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Fuchs J, Allen JM, Boughton CK, Wilinska ME, Thankamony A, de Beaufort C, Campbell F, Yong J, Froehlich-Reiterer E, Mader JK, Hofer SE, Kapellen TM, Rami-Merhar B, Tauschmann M, Hood K, Kimbell B, Lawton J, Roze S, Sibayan J, Cohen N, Hovorka R. Assessing the efficacy, safety and utility of closed-loop insulin delivery compared with sensor-augmented pump therapy in very young children with type 1 diabetes (KidsAP02 study): an open-label, multicentre, multinational, randomised cross-over study protocol. BMJ Open 2021; 11:e042790. [PMID: 33579766 PMCID: PMC7883854 DOI: 10.1136/bmjopen-2020-042790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Diabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group. METHODS AND ANALYSIS The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed. ETHICS AND DISSEMINATION Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03784027.
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Affiliation(s)
- Julia Fuchs
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Janet M Allen
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte K Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Malgorzata E Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Carine de Beaufort
- DECCP, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - James Yong
- Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Elke Froehlich-Reiterer
- Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Julia K Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Steiermark, Austria
| | - Sabine E Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien, Austria
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien, Austria
| | - Korey Hood
- Endocrinology, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara Kimbell
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Julia Lawton
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | | | - Judy Sibayan
- Jaeb Centre for Health Research, Tampa, Florida, USA
| | - Nathan Cohen
- Jaeb Centre for Health Research, Tampa, Florida, USA
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Artificial Pancreas Technology Offers Hope for Childhood Diabetes. Curr Nutr Rep 2021; 10:47-57. [DOI: 10.1007/s13668-020-00347-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
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Dovc K, Battelino T. Time in range centered diabetes care. Clin Pediatr Endocrinol 2021; 30:1-10. [PMID: 33446946 PMCID: PMC7783127 DOI: 10.1297/cpe.30.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Optimal glycemic control remains challenging and elusive for many people with diabetes. With the comprehensive clinical evidence on safety and efficiency in large populations, and with broader reimbursement, the adoption of continuous glucose monitoring (CGM) is rapidly increasing. Standardized visual reporting and interpretation of CGM data and clear and understandable clinical targets will help professionals and individuals with diabetes use diabetes technology more efficiently, and finally improve long-term outcomes with less everyday disease burden. For the majority of people with type 1 or type 2 diabetes, time in range (between 70 and 180 mg/dL, or 3.9 and 10 mmol/L) target of more than 70% is recommended, with each incremental increase of 5% towards this target being clinically meaningful. At the same time, the goal is to minimize glycemic excursions: a recommended target for a time below range (< 70 mg/dL or < 3.9 mmol/L) is less than 4%, and time above range (> 180 mg/dL or 10 mmol/L) less than 25%, with less stringent goals for older individuals or those at increased risk. These targets should be individualized: the personal use of CGM with the standardized data presentation provides all necessary means to accurately tailor diabetes management to the needs of each individual with diabetes.
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Affiliation(s)
- Klemen Dovc
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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de Beaufort C, Pit-ten Cate IM, Schierloh U, Cohen N, Boughton CK, Tauschmann M, Allen JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D, Fichelle M, Thiele AG, Abt D, Faninger K, Mader JK, Slegtenhorst S, Ashcroft N, Wilinska ME, Sibayan J, Kollman C, Hofer SE, Fröhlich-Reiterer E, Kapellen TM, Acerini CL, Campbell F, Rami-Merhar B, Hovorka R. Psychological Well-Being of Parents of Very Young Children With Type 1 Diabetes - Baseline Assessment. Front Endocrinol (Lausanne) 2021; 12:721028. [PMID: 34456876 PMCID: PMC8397439 DOI: 10.3389/fendo.2021.721028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Type 1 diabetes in young children is a heavy parental burden. As part of pilot phase of the KIDSAP01 study, we conducted a baseline assessment in parents to study the association between hypoglycemia fear, parental well-being and child behavior. METHODS All parents were invited to fill in baseline questionnaires: hypoglycemia fear survey (HFS), WHO-5, Epworth Sleepiness Scale and Strength and Difficulties Questionnaire (SDQ). RESULTS 24 children (median age: 5-year, range 1-7 years, 63% male, mean diabetes duration: 3 ± 1.7 years) participated. 23/24 parents filled out the questionnaires. We found a higher score for the hypoglycemia fear behavior 33.9 ± 5.6 compared to hypoglycemia worry 34.6 ± 12.2. Median WHO-5 score was 16 (8 - 22) with poor well-being in two parents. Median daytime sleepiness score was high in five parents (>10). For six children a high total behavioral difficulty score (>16) was reported. Pro social behavior score was lower than normal in six children (<6). Parental well-being was negatively associated with HFS total (r = - 0.50, p <.05) and subscale scores (r = - 0.44, p <.05 for HFS-Worry and HFS-Behavior), child behavior (r = - 0.45, p = .05) and positively with child age and diabetes duration (r = 0.58, p <.01, r = 0.6, p <.01). HFS, parental well-being nor daytime sleepiness are associated with the HbA1c. CONCLUSION Regular screening of parental well-being, hypoglycemia fear and child behavior should be part of routine care to target early intervention.
