, Strati MF, Ponzano M, Minuto N, Maggi D. One-year follow-up comparison of two hybrid closed-loop systems in Italian children and adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1099024. [PMID: 36777356 PMCID: PMC9909036 DOI: 10.3389/fendo.2023.1099024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND AIMS Tandem Control-IQ and MiniMed 780G are the main Advanced Hybrid Closed Loop (AHCL) systems currently available in pediatric and adult patients with Type 1 Diabetes (T1D). The aim of our study was to evaluate glycemic control after 1-year of follow-up extending our previous study of 1-month comparison between the two systems. METHODS We retrospectively compared clinical and continuous glucose monitoring (CGM) data from the patients included in the previous study which have completed 1-year observation period. The study population consisted of 74 patients, 42 Minimed 780G users and 32 Tandem Control-IQ users. Linear mixed models with random intercept were performed to study the variations over time and the interaction between time and system; Mann-Whitney or T-test were used to compare systems at 1-year. RESULTS Both systems have been shown to be effective in maintaining the glycemic improvement achieved one month after starting AHCL. Significant changes over time were observed for TIR, TAR, TAR>250mg/dl, average glucose levels and SD (p<0.001). At 1-year follow-up Minimed 780G obtained better improvement in TIR (p<0.001), TAR (p=0.002), TAR>250mg/dl (p=0.001), average glucose levels (p<0.001). The comparison of the glycemic parameters at 1-year showed a significant superiority of Minimed 780G in terms of TIR (71% vs 68%; p=0.001), TAR (p=0.001), TAR>250 (p=0.009), average glucose levels(p=0.001) and SD (p=0.031). CONCLUSIONS The use of AHCL systems led to a significant improvement of glycemic control at 1-month, which is maintained at 1-year follow-up. MiniMed is more effective than Tandem in reaching the International recommended glycemic targets. Continuous training and education in the use of technology is essential to get the best out of the most advanced technological tools.
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Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Luca Patti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Irene Silvestrini
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marta Ponzano
- Department of Health Science (DiSSAL), University of Genoa, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
- *Correspondence: Nicola Minuto,
| | - Davide Maggi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
- Diabetes Clinic, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
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Murata Y, Takita M, Kami M. Open-Source Automated Insulin Delivery in Type 1 Diabetes. N Engl J Med 2022; 387:2006. [PMID: 36416773 DOI: 10.1056/nejmc2213228] [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: 11/25/2022]
Affiliation(s)
- Yuki Murata
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Ware J, Hovorka R. Closed-loop insulin delivery: update on the state of the field and emerging technologies. Expert Rev Med Devices 2022; 19:859-875. [PMID: 36331211 PMCID: PMC9780196 DOI: 10.1080/17434440.2022.2142556] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Over the last five years, closed-loop insulin delivery systems have transitioned from research-only to real-life use. A number of systems have been commercialized and are increasingly used in clinical practice. Given the rapidity of new developments in the field, understanding the capabilities and key similarities and differences of current systems can be challenging. This review aims to provide an update on the state of the field of closed-loop insulin delivery systems, including emerging technologies. AREAS COVERED We summarize key clinical safety and efficacy evidence of commercial and emerging insulin-only hybrid closed-loop systems for type 1 diabetes. A literature search was conducted and clinical trials using closed-loop systems during free-living conditions were identified to report on safety and efficacy data. We comment on emerging technologies and adjuncts for closed-loop systems, as well as non-technological priorities in closed-loop insulin delivery. EXPERT OPINION Commercial hybrid closed-loop insulin delivery systems are efficacious, consistently improving glycemic control when compared to standard therapy. Challenges remain in widespread adoption due to clinical inertia and the lack of resources to embrace technological developments by health care professionals.
