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Suttiratana SC, Wong JJ, Lanning MS, Dunlap A, Hanes SJ, Hood KK, Lal RA, Naranjo D. Qualitative Study of User Experiences with Loop, an Open-Source Automated Insulin Delivery System. Diabetes Technol Ther 2022; 24:416-423. [PMID: 35099278 PMCID: PMC9208860 DOI: 10.1089/dia.2021.0485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Loop is an open-source automated insulin delivery (AID) system, used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation. Methods: Focus groups revealed 72 new and existing users' perspectives on Loop uptake, use, and persistence. A subsample of participants from a mixed-methods, observational cohort study shared first-hand accounts of their experiences using Loop. Participants were predominately white (95%), male (50%), privately insured (94%), and reported annual household income ≥$100K (73%) and education exceeding a bachelor's degree (87%) with a mean HbA1c of 6.6% ± 0.8%. Data were analyzed and synthesized by a multidisciplinary team. Results: Participants detailed their experiences with (1) Loop technical support and troubleshooting, (2) decreased mental/behavioral burden, (3) technical issues with parts of the system, (4) glycemic control, (5) personalizing settings, and (6) providers while using Loop. Decreased burden was the most endorsed benefit defined by less worry, stress, and cognitive effort and less time spent on diabetes management tasks. Participants highlighted the benefits of Loop overnight and their introduction to "Loop communities" during use. The most discussed challenges involved technical issues. A range of provider attitudes and knowledge about Loop complicated users' clinical experiences and disclosure. Conclusions: This sample of new and experienced Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components, customizing the system to suit one's lifestyle and habits, and adjusting system settings. Challenges related to system setup and calibrating settings are remediable and, if addressed, may better serve Loop users. Users reported feeling empowered by the customizability of and the educational effects facilitated by the open-source AID system. Loop helped users learn more about their chronic illness and physiology in an acceptable format. Clinical Trial Registration number: NCT03838900.
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Affiliation(s)
- Sakinah C. Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Address correspondence to: Sakinah C. Suttiratana, PhD, MPH, MBA, Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Jessie J. Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Monica S. Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Adrienne Dunlap
- Division of Agriculture, Food, and Environment, Tufts University, Friedman School of Nutrition Science and Policy, Medford, Massachusetts, USA
| | - Sarah J. Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K. Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
| | - Rayhan A. Lal
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
- Division of Endocrinology, Department of Medicine, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, California, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center (SDRC), Stanford University School of Medicine, Stanford, California, USA
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Domingo-Lopez DA, Lattanzi G, H. J. Schreiber L, Wallace EJ, Wylie R, O'Sullivan J, Dolan EB, Duffy GP. Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus. Adv Drug Deliv Rev 2022; 185:114280. [PMID: 35405298 DOI: 10.1016/j.addr.2022.114280] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/21/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus refers to a group of metabolic disorders which affect how the body uses glucose impacting approximately 9% of the population worldwide. This review covers the most recent technological advances envisioned to control and/or reverse Type 1 diabetes mellitus (T1DM), many of which will also prove effective in treating the other forms of diabetes mellitus. Current standard therapy for T1DM involves multiple daily glucose measurements and insulin injections. Advances in glucose monitors, hormone delivery systems, and control algorithms generate more autonomous and personalised treatments through hybrid and fully automated closed-loop systems, which significantly reduce hypo- and hyperglycaemic episodes and their subsequent complications. Bi-hormonal systems that co-deliver glucagon or amylin with insulin aim to reduce hypoglycaemic events or increase time spent in target glycaemic range, respectively. Stimuli responsive materials for the controlled delivery of insulin or glucagon are a promising alternative to glucose monitors and insulin pumps. By their self-regulated mechanism, these "smart" drugs modulate their potency, pharmacokinetics and dosing depending on patients' glucose levels. Islet transplantation is a potential cure for T1DM as it restores endogenous insulin and glucagon production, but its use is not yet widespread due to limited islet sources and risks of chronic immunosuppression. New encapsulation strategies that promote angiogenesis and oxygen delivery while protecting islets from recipients' immune response may overcome current limiting factors.
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103
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Sawyer A, Sobczak M, Forlenza GP, Alonso GT. Glycemic Control in Relation to Technology Use in a Single-Center Cohort of Children with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:409-415. [PMID: 35099306 PMCID: PMC9208858 DOI: 10.1089/dia.2021.0471] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Technology for patients with type 1 diabetes (T1D), including continuous glucose monitoring (CGM), insulin pumps, and hybrid closed-loop (HCL) systems, is improving, being used more commonly in the pediatric population, and impacts glycemic control. Materials and Methods: We evaluated the use of these technologies and their impact on glycemic control among patients with T1D who were seen at the Barbara Davis Center (n = 4003) between January 2018 and December 2020, <22 years old, with diabetes duration >3 months. Data were analyzed by age group and technology-use group defined as multiple daily injection with blood glucose meter (MDI/BGM), pump with BGM (pump/BGM), MDI with CGM (MDI/CGM), and pump with CGM (pump/CGM). Glycemic control was compared using analysis of covariance (ANCOVA) and controlling for diabetes duration, race, and insurance. Results: Among 4003 patients, 20% used MDI/BGM (mean hemoglobin A1c [HbA1c] = 10.0%); 14.4% used pump/BGM (mean HbA1c = 10.0%); 15.4% used MDI/CGM (mean HbA1c = 8.6%); and 49.8% used pump/CGM (mean HbA1c = 8.1%). Compared with MDI/BGM patients, MDI/CGM and pump/CGM users had a lower HbA1c and were more likely to reach an HbA1c <7.0% (all P < 0.0001). Among pump/CGM users, 35% used HCL technology (mean HbA1c = 7.6%) and had a lower HbA1c and were more likely to reach an HbA1c <7% than non-HCL users (P < 0.001). Conclusions: CGM use was associated with a lower HbA1c in both MDI and pump users. Pump use was only associated with a lower HbA1c if used with CGM. HCL was associated with the lowest HbA1c. Spanish language and minority race/ethnicity were associated with lower rates of pump and CGM use, highlighting the need to reduce disparities.