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Affiliation(s)
- Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
- Department of Pediatrics, University Clinic Brussels, Brussels, Belgium
- *Correspondence: Carine de Beaufort,
| | - Ineke M. Pit-ten Cate
- Luxembourg Center for Educational Assessment, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Ulrike Schierloh
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Nathan Cohen
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Charlotte K. Boughton
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Martin Tauschmann
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Janet M. Allen
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Katrin Nagl
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - James Yong
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Emily Metcalfe
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Dominique Schaeffer
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Muriel Fichelle
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Alena G. Thiele
- Division of Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Daniela Abt
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria
| | - Kerstin Faninger
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Sonja Slegtenhorst
- Department of Nutrition & Dietetics, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Nicole Ashcroft
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Malgorzata E. Wilinska
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Judy Sibayan
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Sabine E. Hofer
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Fröhlich-Reiterer
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Thomas M. Kapellen
- Division of Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Carlo L. Acerini
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Fiona Campbell
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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Dovc K, Battelino T. Closed-loop insulin delivery systems in children and adolescents with type 1 diabetes. Expert Opin Drug Deliv 2020; 17:157-166. [PMID: 32077342 DOI: 10.1080/17425247.2020.1713747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Optimal glycemic control remains challenging in children and adolescents with type 1 diabetes due to highly variable day-to-day and night-to-night insulin requirements. This hurdle could be addressed by glucose-responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review summaries recent advances of closed-loop systems in children and adolescents with type 1 diabetes, using both single- and dual-hormone closed-loop systems. The main outcomes, proportions of time spent in target range 70-180 mg/dl, and time spent in hypoglycemia below 70 mg/dl, are assessed particularly during unsupervised free-living randomized controlled trials.Expert opinion: Noteworthy and clinically meaningful translation of experimental investigations from controlled in-hospital settings to unrestricted home studies have been achieved over the past years, resulting in the regulatory approval of the first hybrid closed-loop system also in the pediatric population and with several other advanced devices in the pipeline. Large multinational and pivotal clinical trials including broad age populations are underway to facilitate the use of closed-loop systems in routine clinical practice.
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Affiliation(s)
- Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Tubiana-Rufi N, Schaepelynck P, Franc S, Chaillous L, Joubert M, Renard E, Reznik Y, Abettan C, Bismuth E, Beltrand J, Bonnemaison E, Borot S, Charpentier G, Delemer B, Desserprix A, Durain D, Farret A, Filhol N, Guerci B, Guilhem I, Guillot C, Jeandidier N, Lablanche S, Leroy R, Melki V, Munch M, Penfornis A, Picard S, Place J, Riveline JP, Serusclat P, Sola-Gazagnes A, Thivolet C, Hanaire H, Benhamou PY. Practical implementation of automated closed-loop insulin delivery: A French position statement. DIABETES & METABOLISM 2020; 47:101206. [PMID: 33152550 DOI: 10.1016/j.diabet.2020.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023]
Abstract
Automated closed-loop (CL) insulin therapy has come of age. This major technological advance is expected to significantly improve the quality of care for adults, adolescents and children with type 1 diabetes. To improve access to this innovation for both patients and healthcare professionals (HCPs), and to promote adherence to its requirements in terms of safety, regulations, ethics and practice, the French Diabetes Society (SFD) brought together a French Working Group of experts to discuss the current practical consensus. The result is the present statement describing the indications for CL therapy with emphasis on the idea that treatment expectations must be clearly defined in advance. Specifications for expert care centres in charge of initiating the treatment were also proposed. Great importance was also attached to the crucial place of high-quality training for patients and healthcare professionals. Long-term follow-up should collect not only metabolic and clinical results, but also indicators related to psychosocial and human factors. Overall, this national consensus statement aims to promote the introduction of marketed CL devices into standard clinical practice.