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Affiliation(s)
- Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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Castañeda J, Mathieu C, Aanstoot HJ, Arrieta A, Da Silva J, Shin J, Cohen O. Predictors of time in target glucose range in real-world users of the MiniMed 780G system. Diabetes Obes Metab 2022; 24:2212-2221. [PMID: 35791621 DOI: 10.1111/dom.14807] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
AIM Automated insulin delivery systems have improved glycaemic control in people with type 1 diabetes mellitus. The analysis investigated predictors of improved sensor glucose time-in-range (TIR; 70-180 mg/dl) based on real-world use of the MiniMed 780G advanced hybrid closed-loop (AHCL) system. METHODS Data uploaded by MiniMed 780G system users from August 2020-July 2021 were analysed using univariate and multivariable models to identify baseline, demographic and system use characteristics associated with TIR after AHCL initiation (post-AHCL). System settings associated with improved TIR post-AHCL were identified and their impact on time below range (TBR, <70 mg/dl) post-AHCL was explored. RESULTS In total, 12 870 users were included, of which 2977 had baseline sensor glucose data. Baseline TIR and time in AHCL (defined as the percentage of time the system was in Auto-mode) were positively associated with TIR post-AHCL with larger values predicting greater mean TIR post-AHCL. Characteristics inversely associated with TIR post-AHCL included the percentage of daily basal insulin dose, daily autocorrection dose, number of daily AHCL exits triggered by the system and number of daily alarms, wherein larger values of these characteristics predicted lower mean TIR post-AHCL. System settings that predicted the largest mean TIR post-AHCL were active insulin time of 2 h and glucose target of 100 mg/dl. Active insulin time was not associated with TBR post-AHCL. CONCLUSION Modifiable factors, including optimized pump settings, can allow users to achieve glycaemic targets with >80% TIR. The findings from this analysis will potentially guide the optimal use of the MiniMed 780G system and facilitate meaningful improvements in safe glycaemic control.
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Affiliation(s)
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Henk-Jan Aanstoot
- Diabeter, Center for Diabetes Care and Research, Rotterdam, The Netherlands
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - John Shin
- Medtronic, Northridge, California, USA
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Choudhary P, Kolassa R, Keuthage W, Kroeger J, Thivolet C, Evans M, Ré R, de Portu S, Vorrink L, Shin J, Habteab A, Castañeda J, da Silva J, Cohen O. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study. Lancet Diabetes Endocrinol 2022; 10:720-731. [PMID: 36058207 DOI: 10.1016/s2213-8587(22)00212-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population. METHODS The Advanced Hybrid Closed Loop Study in Adult Population with Type 1 Diabetes (ADAPT) trial is a prospective, multicentre, open-label, randomised controlled trial that involved 14 centres in three European countries (France, Germany, and the UK). We enrolled patients who were at least 18 years of age, had a type 1 diabetes duration of at least 2 years, HbA1c of at least 8% (64 mmol/mol), and were using multiple daily injections of insulin plus isCGM (cohort A) or real time continuous glucose monitoring (cohort B) for at least 3 months. Here, only results for cohort A are reported. Participants were randomly allocated 1:1 to AHCL therapy or continuation of multiple daily injections of insulin plus continuous glucose monitoring for 6 months with an investigator-blinded block randomisation procedure. Participants and treating clinicians could not be masked to the arm assignment. The primary endpoint was the between-group difference in mean HbA1c change from baseline to 6 months in the intention-to-treat population using AHCL therapy and those using multiple daily injections of insulin plus isCGM. The primary endpoint was analysed using a repeated measures random-effects model with the study arm and period as factors. Safety endpoints included the number of device deficiencies, severe hypoglycaemic events, diabetic ketoacidosis, and serious adverse events. This study is registered with ClinicalTrials.gov, NCT04235504. FINDINGS Between July 13, 2020, and March 12, 2021, 105 people were screened and 82 randomly assigned to treatment (41 in each arm). At 6 months, mean HbA1c had decreased by 1·54% (SD 0·73), from 9·00% to 7·32% in the AHCL group and 0·20% (0·80) in the multiple daily injections of insulin plus isCGM from 9·07% to 8·91% (model-based difference -1·42%, 95% CI -1·74 to -1·10; p<0·0001). No diabetic ketoacidosis, severe hypoglycaemia, or serious adverse events related to study devices occurred in either group; two severe hypoglycaemic events occurred in the run-in phase. 15 device-related non-serious adverse events occurred in the AHCL group, compared with three in the multiple daily injections of insulin plus isCGM group. Two serious adverse events occurred (one in each group), these were breast cancer (in one patient in the AHCL group) and intravitreous haemorrhage (in one patient in the multiple daily injections of insulin plus isCGM group). INTERPRETATION In people with type 1 diabetes using multiple daily injections of insulin plus isCGM and with HbA1c of at least 8%, the use of AHCL confers benefits in terms of glycaemic control beyond those that can be achieved with multiple daily injections of insulin plus isCGM. These data support wider access to AHCL in people with type 1 diabetes not at target glucose levels. FUNDING Medtronic International Trading Sàrl.