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Affiliation(s)
- Alexandra Sawyer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marisa Sobczak
- Graduate Medical Education, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Guy Todd Alonso
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Address correspondence to: Guy Todd Alonso, MD, Barbara Davis Center, University of Colorado Anschutz Medical Campus, 1775 Aurora CT, MS A140, Aurora, CO 80045, USA
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104
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Abstract
Combining technologies including rapid insulin analogs, insulin pumps, continuous glucose monitors, and control algorithms has allowed for the creation of automated insulin delivery (AID) systems. These systems have proven to be the most effective technology for optimizing metabolic control and could hold the key to broadly achieving goal-level glycemic control for people with type 1 diabetes. The use of AID has exploded in the past several years with several options available in the United States and even more in Europe. In this article, we review the largest studies involving these AID systems, and then examine future directions for AID with an emphasis on usability.
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Affiliation(s)
- Gregory P. Forlenza
- School of Medicine, Barbara Davis Center, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Rayhan A. Lal
- Department of Medicine & Pediatrics, Divisions of Endocrinology Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
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Usoh CO, Johnson CP, Speiser JL, Bundy R, Dharod A, Aloi JA. Real-World Efficacy of the Hybrid Closed-Loop System. J Diabetes Sci Technol 2022; 16:659-662. [PMID: 33430621 PMCID: PMC9294561 DOI: 10.1177/1932296820985103] [Citation(s) in RCA: 13] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode. We aimed to assess HCL when used in a typical outpatient endocrine clinic. METHODS We initially analyzed data from 80 individuals with type 1 diabetes managed in an endocrine clinic by a single certified diabetes educator (CDE). We then included our other providers and had 230 subjects by the end of the study. Patients were either transitioned from traditional insulin pump or multiple daily insulin injection therapy (MDI) to HCL. Patients initiated to HCL pump therapy from July 2017 through February 2020 were studied. Endpoints of change in time in hypoglycemic/hyperglycemic range and time in target range were analyzed. The primary outcome was a change in percent time in the target range during manual mode compared with auto mode. RESULTS There was an 18.2% increase in average time in target range when comparing manual mode to auto mode (59.3% vs 70.1%, P < .0001). Average time in hyperglycemic range was significantly reduced by 26.7% (39.0% vs 28.6%, P < .0001) but without increasing average time in hypoglycemic range (1.7% vs 1.3%, P = 0.95). CONCLUSIONS HCL was effective in reducing hyperglycemia and increasing time in the target range but did not increase hypoglycemia. These data suggest HCL will improve the metrics of glucose control.
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Affiliation(s)
- Chinenye O. Usoh
- Division of Endocrinology, Diabetes and
Metabolism, Wake Forest University School of Medicine, NC, USA
- Chinenye O. Usoh, Division of Endocrinology,
Diabetes and Metabolism, Wake Forest University School of Medicine, Medical Center Blvd.,
Winston-Salem, NC 27157, USA.
| | - Crystal Paige Johnson
- Division of Endocrinology, Diabetes and
Metabolism, Wake Forest University School of Medicine, NC, USA
| | - Jaime L. Speiser
- Department of Biostatistics and Data Science,
Division of Public Health Sciences, Wake Forest University School of Medicine, NC, USA
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest
University School of Medicine, NC, USA
| | - Ajay Dharod
- Wake Forest Department of Implementation
Science, Wake Forest Center for Healthcare Innovation, Wake Forest Center for Biomedical
Informatics, Wake Forest University School of Medicine, Department of Internal Medicine, NC,
USA
| | - Joseph A. Aloi
- Division of Endocrinology, Diabetes and
Metabolism, Wake Forest University School of Medicine, NC, USA
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106
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Kaur RJ, Deshpande S, Pinsker JE, Gilliam WP, McCrady-Spitzer S, Zaniletti I, Desjardins D, Church MM, Doyle III FJ, Kremers WK, Dassau E, Kudva YC. Outpatient Randomized Crossover Automated Insulin Delivery Versus Conventional Therapy with Induced Stress Challenges. Diabetes Technol Ther 2022; 24:338-349. [PMID: 35049354 PMCID: PMC9271334 DOI: 10.1089/dia.2021.0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Automated insulin delivery (AID) systems have not been evaluated in the context of psychological and pharmacological stress in type 1 diabetes. Our objective was to determine glycemic control and insulin use with Zone Model Predictive Control (zone-MPC) AID system enhanced for states of persistent hyperglycemia versus sensor-augmented pump (SAP) during outpatient use, including in-clinic induced stress. Materials and Methods: Randomized, crossover, 2-week trial of zone-MPC AID versus SAP in 14 adults with type 1 diabetes. In each arm, each participant was studied in-clinic with psychological stress induction (Trier Social Stress Test [TSST] and Socially Evaluated Cold Pressor Test [SECPT]), followed by pharmacological stress induction with oral hydrocortisone (total four sessions per participant). The main outcomes were 2-week continuous glucose monitor percent time in range (TIR) 70-180 mg/dL, and glucose and insulin outcomes during and overnight following stress induction. Results: During psychological stress, AID decreased glycemic variability percentage by 13.4% (P = 0.009). During pharmacological stress, including the following overnight, there were no differences in glucose outcomes and total insulin between AID and physician-assisted SAP. However, with AID total user-requested insulin was lower by 6.9 U (P = 0.01) for pharmacological stress. Stress induction was validated by changes in heart rate and salivary cortisol levels. During the 2-week AID use, TIR was 74.4% (vs. SAP 63.1%, P = 0.001) and overnight TIR was 78.3% (vs. SAP 63.1%, P = 0.004). There were no adverse events. Conclusions: Zone-MPC AID can reduce glycemic variability and the need for user-requested insulin during pharmacological stress and can improve overall glycemic outcomes. Clinical Trial Identifier NCT04142229.