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Affiliation(s)
- N Tubiana-Rufi
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - P Schaepelynck
- Nutrition-Endocrinologie-Maladies Métaboliques, pôle ENDO, Hôpital de la Conception, APHM, Marseille, France
| | - S Franc
- Diabétologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, CERITD, Bioparc Genopole Evry-Corbeil, LBEPS, Université Evry, IRBA, Université Paris Saclay, Evry, France
| | - L Chaillous
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - M Joubert
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - E Renard
- Endocrinologie, Diabète, Nutrition et CIC INSERM 1411, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - Y Reznik
- Université de Caen et Endocrinologie Diabétologie, CHU Côte de Nacre, Caen, France
| | - C Abettan
- Endocrinologie Diabétologie Nutrition, Institut du Thorax, CHU, Nantes, France
| | - E Bismuth
- Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, APHP Nord, Université de Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - J Beltrand
- APHP Centre, Université de Paris, Hôpital Necker Enfants Malades, Paris et Aide aux Jeunes Diabétiques AJD, Paris, et SFEDP, France
| | - E Bonnemaison
- Unité de Spécialités Pédiatriques, Hôpital Clocheville, CHRU de Tours, et SFEDP, France
| | - S Borot
- Université Franche-Comté et Endocrinologie, Nutrition et Diabétologie, CHU, Besançon, France
| | | | - B Delemer
- Endocrinologie Diabétologie, CHU, Reims, et Présidente du CNP d'Endocrinologie Diabétologie et Maladies Métaboliques, France
| | - A Desserprix
- IDE I-ETP, Hotel Dieu Le Creusot (71), Groupe SOS Santé et Vice-présidente de la SFD-Paramédical, France
| | - D Durain
- Cadre de Santé Endocrinologie et Diabétologie et ETP, CHRU, Nancy et SFD-Paramédical, France
| | - A Farret
- Endocrinologie, Diabète, Nutrition, CHU, Montpellier, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - N Filhol
- Endocrinologie et Diabétologie, Hôpital de la Conception, APHM, Marseille, France
| | - B Guerci
- Université de Lorraine et Endocrinologie Diabétologie Maladies Métaboliques et Nutrition, CHU, Nancy, France
| | - I Guilhem
- Endocrinologie-Diabétologie-Nutrition, CHU, Rennes, France
| | - C Guillot
- Sociologue responsable du Diabète LAB, FFD, Paris, France
| | - N Jeandidier
- Université de Strasbourg et Endocrinologie Diabétologie Nutrition, Hôpitaux Universitaires de Strasbourg, France
| | - S Lablanche
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, France
| | - R Leroy
- Cabinet libéral d'endocrinologie diabétologie, Lille, France
| | - V Melki
- Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - M Munch
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU Strasbourg, France
| | - A Penfornis
- Université Paris-Saclay et Endocrinologie, Diabétologie et Maladies Métaboliques, CHSF Corbeil-Essonnes, France
| | - S Picard
- Cabinet d'Endocrino-Diabétologie, Point Médical, Dijon et FENAREDIAM, France
| | - J Place
- Ingénieur d'Études, Institut de Génomique Fonctionnelle, CNRS, INSERM, Université de Montpellier, France
| | - J P Riveline
- Centre Universitaire du Diabète, Hôpital Lariboisière, APHP, Paris, France
| | - P Serusclat
- Groupe Hospitalier Mutualiste Les Portes du Sud, Vénissieux, France
| | - A Sola-Gazagnes
- Endocrinologie Diabétologie, Hôpital Cochin, APHP, Paris, France
| | - C Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Président de la SFD, France
| | - H Hanaire
- Université de Toulouse et Diabétologie, Maladies Métaboliques et Nutrition, CHU Rangueil, Toulouse, France
| | - P Y Benhamou
- Université Grenoble Alpes, INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Président du groupe de travail Télémédecine et Technologies Innovantes de la SFD, France.
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Fuchs J, Hovorka R. Closed-loop control in insulin pumps for type-1 diabetes mellitus: safety and efficacy. Expert Rev Med Devices 2020; 17:707-720. [PMID: 32569476 PMCID: PMC7441745 DOI: 10.1080/17434440.2020.1784724] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Type 1 diabetes is a lifelong disease with high management burden. The majority of people with type 1 diabetes fail to achieve glycemic targets. Algorithm-driven automated insulin delivery (closed-loop) systems aim to address these challenges. This review provides an overview of commercial and emerging closed-loop systems. AREAS COVERED We review safety and efficacy of commercial and emerging hybrid closed-loop systems. A literature search was conducted and clinical trials using day-and-night closed-loop systems during free-living conditions were used to report on safety data. We comment on efficacy where robust randomized controlled trial data for a particular system are available. We highlight similarities and differences between commercial systems. EXPERT OPINION Study data shows that hybrid closed-loop systems are safe and effective, consistently improving glycemic control when compared to standard therapy. While a fully closed-loop system with minimal burden remains the end-goal, these hybrid closed-loop systems have transformative potential in diabetes care.