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Affiliation(s)
- Pratik Choudhary
- Kings College Hospital NHS Foundation Trust, London, UK; Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Ralf Kolassa
- Diabetologische Schwerpunktpraxis, Bergheim, Germany
| | - Winfried Keuthage
- Schwerpunktpraxis für Diabetes und Ernährungsmedizin, Münster, Germany
| | - Jens Kroeger
- Zentrum für Diabetologie Bergedorf, Hamburg, Germany
| | | | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Roseline Ré
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Simona de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Linda Vorrink
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - John Shin
- Medtronic, Northridge, California, USA
| | - Aklilu Habteab
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | | - Julien da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
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Seget S, Jarosz-Chobot P, Ochab A, Polanska J, Rusak E, Witoszek P, Chobot A. Body mass index, basal insulin and glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system remain stable - 1-year prospective, observational, two-center study. Front Endocrinol (Lausanne) 2022; 13:1036808. [PMID: 36303875 PMCID: PMC9592809 DOI: 10.3389/fendo.2022.1036808] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Information on the influence of insulin treatment using advanced hybrid closed loop systems (AHCL) on body weight of young patients with type 1 diabetes (T1D) is scarce. The aim of this study was to observe whether there were any changes in body mass index (BMI) of children and adolescents with T1D treated using the Medtronic Minimed 780G AHCL after 1 year of follow up and to analyze potential associations between these changes and the insulin doses. MATERIALS AND METHODS For 50 children and adolescents (age 5.4-16.8 years, 24 (48%) boys, T1D for 3.9 ± 2.56 years) using an AHCL system anthropometric and AHCL data were collected prospectively. BMI Z-scores and two-week AHCL records obtained after AHCL enrollment were compared with data after 6 months and also 1 year after starting AHCL. RESULTS The BMI Z-score of the patients at 1 year follow-up did not change from time of AHCL initiation (0.51 ± 2.79 vs 0.57 ± 2.85, p>0.05). There was a slight increase in total daily insulin per kg of body weight (0.67 ± 0.21 U/kg vs 0.80 ± 0.21 U/kg, p <0.001), but the percent of basal insulin was unchanged (34.88 ± 6.91% vs 35.08 ± 6.30%, p>0.05). We observed also no change (AHCL start vs after 1 year) in glycemic control parameters: average sensor glucose (131.36± 11.04 mg/dL vs 132.45 ± 13.42 mg/dL, p>0.05), coefficient of variation (34.99± 5.17% vs 34.06 ± 5.38%, p>0.05), glucose management indicator (6.45 ± 0.26% vs 6.48 ± 0.32%, p>0.05), and time spent in the range of 70-180 mg/dL (79.28 ± 8.12% vs 80.40 ± 8.25%, p>0.05). CONCLUSION During the 1 year of follow-up the BMI of children and adolescents with T1D treated with an AHCL system remained stable. Although there was a slight increase in the total daily insulin dose, the percent of basal insulin was unchanged. The patients maintained recommended glycemic control.
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Affiliation(s)
- Sebastian Seget
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | | | - Agnieszka Ochab
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
| | - Ewa Rusak
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | - Paulina Witoszek
- Department of Children’s Diabetology and Pediatrics, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
- *Correspondence: Agata Chobot,
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