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Affiliation(s)
- Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | | | | | - Shelly McCrady-Spitzer
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabella Zaniletti
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Donna Desjardins
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Francis J. Doyle III
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Walter K. Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
- Address correspondence to: Yogish C. Kudva, MBBS, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester MN 55902, USA
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107
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Forlenza GP, Ekhlaspour L, DiMeglio LA, Fox LA, Rodriguez H, Shulman DI, Kaiserman KB, Liljenquist DR, Shin J, Lee SW, Buckingham BA. Glycemic outcomes of children 2-6 years of age with type 1 diabetes during the pediatric MiniMed™ 670G system trial. Pediatr Diabetes 2022; 23:324-329. [PMID: 35001477 PMCID: PMC9304187 DOI: 10.1111/pedi.13312] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/17/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Highly variable insulin sensitivity, susceptibility to hypoglycemia and inability to effectively communicate hypoglycemic symptoms pose significant challenges for young children with type 1 diabetes (T1D). Herein, outcomes during clinical MiniMed™ 670G system use were evaluated in children aged 2-6 years with T1D. METHODS Participants (N = 46, aged 4.6 ± 1.4 years) at seven investigational centers used the MiniMed™ 670G system in Manual Mode during a two-week run-in period followed by Auto Mode during a three-month study phase. Safety events, mean A1C, sensor glucose (SG), and percentage of time spent in (TIR, 70-180 mg/dl), below (TBR, <70 mg/dl) and above (TAR, >180 mg/dl) range were assessed for the run-in and study phase and compared using a paired t-test or Wilcoxon signed-rank test. RESULTS From run-in to end of study (median 87.1% time in auto mode), mean A1C and SG changed from 8.0 ± 0.9% to 7.5 ± 0.6% (p < 0.001) and from 173 ± 24 to 161 ± 16 mg/dl (p < 0.001), respectively. Overall TIR increased from 55.7 ± 13.4% to 63.8 ± 9.4% (p < 0.001), while TBR and TAR decreased from 3.3 ± 2.5% to 3.2 ± 1.6% (p = 0.996) and 41.0 ± 14.7% to 33.0 ± 9.9% (p < 0.001), respectively. Overnight TBR remained unchanged and TAR was further improved 12:00 am-6:00 am. Throughout the study phase, there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA) and no serious adverse device-related events. CONCLUSIONS At-home MiniMed™ 670G Auto Mode use by young children safely improved glycemic outcomes compared to two-week open-loop Manual Mode use. The improvements are similar to those observed in older children, adolescents and adults with T1D using the same system for the same duration of time.
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Affiliation(s)
| | - Laya Ekhlaspour
- Division of Pediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
| | - Linda A. DiMeglio
- Division of Pediatric Endocrinology and DiabetologyWells Center for Pediatric Research, Indiana UniversityIndianapolisIndianaUSA
| | - Larry A. Fox
- Division of Endocrinology, Diabetes and MetabolismNemours Children's Health SystemJacksonvilleFloridaUSA
| | - Henry Rodriguez
- Division of Pediatric EndocrinologyUniversity of South FloridaTampaFloridaUSA
| | - Dorothy I. Shulman
- Division of Pediatric EndocrinologyUniversity of South FloridaTampaFloridaUSA
| | | | | | - John Shin
- Medtronic DiabetesNorthridgeCaliforniaUSA
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Jendle J, Buompensiere MI, Holm AL, de Portu S, Malkin SJP, Cohen O. A Response to: Letter to the Editor with Regard to the Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: A Health Economic Analysis in Sweden. Diabetes Ther 2022; 13:1125-1129. [PMID: 35403952 PMCID: PMC9076762 DOI: 10.1007/s13300-022-01252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- J Jendle
- Institute of Medical Sciences, Örebro University, Campus USÖ, 701 82, Örebro, Sweden.
| | | | - A L Holm
- Medtronic Denmark, Copenhagen, Denmark
| | - S de Portu
- Medtronic International Trading Sàrl, Tolechenaz, Switzerland
| | - S J P Malkin
- Ossian Health Economics and Communications, Basel, Switzerland
| | - O Cohen
- Medtronic International Trading Sàrl, Tolechenaz, Switzerland
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109
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Berget C, Sherr JL, DeSalvo DJ, Kingman RS, Stone SL, Brown SA, Nguyen A, Barrett L, Ly TT, Forlenza GP. Clinical Implementation of the Omnipod 5 Automated Insulin Delivery System: Key Considerations for Training and Onboarding People With Diabetes. Clin Diabetes 2022; 40:168-184. [PMID: 35669307 PMCID: PMC9160549 DOI: 10.2337/cd21-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Automated insulin delivery (AID) systems, which connect an insulin pump, continuous glucose monitoring system, and software algorithm to automate insulin delivery based on real-time glycemic data, hold promise for improving outcomes and reducing therapeutic burden for people with diabetes. This article reviews the features of the Omnipod 5 Automated Insulin Delivery System and how it compares to other AID systems available on or currently under review for the U.S. market. It also provides practical guidance for clinicians on how to effectively train and onboard people with diabetes on the Omnipod 5 System, including how to personalize therapy and optimize glycemia. Many people with diabetes receive their diabetes care in primary care settings rather than in a diabetes specialty clinic. Therefore, it is important that primary care providers have access to resources to support the adoption of AID technologies such as the Omnipod 5 System.