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Affiliation(s)
- Julia Fuchs
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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MUW researcher of the month. Wien Klin Wochenschr 2020; 132:274-275. [PMID: 32462503 DOI: 10.1007/s00508-020-01674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Polsky S, Akturk HK. Case series of a hybrid closed-loop system used in pregnancies in clinical practice. Diabetes Metab Res Rev 2020; 36:e3248. [PMID: 31758630 DOI: 10.1002/dmrr.3248] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hybrid closed-loop (HCL) therapy is rarely studied in pregnancy. We present three cases of women with type 1 diabetes who used the Medtronic 670G HCL system for most or all of gestation. METHODS The Medtronic 670G system has a manual mode (no automated insulin delivery) and an auto mode (AM, HCL therapy). Women in this case series used AM off-label in gestation. RESULTS Case 1 started HCL therapy in the second trimester, her sensor glucose time spent <3.9 and >10 mmol/L improved thereafter. Case 1 had average sensor glucose (ASG) levels of 6.4 ± 2.4 mmol/L in the first trimester, 7.0 ± 2.7 mmol/L in the second trimester before HCL use, 7.1 ± 2.1 mmol/L in the second trimester after HCL use, and 6.8 ± 1.9 mmol/L in the third trimester. Case 1 continued AM during operative delivery and post-partum. Cases 2 and 3 used HCL therapy throughout gestation but with inconsistent time in AM. When they increased time in AM their glycaemic indices improved. Case 2 had ASG of 9.5 ± 3.4, 8.6 ± 2.9, and 7.9 ± 2.5 mmol/L in the first through third trimesters, respectively. Case 3 had ASG of 11.1 ± 4.8 and 3.9 to 10 mmol/L in the first and second trimesters, respectively. Case 2 continued HCL therapy post-partum, Case 3 did not. CONCLUSIONS CareLink® Clinical Software only reports the non-pregnant time in range. Nonetheless, this represents the first report of HCL therapy in pregnancy with a system approved by the Food and Drug Administration in non-pregnant populations.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Nevo-Shenker M, Phillip M, Nimri R, Shalitin S. Type 1 diabetes mellitus management in young children: implementation of current technologies. Pediatr Res 2020; 87:624-629. [PMID: 31715623 DOI: 10.1038/s41390-019-0665-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/29/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022]
Abstract
The use of advanced technologies for diabetes management is on the rise among pediatric patients with type 1 diabetes (T1D). Continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring, predictive low glucose suspend, hybrid closed-loop insulin delivery systems-all enable better diabetes management and glycemic control. However, when used by children, and especially very young children, specific aspects must be taken into consideration, including technical parameters, ease of use, parental stress, and satisfaction. The unique characteristics of T1D in children aged <6 years are reviewed and studies of the pros and cons of different technologies in this specific age group are presented. Addressing such issues when implementing advanced technologies among very young children with T1D will enable better diabetes management and will hopefully ease a tremendous burden of both children and families.
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Affiliation(s)
- Michal Nevo-Shenker
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Moshe Phillip
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Revital Nimri
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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62
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Sherr JL, Buckingham BA, Forlenza GP, Galderisi A, Ekhlaspour L, Wadwa RP, Carria L, Hsu L, Berget C, Peyser TA, Lee JB, O'Connor J, Dumais B, Huyett LM, Layne JE, Ly TT. Safety and Performance of the Omnipod Hybrid Closed-Loop System in Adults, Adolescents, and Children with Type 1 Diabetes Over 5 Days Under Free-Living Conditions. Diabetes Technol Ther 2020; 22:174-184. [PMID: 31596130 PMCID: PMC7047109 DOI: 10.1089/dia.2019.0286] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The objective of this study was to assess the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm in adults, adolescents, and children aged ≥6 years with type 1 diabetes (T1D) under free-living conditions using an investigational device. Materials and Methods: A 96-h hybrid closed-loop (HCL) study was conducted in a supervised hotel/rental home setting following a 7-day outpatient standard therapy (ST) phase. Eligible participants were aged 6-65 years with A1C <10.0% using insulin pump therapy or multiple daily injections. Meals during HCL were unrestricted, with boluses administered per usual routine. There was daily physical activity. The primary endpoints were percentage of time with sensor glucose <70 and ≥250 mg/dL. Results: Participants were 11 adults, 10 adolescents, and 15 children aged (mean ± standard deviation) 28.8 ± 7.9, 14.3 ± 1.3, and 9.9 ± 1.0 years, respectively. Percentage time ≥250 mg/dL during HCL was 4.5% ± 4.2%, 3.5% ± 5.0%, and 8.6% ± 8.8% per respective age group, a 1.6-, 3.4-, and 2.0-fold reduction compared to ST (P = 0.1, P = 0.02, and P = 0.03). Percentage time <70 mg/dL during HCL was 1.9% ± 1.3%, 2.5% ± 2.0%, and 2.2% ± 1.9%, a statistically significant decrease in adults when compared to ST (P = 0.005, P = 0.3, and P = 0.3). Percentage time 70-180 mg/dL increased during HCL compared to ST, reaching significance for adolescents and children: HCL 73.7% ± 7.5% vs. ST 68.0% ± 15.6% for adults (P = 0.08), HCL 79.0% ± 12.6% vs. ST 60.6% ± 13.4% for adolescents (P = 0.01), and HCL 69.2% ± 13.5% vs. ST 54.9% ± 12.9% for children (P = 0.003). Conclusions: The Omnipod personalized MPC algorithm was safe and performed well over 5 days and 4 nights of use by a cohort of participants ranging from youth aged ≥6 years to adults with T1D under supervised free-living conditions with challenges, including daily physical activity and unrestricted meals.