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Affiliation(s)
- Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Jennifer L. Sherr
- Section of Pediatric Endocrinology, Yale School of Medicine, New Haven, CT
| | - Daniel J. DeSalvo
- Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Houston, TX
| | - Ryan S. Kingman
- Department of Pediatric Endocrinology, Stanford School of Medicine, Palo Alto, CA
| | | | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | | | | | - Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
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110
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Arunachalum S, Velado K, Vigersky RA, Cordero TL. Glycemic Outcomes During Real-World Hybrid Closed-Loop System Use by Individuals With Type 1 Diabetes in the United States. J Diabetes Sci Technol 2022:19322968221088608. [PMID: 35414272 DOI: 10.1177/19322968221088608] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glycemic outcomes during real-world hybrid closed-loop (HCL) system use by individuals with type 1 diabetes, in the United States, were retrospectively analyzed. METHODS Hybrid closed-loop system data voluntarily uploaded to Carelink™ personal software from March 2017 to November 2020 by individuals (aged ≥7 years) using the MiniMed™ 670G system and having ≥10 days of continuous glucose monitoring data after initiating Auto Mode were assessed. Glycemic outcomes including the mean glucose management indicator (GMI), sensor glucose (SG), percentage of time spent in (TIR), below (TBR), and above (TAR) target range (70-180 mg/dL) were analyzed. Outcomes were also analyzed in a subgroup of users per baseline GMI of <7% versus >8%. RESULTS The overall cohort (N = 123 355 users, with a mean of 87.9% of time in Auto Mode) had a GMI of 7.0% ± 0.4%, TIR of 70.4% ± 11.2%, TBR <70 mg/dL of 2.2% ± 2.1% and TAR>180 mg/dL of 27.5% ± 11.6%, post-Auto Mode initiation. Compared with pre-Auto Mode initiation, users (N = 52 941, 88.6% of time in Auto Mode) had a GMI that decreased from 7.3% ± 0.6% to 7.1% ± 0.5% (P < .001), TIR that increased from 61.5% ± 15.1% to 68.1% ± 11.9% (P < .001), TAR>180 mg/dL that decreased from 36.3% ± 15.7% to 29.8% ± 12.2% (P < .001) and TBR<70 mg/dL that decreased from 2.11 ± 2.4 to 2.07% ± 2.25% (P = .002). While all metrics statistically improved for the baseline GMI >8.0% group, the baseline GMI <7.0% group had unchanged TIR (77.4% ± 7.4% to 77.5% ± 8.0%, P = .456) and TAR>180 mg/dL that increased (19.2 ± 6.7 to 19.6 ± 7.9%, p < 0.001). CONCLUSION Real-world HCL system use in the U.S. demonstrated overall glycemic control that trended similarly with the system pivotal trial outcomes and previous real-world system use analyses.
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111
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Forlenza GP, Vigers T, Berget C, Messer LH, Lal RA, Basina M, Maahs DM, Hood K, Buckingham B, Wilson DM, Wadwa RP, Driscoll KA, Pyle L. Predicting Success with a First-Generation Hybrid Closed-Loop Artificial Pancreas System Among Children, Adolescents, and Young Adults with Type 1 Diabetes: A Model Development and Validation Study. Diabetes Technol Ther 2022; 24:157-166. [PMID: 34780306 PMCID: PMC8971998 DOI: 10.1089/dia.2021.0326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Hybrid Closed-Loop (HCL) systems aid individuals with type 1 diabetes in improving glycemic control; however, sustained use over time has not been consistent for all users. This study developed and validated prognostic models for successful 12-month use of the first commercial HCL system based on baseline and 1- or 3-month data. Methods and Materials: Data from participants at the Barbara Davis Center (N = 85) who began use of the MiniMed 670G HCL were used to develop prognostic models using logistic regression and Lasso model selection. Candidate factors included sex, age, duration of diabetes, baseline hemoglobin A1c (HbA1c), race, ethnicity, insurance status, history of insulin pump and continuous glucose monitor use, 1- or 3-month Auto Mode use, boluses per day, and time in range (TIR; 70-180 mg/dL), and scores on behavioral questionnaires. Successful use of HCL was predefined as Auto Mode use ≥60%. The 3-month model was then externally validated against a sample from Stanford University (N = 55). Results: Factors in the final model included baseline HbA1c, sex, ethnicity, 1- or 3-month Auto Mode use, Boluses per Day, and TIR. The 1- and 3-month prognostic models had very good predictive ability with area under the curve values of 0.894 and 0.900, respectively. External validity was acceptable with an area under the curve of 0.717. Conclusions: Our prognostic models use clinically accessible baseline and early device-use factors to identify risk for failure to succeed with 670G HCL technology. These models may be useful to develop targeted interventions to promote success with new technologies.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Address correspondence to: Gregory P. Forlenza, MD, Associate Professor of Pediatrics, Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus,, 1775 Aurora Court, MS A140, Aurora, CO 80045, USA
| | - Tim Vigers
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Laurel H. Messer
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Rayhan A. Lal
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Marina Basina
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - David M. Maahs
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Korey Hood
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Bruce Buckingham
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - Darrell M. Wilson
- Stanford Diabetes Research Center, School of Medicine, Stanford University, Stanford, California, USA
| | - R. Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Laura Pyle
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, University of Colorado Anschutz Campus, Aurora, Colorado, USA
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112
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Proietti A, Raggio M, Paz M, Rubin G, Kabakian M, Saleme A, Grosembacher L. Six-Month Glycemic Control with a Hybrid Closed-Loop System in Type 1 Diabetes Patients in a Latin American Country. Diabetes Technol Ther 2022; 24:220-226. [PMID: 34668782 DOI: 10.1089/dia.2021.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The goal of this study was to assess the 6-month effectiveness of hybrid closed loop on glycemic control in type 1 diabetes (T1D) patients in Latin America. An exploratory analysis of data prospectively collected from non-selected consecutive patients with T1D who initiated treatment with the MiniMed™ 670G system in Argentina was conducted. Baseline and follow-up visits at days 7, 28, 90, and 180 were carried out and data were downloaded at each visit. A total of 30 patients (age range 9-57 years, female 63.3%), 73.3% (n = 22) of whom previously used sensor augmented pump-predictive low glucose management (SAP-PLGM), with baseline glycated hemoglobin 7.4% ± 1% were included. Time in range between 70 and 180 mg/dL significantly increased from 65.1% at baseline to 77.3%, 76.2%, 75.7%, and 75.2% at days 7, 28, 90 and 180, respectively. Time above range (>180 mg/dL) significantly decreased from 33% to 22.5% (P < 0.001), while time below range (<70 mg/dL) did not change. Mean glucose levels were reduced from 163.5 mg/dL at baseline to 150.9 mg/dL (P = 0.001) at last visit. The Auto Mode feature was used > 90% of the time. Virtual training was successfully completed with a Net Promoter Score® (NPS®) of 87%. This analysis confirms that MiniMed 670G system use allowed successful achievement of glycemic control within recommended targets in a non-selected Latin American patient population who underwent virtual system training.
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Affiliation(s)
- Adrian Proietti
- Private Practice, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Marcela Raggio
- Department of Pediatric Nutrition, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - María Paz
- Department of Pediatric Diabetology, Hospital de Niños Santísima Trinidad, Córdoba, Argentina
| | - Graciela Rubin
- Department of Nutrition & Diabetology, Hospital Privado de Córdoba, Córdoba, Argentina
| | - María Kabakian
- Hospital Churruca Visca, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Saleme
- Universidad Favaloro, and Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Luis Grosembacher
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
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113
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Carlson AL, Sherr JL, Shulman DI, Garg SK, Pop-Busui R, Bode BW, Lilenquist DR, Brazg RL, Kaiserman KB, Kipnes MS, Thrasher JR, Reed JHC, Slover RH, Philis-Tsimikas A, Christiansen M, Grosman B, Roy A, Vella M, Jonkers RA, Chen X, Shin J, Cordero TL, Lee SW, Rhinehart AS, Vigersky RA. Safety and Glycemic Outcomes During the MiniMed™ Advanced Hybrid Closed-Loop System Pivotal Trial in Adolescents and Adults with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:178-189. [PMID: 34694909 PMCID: PMC8971997 DOI: 10.1089/dia.2021.0319] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: This trial assessed safety and effectiveness of an advanced hybrid closed-loop (AHCL) system with automated basal (Auto Basal) and automated bolus correction (Auto Correction) in adolescents and adults with type 1 diabetes (T1D). Materials and Methods: This multicenter single-arm study involved an intent-to-treat population of 157 individuals (39 adolescents aged 14-21 years and 118 adults aged ≥22-75 years) with T1D. Study participants used the MiniMed™ AHCL system during a baseline run-in period in which sensor-augmented pump +/- predictive low glucose management or Auto Basal was enabled for ∼14 days. Thereafter, Auto Basal and Auto Correction were enabled for a study phase (∼90 days), with glucose target set to 100 or 120 mg/dL for ∼45 days, followed by the other target for ∼45 days. Study endpoints included safety events and change in mean A1C, time in range (TIR, 70-180 mg/dL) and time below range (TBR, <70 mg/dL). Run-in and study phase values were compared using Wilcoxon signed-rank test or paired t-test. Results: Overall group time spent in closed loop averaged 94.9% ± 5.4% and involved only 1.2 ± 0.8 exits per week. Compared with run-in, AHCL reduced A1C from 7.5% ± 0.8% to 7.0% ± 0.5% (<0.001, Wilcoxon signed-rank test, n = 155), TIR increased from 68.8% ± 10.5% to 74.5% ± 6.9% (<0.001, Wilcoxon signed-rank test), and TBR reduced from 3.3% ± 2.9% to 2.3% ± 1.7% (<0.001, Wilcoxon signed-rank test). Similar benefits to glycemia were observed for each age group and were more pronounced for the nighttime (12 AM-6 AM). The 100 mg/dL target increased TIR to 75.4% (n = 155), which was further optimized at a lower active insulin time (AIT) setting (i.e., 2 h), without increasing TBR. There were no severe hypoglycemic or diabetic ketoacidosis events during the study phase. Conclusions: These findings show that the MiniMed AHCL system is safe and allows for achievement of recommended glycemic targets in adolescents and adults with T1D. Adjustments in target and AIT settings may further optimize glycemia and improve user experience. Clinical Trial Registration number: NCT03959423.
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Affiliation(s)
- Anders L. Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Jennifer L. Sherr
- Yale University School of Medicine Pediatric Endocrinology, New Haven, Connecticut, USA
| | - Dorothy I. Shulman
- University of South Florida Diabetes and Endocrinology, Tampa, Florida, USA
| | - Satish K. Garg
- Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Ron L. Brazg
- Rainier Clinical Research Center, Renton, Washington, USA
| | | | - Mark S. Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | - James R. Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | | | - Robert H. Slover
- Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | | | | | | | | | | | | | | | - John Shin
- Medtronic, Northridge, California, USA
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114
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Boscari F, Ferretto S, Cavallin F, Bruttomesso D. Switching from predictive low glucose suspend to advanced hybrid closed loop control: Effects on glucose control and patient reported outcomes. Diabetes Res Clin Pract 2022; 185:109784. [PMID: 35183648 DOI: 10.1016/j.diabres.2022.109784] [Citation(s) in RCA: 13] [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: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
AIMS Automated insulin delivery improves glucose control. Aim of this study was to compare in real life the effects on glucose control and patient reported outcomes of an advanced hybrid closed loop system (Control-IQ), versus a simpler system with predictive low glucose suspend function (Basal-IQ). METHODS Thirty-one type 1 diabetic subjects were studied during Basal-IQ and after switching to Control-IQ. Variables analyzed were time spent in range (70-180 mg/dL), in tight range (70-140 mg/dL), above range (>180 mg/dL), below range (<70 mg/dL), mean glucose, coefficient of variation and glycated hemoglobin. Questionnaires were administered regarding therapy satisfaction (Diabetes Treatment Satisfaction Questionnaire in status/change form), fear of hypoglycemia (Hypoglycemia Fear Survey), quality of sleep (Pittsburgh Sleep Quality Index). RESULTS After 12 weeks of Control-IQ, time in range increased from 62.7 to 74.0%, p < 0.0001, time in tight range increased from 37.1 to 44.6 %, p < 0.001, time above range decreased from 35.6 to 24.4% p < 0.0001. Improvements were observed in mean glucose and glucose variability. Glycated hemoglobin decreased from 7.0% (53 mmol/mol) to 6.6% (49 mmol/mol), p < 0.0001. Subjects using Control-IQ manifested greater satisfaction and less fear of hypoglycemia. CONCLUSION Compared to Basal-IQ, Control-IQ improves glucose control and therapy satisfaction.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Disease, University of Padova, 35128 Padova, Italy
| | - Sara Ferretto
- Department of Medicine, Unit of Metabolic Disease, University of Padova, 35128 Padova, Italy
| | | | - Daniela Bruttomesso
- Department of Medicine, Unit of Metabolic Disease, University of Padova, 35128 Padova, Italy.