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Affiliation(s)
- Jennifer L. Sherr
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
- Address correspondence to: Jennifer L. Sherr, MD, PhD, Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, One Long Wharf Drive Suite 503, New Haven, CT 06511
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alfonso Galderisi
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Laya Ekhlaspour
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori Carria
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Liana Hsu
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Cari Berget
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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63
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Abstract
The advent of insulin pump therapy marked an important milestone in diabetes treatment in the past few decades and has become the tipping point for the development of automated insulin delivery systems (AID). Standalone insulin pump systems have evolved over the course of years and have been replaced by modern high-technology insulin pumps with continuous glucose monitor interface allowing real-time insulin dose adjustment to optimize treatment. This review summarizes evidence from AID studies conducted in children with type 1 diabetes and discusses the outlook for future generation AID systems from a pediatric treatment perspective.
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Affiliation(s)
- Eda Cengiz
- Yale School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520, USA; Bahçeşehir Üniversitesi, Istanbul, Turkey.
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64
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Dovc K, Piona C, Yeşiltepe Mutlu G, Bratina N, Jenko Bizjan B, Lepej D, Nimri R, Atlas E, Muller I, Kordonouri O, Biester T, Danne T, Phillip M, Battelino T. Faster Compared With Standard Insulin Aspart During Day-and-Night Fully Closed-Loop Insulin Therapy in Type 1 Diabetes: A Double-Blind Randomized Crossover Trial. Diabetes Care 2020; 43:29-36. [PMID: 31575640 DOI: 10.2337/dc19-0895] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated the safety and efficacy of day-and-night fully closed-loop insulin therapy using faster (Faster-CL) compared with standard insulin aspart (Standard-CL) in young adults with type 1 diabetes. RESEARCH DESIGN AND METHODS In a double-blind, randomized, crossover trial, 20 participants with type 1 diabetes on insulin pump therapy (11 females, aged 21.3 ± 2.3 years, HbA1c 7.5 ± 0.5% [58.5 ± 5.5 mmol/mol]) underwent two 27-h inpatient periods with unannounced afternoon moderate-vigorous exercise and unannounced/uncovered meals. We compared Faster-CL and Standard-CL in random order. During both interventions, the fuzzy-logic control algorithm DreaMed GlucoSitter was used. Glucose sensor data were analyzed by intention-to-treat principle with the difference (between Faster-CL and Standard-CL) in proportion of time in range 70-180 mg/dL (TIR) over 27 h as the primary end point. RESULTS The proportion of TIR was similar for both arms: 53.3% (83% overnight) in Faster-CL and 57.9% (88% overnight) in Standard-CL (P = 0.170). The proportion of time in hypoglycemia <70 mg/dL was 0.0% for both groups. Baseline-adjusted interstitial prandial glucose increments 1 h after meals were greater in Faster-CL compared with Standard-CL (P = 0.017). The gaps between measured plasma insulin and estimated insulin-on-board levels at the beginning, at the end, and 2 h after the exercise were smaller in the Standard-CL group (P = 0.029, P = 0.003, and P = 0.004, respectively). No severe adverse events occurred. CONCLUSIONS Fully closed-loop insulin delivery using either faster or standard insulin aspart was safe and efficient in achieving near-normal glucose concentrations outside postprandial periods. The closed-loop algorithm was better adjusted to the standard insulin aspart.
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Affiliation(s)
- Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, University City Hospital, Verona, Italy
| | - Gül Yeşiltepe Mutlu
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, İstanbul, Turkey
| | - Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Barbara Jenko Bizjan
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Dusanka Lepej
- Department of Pulmonology, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Revital Nimri
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Centre for Childhood Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Eran Atlas
- DreaMed Diabetes Ltd., Petah Tikva, Israel
| | - Ido Muller
- DreaMed Diabetes Ltd., Petah Tikva, Israel
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Moshe Phillip
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Centre for Childhood Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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65
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O'Donnell S, Lewis D, Marchante Fernández M, Wäldchen M, Cleal B, Skinner T, Raile K, Tappe A, Ubben T, Willaing I, Hauck B, Wolf S, Braune K. Evidence on User-Led Innovation in Diabetes Technology (The OPEN Project): Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e15368. [PMID: 31742563 PMCID: PMC6891827 DOI: 10.2196/15368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 01/24/2023] Open
Abstract
Background Digital innovations in health care have traditionally followed a top-down pathway, with manufacturers leading the design and production of technology-enabled solutions and those living with chronic conditions involved only as passive recipients of the end product. However, user-driven open-source initiatives in health care are becoming increasingly popular. An example is the growing movement of people with diabetes, who create their own “Do-It-Yourself Artificial Pancreas Systems” (DIYAPS). Objective The overall aim of this study is to establish the empirical evidence base for the clinical effectiveness and quality-of-life benefits of DIYAPS and identify the challenges and possible solutions to enable their wider diffusion. Methods A research program comprising 5 work packages will examine the outcomes and potential for scaling up DIYAPS solutions. Quantitative and qualitative methodologies will be used to examine clinical and self-reported outcome measures of DIYAPS users. The majority of members of the research team live with type 1 diabetes and are active DIYAPS users, making Outcomes of Patients’ Evidence With Novel, Do-It-Yourself Artificial Pancreas Technology (OPEN) a unique, user-driven research project. Results This project has received funding from the European Commission’s Horizon 2020 Research and Innovation Program, under the Marie Skłodowska-Curie Action Research and Innovation Staff Exchange. Researchers with both academic and nonacademic backgrounds have been recruited to formulate research questions, drive the research process, and disseminate ongoing findings back to the DIYAPS community and other stakeholders. Conclusions The OPEN project is unique in that it is a truly patient- and user-led research project, which brings together an international, interdisciplinary, and intersectoral research group, comprising health care professionals, technical developers, biomedical and social scientists, the majority of whom are also living with diabetes. Thus, it directly addresses the core research and user needs of the DIYAPS movement. As a new model of cooperation, it will highlight how researchers in academia, industry, and the patient community can create patient-centric innovation and reduce disease burden together. International Registered Report Identifier (IRRID) PRR1-10.2196/15368
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Affiliation(s)
- Shane O'Donnell
- School of Sociology, University College Dublin, Belfield, Ireland
| | | | | | - Mandy Wäldchen
- School of Sociology, University College Dublin, Belfield, Ireland
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Timothy Skinner
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Institut for Psykologi, Københavns Universitet, Copenhagen, Denmark
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tebbe Ubben
- AndroidAPS, Vienna, Austria.,#dedoc° Diabetes Online Community, Berlin, Germany
| | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Saskia Wolf
- #dedoc° Diabetes Online Community, Berlin, Germany
| | - Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
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66
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Beck RW, Bergenstal RM, Laffel LM, Pickup JC. Advances in technology for management of type 1 diabetes. Lancet 2019; 394:1265-1273. [PMID: 31533908 DOI: 10.1016/s0140-6736(19)31142-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 01/07/2023]
Abstract
Technological advances have had a major effect on the management of type 1 diabetes. In addition to blood glucose meters, devices used by people with type 1 diabetes include insulin pumps, continuous glucose monitors, and, most recently, systems that combine both a pump and a monitor for algorithm-driven automation of insulin delivery. In the next 5 years, as many advances are expected in technology for the management of diabetes as there have been in the past 5 years, with improvements in continuous glucose monitoring and more available choices of systems that automate insulin delivery. Expansion of the use of technology will be needed beyond endocrinology practices to primary-care settings and broader populations of patients. Tools to support decision making will also need to be developed to help patients and health-care providers to use the output of these devices to optimise diabetes management.
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Affiliation(s)
- Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA.