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115
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Maahs DM, Addala A, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2022; 24:S107-S128. [PMID: 35475702 DOI: 10.1089/dia.2022.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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116
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Usoh CO, Kilen K, Keyes C, Johnson CP, Aloi JA. Telehealth Technologies and Their Benefits to People With Diabetes. Diabetes Spectr 2022; 35:8-15. [PMID: 35308147 PMCID: PMC8914588 DOI: 10.2337/dsi21-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article reviews the current diabetes technology landscape and how recent advancements are being used to help overcome barriers in the management of diabetes. The authors offer case examples of how digital tools and platforms can facilitate diabetes care via telehealth and remote patient monitoring for individuals in special populations. They also provide tips to ensure success in implementing diabetes technology to provide the best possible care for people with diabetes in outpatient settings.
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Affiliation(s)
- Chinenye O. Usoh
- Division of Endocrinology, Diabetes and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC
- Corresponding author: Chinenye O. Usoh,
| | | | - Carolyn Keyes
- Division of Endocrinology, Diabetes and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Crystal Paige Johnson
- Division of Endocrinology, Diabetes and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph A. Aloi
- Division of Endocrinology, Diabetes and Metabolism, Wake Forest University School of Medicine, Winston-Salem, NC
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117
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Tyler NS, Mosquera-Lopez C, Young GM, El Youssef J, Castle JR, Jacobs PG. Quantifying the impact of physical activity on future glucose trends using machine learning. iScience 2022; 25:103888. [PMID: 35252806 PMCID: PMC8889374 DOI: 10.1016/j.isci.2022.103888] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 01/21/2023] Open
Abstract
Prevention of hypoglycemia (glucose <70 mg/dL) during aerobic exercise is a major challenge in type 1 diabetes. Providing predictions of glycemic changes during and following exercise can help people with type 1 diabetes avoid hypoglycemia. A unique dataset representing 320 days and 50,000 + time points of glycemic measurements was collected in adults with type 1 diabetes who participated in a 4-arm crossover study evaluating insulin-pump therapies, whereby each participant performed eight identically designed in-clinic exercise studies. We demonstrate that even under highly controlled conditions, there is considerable intra-participant and inter-participant variability in glucose outcomes during and following exercise. Participants with higher aerobic fitness exhibited significantly lower minimum glucose and steeper glucose declines during exercise. Adaptive, personalized machine learning (ML) algorithms were designed to predict exercise-related glucose changes. These algorithms achieved high accuracy in predicting the minimum glucose and hypoglycemia during and following exercise sessions, for all fitness levels.
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Affiliation(s)
- Nichole S. Tyler
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering Oregon Health & Science University Portland, OR 97232, USA,Corresponding author
| | - Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering Oregon Health & Science University Portland, OR 97232, USA
| | - Gavin M. Young
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering Oregon Health & Science University Portland, OR 97232, USA
| | - Joseph El Youssef
- Harold Schnitzer Diabetes Health Center, Division of Endocrinology Oregon Health & Science University Portland, OR 97239, USA
| | - Jessica R. Castle
- Harold Schnitzer Diabetes Health Center, Division of Endocrinology Oregon Health & Science University Portland, OR 97239, USA
| | - Peter G. Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering Oregon Health & Science University Portland, OR 97232, USA
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118
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Toschi E, Atakov-Castillo A, Slyne C, Munshi M. Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Data. Diabetes Technol Ther 2022; 24:140-142. [PMID: 34609917 PMCID: PMC8817701 DOI: 10.1089/dia.2021.0311] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: To assess the impact of initiation of closed-loop control (CLC) on glycemic metrics in older adults with type 1 diabetes (T1D) in the real world. Methods: Retrospective analysis of electronic health records from a single tertiary diabetes center of older adults prescribed CLC between January and December 2020. Results: Forty-eight patients (mean age 70 ± 4 years, T1D duration 42 ± 14 years) were prescribed CLC and 39/48 started on the CLC. Among the CLC starters, 97.5% and 95% were prior pump and continuous glucose monitoring (CGM) users, respectively. CGM metrics showed an increase in time-in-range (62% ± 13% to 76% ± 9%; P < 0.001), a reduction in both time spent <70 mg/dL [2% (1%-3%) to 1% (1%-2%); P = 0.03] and >180 mg/dL (30% ± 11% to 20% ± 9%; P < 0.001) at 3 months. Conclusion: In this real-world data most of the older patients with T1D initiating CLC were prior pump and CGM users. Initiation of CLC improved glycemic control and reduced time spent in hypoglycemia compared with prior therapy.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: Elena Toschi, MD, Adult Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA
| | | | | | - Medha Munshi
- Joslin Diabetes Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center Boston, Massachusetts, USA
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119
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Silva JD, Lepore G, Battelino T, Arrieta A, Castañeda J, Grossman B, Shin J, Cohen O. Real-World Performance of the MiniMed™ 780G System: First Report of Outcomes from 4120 Users. Diabetes Technol Ther 2022; 24:113-119. [PMID: 34524003 PMCID: PMC8817690 DOI: 10.1089/dia.2021.0203] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: The MiniMed™ 780G system includes an advanced hybrid closed loop (AHCL) algorithm that provides both automated basal and correction bolus insulin delivery. The preliminary performance of the system in real-world settings was evaluated. Methods: Data uploaded from August 2020 to March 2021 by individuals living in Belgium, Finland, Italy, the Netherlands, Qatar, South Africa, Sweden, Switzerland, and the United Kingdom were aggregated and retrospectively analyzed to determine the mean glucose management indicator (GMI), percentage of time spent within (TIR), below (TBR), and above (TAR) glycemic ranges, system use, and insulin consumption in users having ≥10 days of sensor glucose (SG) data after initiating AHCL. The impact of initiating AHCL was evaluated in a subgroup of users also having ≥10 days of SG data, before AHCL initiation. Results: Users (N = 4120) were observed for a mean of 54 ± 32 days. During this time, they spent a mean of 94.1% ± 11.4% of the time in AHCL and achieved a mean GMI of 6.8% ± 0.3%, TIR of 76.2% ± 9.1%, TBR <70 of 2.5% ± 2.1%, and TAR >180 of 21.3% ± 9.4%, after initiating AHCL. There were 77.3% and 79.0% of users who achieved a TIR >70% and a GMI of <7.0%, respectively. Users for whom comparison with pre-AHCL was possible (N = 812) reduced their GMI by 0.4% ± 0.4% (P = 0.005) and increased their TIR by 12.1% ± 10.5% (P < 0.0001), post-AHCL initiation. More users achieved the glycemic treatment goals of GMI <7.0% (37.6% vs. 75.2%, P < 0.0001) and TIR >70% (34.6% vs. 74.9%, P < 0.0001) when compared with pre-AHCL initiation. Conclusion: Most MiniMed 780G system users achieved TIR >70% and GMI <7%, while minimizing hypoglycemia, in a real-world condition.
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Affiliation(s)
- Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Giuseppe Lepore
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tadej Battelino
- University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | | | - John Shin
- Medtronic, Northridge, California, USA
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
- Address correspondence to: Ohad Cohen, MD, Medtronic International Trading Sàrl, Route du Molliau 31, Tolochenaz 1131, Switzerland
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120
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Mardare I, Campbell SM, Meyer JC, Sefah IA, Massele A, Godman B. Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care. Front Pharmacol 2022; 12:794363. [PMID: 35095504 PMCID: PMC8795368 DOI: 10.3389/fphar.2021.794363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.
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Affiliation(s)
- Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Stephen M. Campbell
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amos Massele
- Pharmacology and Therapeutics Department, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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121
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Abstract
Hybrid closed-loop therapy is an emerging technology transforming the management of type 1 diabetes (T1D). Research studies demonstrate glycemic and quality of life benefits of hybrid closed-loop therapy for people with T1D. Translating these outcomes into standard clinical practice is critical for reimbursement and improving access to this technology.High-quality training is essential for achieving optimal outcomes with hybrid closed-loop therapy. Basic diabetes skills and tasks are as important, or even more important, with closed-loop therapy than with standard insulin therapy and need to be reiterated. Establishing expectations of hybrid closed-loop therapy clearly at the outset promotes long-term usage and optimal outcomes.We share key aspects of training and support for users of commercially available hybrid closed-loop systems and consider who may benefit from this technology.
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Affiliation(s)
- Charlotte K. Boughton
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
- Charlotte K. Boughton, MBBS, PhD, University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - Sara Hartnell
- Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK
| | - Janet M. Allen
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Julia Fuchs
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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122
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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123
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Gianini A, Suklan J, Skela-Savič B, Klemencic S, Battelino T, Dovc K, Bratina N. Patient reported outcome measures in children and adolescents with type 1 diabetes using advanced hybrid closed loop insulin delivery. Front Endocrinol (Lausanne) 2022; 13:967725. [PMID: 36060958 PMCID: PMC9437950 DOI: 10.3389/fendo.2022.967725] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the impact of advanced hybrid closed - loop (AHCL) insulin delivery on quality of life, metabolic control and time in range (TIR) in youth with type 1 diabetes mellitus (T1DM). METHODS Twenty-four children and adolescents with T1DM (14 female) aged of 10 to 18 years participated in the study. Mixed methods study design was implemented. Quantitative part of the study was conducted as a longitudinal crossover study with data collection before and at the end of AHCL use. Qualitative data were obtained with modeled interviews of four focus groups before and the end of the period. Clinical data were collected from the electronic medical records. RESULTS The use of AHCL significantly improved the quality of life in terms of decreased fear of hypoglycemia (p<0.001), decrease in diabetes-related emotional distress (p<0.001), and increased wellbeing (p=0.003). The mean A1C decreased from 8.55 ± 1.34% (69.9 ± 12.3 mmol/mol) to 7.73 ± 0.42 (61.1 ± 2.2 mmol/mol) (p=0.002) at the end of the study. Mean TIR was 68.22% (± 13.89) before and 78.26 (± 6.29) % (p<0.001) at the end of the study. CONCLUSION The use of advanced hybrid closed loop significantly improved the quality of life and metabolic control in children and adolescents with T1DM.
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Affiliation(s)
- Ana Gianini
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Suklan
- NIHR Newcastle In Vitro Diagnostics Co-operative, Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Brigita Skela-Savič
- Department for Masters and Phd in Health Care Science, Angela Boškin Faculty of Health Care, Jesenice, Slovenia
| | - Simona Klemencic
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Nataša Bratina,
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Templer S. Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions. Front Endocrinol (Lausanne) 2022; 13:919942. [PMID: 35733769 PMCID: PMC9207329 DOI: 10.3389/fendo.2022.919942] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/06/2022] [Indexed: 12/16/2022] Open
Abstract
Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. The first iterations of glucose-responsive insulin delivery were pioneered in the 1960s and 1970s, with the development of systems that used venous glucose measurements to dictate intravenous infusions of insulin and dextrose in order to maintain normoglycemia. Only recently have these bulky, bedside technologies progressed to miniaturized, wearable devices. These modern closed-loop systems use interstitial glucose sensing, subcutaneous insulin pumps, and increasingly sophisticated algorithms. As the number of commercially available hybrid closed-loop systems has grown, so too has the evidence supporting their efficacy. Future challenges in closed-loop technology include the development of fully closed-loop systems that do not require user input for meal announcements or carbohydrate counting. Another evolving avenue in research is the addition of glucagon to mitigate the risk of hypoglycemia and allow more aggressive insulin dosing.
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125
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Cobry EC, Reznick-Lipina T, Pyle L, Slover R, Thomas JF, Alonso GT, Wadwa RP. Diabetes Technology Use in Remote Pediatric Patients with Type 1 Diabetes Using Clinic-to-Clinic Telemedicine. Diabetes Technol Ther 2022; 24:67-74. [PMID: 34524007 PMCID: PMC8783625 DOI: 10.1089/dia.2021.0229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Clinic-to-clinic telemedicine can increase visit frequency in pediatric patients with type 1 diabetes (T1D) living far from a diabetes specialty clinic, but the impact on adoption of diabetes technology is unclear. Materials and Methods: Pediatric patients with T1D in Colorado and surrounding states who received diabetes care using clinic-to-clinic telemedicine were enrolled. Medical records and surveys were reviewed to ascertain technology use, and data were compared to patients from the main clinic population. Results: Patients (N = 128, baseline mean age 12.4 ± 4.2 years, median T1D duration 3.3 years [IQR 1.4-7.7], mean A1c 8.9% ± 1.8%, 60% male, 75% non-Hispanic white, 77% private insurance) who utilized telemedicine were included. Technology use among telemedicine patients was not associated with gender, T1D duration, insurance, distance from the main clinic or rural designation but was associated with ethnicity and A1c. Compared to the main clinic cohort (N = 3636), continuous glucose monitor (CGM) use and pump/CGM combination use was lower among patients participating in clinic-to-clinic telemedicine (CGM: 29.7% vs. 56.0%, P < 0.001; CGM/pump combination: 27.3% vs. 40.3%, P = 0.004). Technology use was associated with lower A1c regardless of cohort. Conclusions: Compared to patients attending in-person clinic, pediatric T1D patients who use clinic-to-clinic telemedicine due to their distance from the main clinic, have lower CGM and combination CGM/pump use. For both telemedicine and main clinic patients, CGM and CGM/pump combination was associated with lower A1c. Additional research is needed to explore reasons for this discrepancy and find methods to improve CGM use in this population.