| | - Richard M Bergenstal
- International Diabetes Center, Park Nicollet and Health Partners, Minneapolis, MN, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - John C Pickup
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
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67
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Musolino G, Dovc K, Boughton CK, Tauschmann M, Allen JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D, Fichelle M, Schierloh U, Thiele AG, Abt D, Kojzar H, Mader JK, Slegtenhorst S, Ashcroft N, Wilinska ME, Sibayan J, Cohen N, Kollman C, Hofer SE, Fröhlich‐Reiterer E, Kapellen TM, Acerini CL, de Beaufort C, Campbell F, Rami‐Merhar B, Hovorka R. Reduced burden of diabetes and improved quality of life: Experiences from unrestricted day-and-night hybrid closed-loop use in very young children with type 1 diabetes. Pediatr Diabetes 2019; 20:794-799. [PMID: 31140654 PMCID: PMC6771658 DOI: 10.1111/pedi.12872] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the experiences of families with very young children aged 1 to 7 years (inclusive) with type 1 diabetes using day-and-night hybrid closed-loop insulin delivery. METHODS Parents/caregivers of 20 children aged 1 to 7 years with type 1 diabetes completed a closed-loop experience survey following two 3-week periods of unrestricted day-and-night hybrid closed-loop insulin therapy using Cambridge FlorenceM system at home. Benefits, limitations, and improvements of closed-loop technology were explored. RESULTS Responders reported reduced burden of diabetes management, less time spent managing diabetes, and improved quality of sleep with closed-loop. Ninety percent of the responders felt less worried about their child's glucose control using closed-loop. Size of study devices, battery performance and connectivity issues were identified as areas for improvement. Parents/caregivers wished for more options to input information to the system such as temporary glucose targets. CONCLUSIONS Parents/caregivers of very young children reported important quality of life benefits associated with using closed-loop, supporting adoption of this technology in this population.
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Affiliation(s)
- Gianluca Musolino
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital, University Medical CentreLjubljanaSlovenia
| | | | - Martin Tauschmann
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK,Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Janet M. Allen
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Katrin Nagl
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - James Yong
- Department of Paediatric DiabetesLeeds Children's HospitalLeedsUK
| | - Emily Metcalfe
- Department of Paediatric DiabetesLeeds Children's HospitalLeedsUK
| | - Dominique Schaeffer
- Department of Pediatric Diabetes and EndocrinologyClinique Pédiatrique, Centre HospitalierLuxembourg CityLuxembourg
| | - Muriel Fichelle
- Department of Pediatric Diabetes and EndocrinologyClinique Pédiatrique, Centre HospitalierLuxembourg CityLuxembourg
| | - Ulrike Schierloh
- Department of Pediatric Diabetes and EndocrinologyClinique Pédiatrique, Centre HospitalierLuxembourg CityLuxembourg
| | - Alena G. Thiele
- Division for Paediatric DiabetologyUniversity of LeipzigLeipzigGermany
| | - Daniela Abt
- Department of Pediatrics IMedical University of InnsbruckInnsbruckAustria
| | - Harald Kojzar
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Sonja Slegtenhorst
- Department of Nutrition & DieteticsCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Nicole Ashcroft
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Malgorzata E. Wilinska
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | | | | | - Sabine E. Hofer
- Department of Pediatrics IMedical University of InnsbruckInnsbruckAustria
| | | | | | | | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyClinique Pédiatrique, Centre HospitalierLuxembourg CityLuxembourg,Department of PediatricsFree University VUBBrusselsBelgium
| | - Fiona Campbell
- Department of Paediatric DiabetesLeeds Children's HospitalLeedsUK
| | - Birgit Rami‐Merhar
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
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68
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Salehi P, Roberts AJ, Kim GJ. Efficacy and Safety of Real-Life Usage of MiniMed 670G Automode in Children with Type 1 Diabetes Less than 7 Years Old. Diabetes Technol Ther 2019; 21:448-451. [PMID: 31166801 DOI: 10.1089/dia.2019.0123] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Medtronic MiniMed 670G system with SmartGuard™ (Medtronic, Northridge, CA) is a commercial hybrid closed-loop (HCL) system approved for use in 2018 for children >7 years. Studies of this HCL system in subjects >7 years old show improvement in glycemic control, but no study has described its use in younger children. This is a retrospective analysis of patients with type 1 diabetes (T1D) <7 years of age who used the 670G HCL system at Seattle Children's Hospital for 3 months. We compared 2-week data from Carelink™ while in manual mode (MM) with suspend before low active with those in auto mode (AM). We used two tailed t-test to compare variables related to glycemic control. Sixteen children were reviewed [age of AM start: average 4.3 years (range 2-6); 10 male]. The average time in AM was 6.3 ± 2.9 months (range 3-12). There was a statistically significant change for A1c [MM 7.9% (62.8 mmol/mol), AM 7.4% (57.4 mmol/mol); P-value <0.001], percentage time in range (MM 42.8%, AM 56.2%; P-value <0.001), percentage hypoglycemia (MM 1.3%, AM 2.4%; P-value 0.04), and average sensor glucose [MM 200 mg/dL (11.1 mmol/L), AM 176 mg/dL (9.8 mmol/L); P-value <0.001]. No serious adverse reports noted. This case series showed improvement in glycemic control in very young children using the 670G HCL. We did note more hypoglycemia although no serious adverse events, such as hypoglycemic seizure, were reported. A HCL system can be used in young children with T1D safely and effectively and should be an option for children <7 years.
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Affiliation(s)
- Parisa Salehi
- Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
| | - Alissa J Roberts
- Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
| | - Grace J Kim
- Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
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69
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Braune K, O'Donnell S, Cleal B, Lewis D, Tappe A, Willaing I, Hauck B, Raile K. Real-World Use of Do-It-Yourself Artificial Pancreas Systems in Children and Adolescents With Type 1 Diabetes: Online Survey and Analysis of Self-Reported Clinical Outcomes. JMIR Mhealth Uhealth 2019; 7:e14087. [PMID: 31364599 PMCID: PMC6691673 DOI: 10.2196/14087] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 01/19/2023] Open
Abstract
Background Patient-driven initiatives have made uptake of Do-it-Yourself Artificial Pancreas Systems (DIYAPS) increasingly popular among people with diabetes of all ages. Observational studies have shown improvements in glycemic control and quality of life among adults with diabetes. However, there is a lack of research examining outcomes of children and adolescents with DIYAPS in everyday life and their social context. Objective This survey assesses the self-reported clinical outcomes of a pediatric population using DIYAPS in the real world. Methods An online survey was distributed to caregivers to assess the hemoglobin A1c levels and time in range (TIR) before and after DIYAPS initiation and problems during DIYAPS use. Results A total of 209 caregivers of children from 21 countries responded to the survey. Of the children, 47.4% were female, with a median age of 10 years, and 99.4% had type 1 diabetes, with a median duration of 4.3 years (SD 3.9). The median duration of DIYAPS use was 7.5 (SD 10.0) months. Clinical outcomes improved significantly, including the hemoglobin A1c levels (from 6.91% [SD 0.88%] to 6.27% [SD 0.67]; P<.001) and TIR (from 64.2% [SD 15.94] to 80.68% [SD 9.26]; P<.001). Conclusions Improved glycemic outcomes were found across all pediatric age groups, including adolescents and very young children. These findings are in line with clinical trial results from commercially developed closed-loop systems.
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Affiliation(s)
- Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Shane O'Donnell
- The Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
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70
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Dovc K, Boughton C, Tauschmann M, Thabit H, Bally L, Allen JM, Acerini CL, Arnolds S, de Beaufort C, Bergenstal RM, Campbell F, Criego A, Dunger DB, Elleri D, Evans ML, Fröhlich-Reiterer E, Hofer S, Kapellen T, Leelarathna L, Pieber TR, Rami-Merhar B, Shah VN, Sibayan J, Wilinska ME, Hovorka R. Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery. Diabetes Care 2019; 42:1344-1347. [PMID: 31221700 PMCID: PMC6609966 DOI: 10.2337/dc18-2625] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/17/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To quantify age-related variability of insulin needs during day and night closed-loop insulin delivery. RESEARCH DESIGN AND METHODS We retrospectively analyzed data from hybrid closed-loop studies involving young children (1-6 years old, n = 20), children (7-12 years, n = 21), adolescents (13-17 years, n = 15), and adults (>18 years, n = 58) with type 1 diabetes. The coefficient of variation quantified variability of insulin needs during 3 weeks of unrestricted-living hybrid closed-loop use. RESULTS Data from 2,365 nights and 2,367 days in 114 participants were analyzed. The coefficient of variation of insulin delivery was higher in young children compared with adults (mean difference at nighttime 10.7 percentage points [95% CI 2.9-18.4], P = 0.003; daytime 6.4 percentage points [95% CI 2.0-10.9], P = 0.002) and compared with adolescents (mean difference at nighttime 10.2 percentage points [95% CI 0.0-20.4], P = 0.049; daytime 7.0 percentage points [95% CI 1.1-12.8], P = 0.014). CONCLUSIONS Diabetes management in young children is complicated by higher variability in insulin requirements, supporting fast-track clinical practice adoption of closed-loop in this vulnerable population.
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Affiliation(s)
- Klemen Dovc
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Pediatric Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Charlotte Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Manchester Diabetes Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester, U.K
| | - Lia Bally
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Departments of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janet M Allen
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Carlo L Acerini
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Sabine Arnolds
- Profil Institut fuer Stoffwechselforschung GmbH, Neuss, Germany
| | | | | | - Fiona Campbell
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, U.K
| | - Amy Criego
- International Diabetes Center at Park Nicollet, St. Louis Park, MN
| | - David B Dunger
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | | | - Mark L Evans
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Kapellen
- Division for Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester, U.K
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado, Denver, CO
| | | | - Malgorzata E Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K. .,Department of Paediatrics, University of Cambridge, Cambridge, U.K
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Artificial Pancreas: Current Progress and Future Outlook in the Treatment of Type 1 Diabetes. Drugs 2019; 79:1089-1101. [DOI: 10.1007/s40265-019-01149-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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