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Affiliation(s)
- Erin C. Cobry
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tyler Reznick-Lipina
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert Slover
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John F. Thomas
- Department of General Academic Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Guy Todd Alonso
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Raj Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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126
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Braune K, Lal RA, Petruželková L, Scheiner G, Winterdijk P, Schmidt S, Raimond L, Hood KK, Riddell MC, Skinner TC, Raile K, Hussain S. Open-source automated insulin delivery: international consensus statement and practical guidance for health-care professionals. Lancet Diabetes Endocrinol 2022; 10:58-74. [PMID: 34785000 PMCID: PMC8720075 DOI: 10.1016/s2213-8587(21)00267-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023]
Abstract
Open-source automated insulin delivery systems, commonly referred to as do-it-yourself automated insulin delivery systems, are examples of user-driven innovations that were co-created and supported by an online community who were directly affected by diabetes. Their uptake continues to increase globally, with current estimates suggesting several thousand active users worldwide. Real-world user-driven evidence is growing and provides insights into safety and effectiveness of these systems. The aim of this consensus statement is two-fold. Firstly, it provides a review of the current evidence, description of the technologies, and discusses the ethics and legal considerations for these systems from an international perspective. Secondly, it provides a much-needed international health-care consensus supporting the implementation of open-source systems in clinical settings, with detailed clinical guidance. This consensus also provides important recommendations for key stakeholders that are involved in diabetes technologies, including developers, regulators, and industry, and provides medico-legal and ethical support for patient-driven, open-source innovations.
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Affiliation(s)
- Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Rayhan A Lal
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | - Lenka Petruželková
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Per Winterdijk
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, Netherlands
| | | | | | - Korey K Hood
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Timothy C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospital NHS Trust, London, UK; Department of Diabetes, King's College London, London, UK; Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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128
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Lunati ME, Morpurgo PS, Rossi A, Gandolfi A, Cogliati I, Bolla AM, Plebani L, Vallone L, Montefusco L, Pastore I, Cimino V, Argenti S, Volpi G, Zuccotti GV, Fiorina P. Hybrid Close-Loop Systems Versus Predictive Low-Glucose Suspend and Sensor-Augmented Pump Therapy in Patients With Type 1 Diabetes: A Single-Center Cohort Study. Front Endocrinol (Lausanne) 2022; 13:816599. [PMID: 35498423 PMCID: PMC9048202 DOI: 10.3389/fendo.2022.816599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Predictive low-glucose suspend (PLGS) and hybrid closed-loop (HCL) systems may improve glucose control and quality of life in type 1 diabetic individuals. This is a cross-sectional, single-center study to compare the effect on metabolic control and glucose variability of PLGS and HCL systems as compared to standard sensor-augmented pump (SAP) therapy. METHODS We retrospectively analyzed 136 adults (men/women 69/67, mean age 47.3 ± 13.9 years) with T1D on insulin pump therapy, divided accordingly to type of insulin pump system (group 1: SAP, 24 subjects; group 2: PLGS, 49 subjects; group 3: HCL, 63 subjects). The groups were matched for age, gender, years of disease, years of CSII use, and CGM wear time. RESULTS The analysis of CGM metrics, in the three groups, showed a statistically significant different percentage of time within the target range, defined as 70-180 mg/dl, with a higher percentage in group 3 and significantly less time spent in the hypoglycemic range in groups 2 and 3. The three groups were statistically different also for the glucose management indicator and coefficient of variation percentage, which were progressively lower moving from group 1 to group 3. In the HCL group, 52.4% of subjects reached a percentage of time passed in the euglycemic range above 70%, as compared to 32.7% in those with PLGS and 20.2% in those with SAP. A positive correlation between the higher percentage of TIR and the use of auto-mode was evident in the HCL group. Finally, the three groups did not show any statistical differences regarding the quality-of-life questionnaire, but there was a significant negative correlation between CV and perceived CSII-use convenience (r = -0.207, p = 0.043). CONCLUSION HCL systems were more effective in improving glucose control and in reducing the risk of hypoglycemia in patients with type 1 diabetes, thereby mitigating risk for acute and chronic complications and positively affecting diabetes technologies' acceptance.
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Affiliation(s)
- Maria Elena Lunati
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Paola Silvia Morpurgo
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Rossi
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Alessandra Gandolfi
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Irene Cogliati
- International Center for T1D, Centro di Ricerca Pediatrica Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, Milan, Italy
| | - Andrea Mario Bolla
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Laura Plebani
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Luciana Vallone
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Laura Montefusco
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Ida Pastore
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Vincenzo Cimino
- International Center for T1D, Centro di Ricerca Pediatrica Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, Milan, Italy
| | - Sabrina Argenti
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Graziella Volpi
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Centro di Ricerca Pediatrica Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università di Milano, Milan, Italy
- Dipartimento di Pediatria, Ospedale dei Bambini Buzzi, Milan, Italy
| | - Paolo Fiorina
- Endocrinology Division, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
- International Center for T1D, Centro di Ricerca Pediatrica Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, Milan, Italy
- Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Paolo Fiorina,
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129
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Nallicheri A, Mahoney KM, Gutow HA, Bellini N, Isaacs D. Review of Automated Insulin Delivery Systems for Type 1 Diabetes and Associated Time in Range Outcomes. Endocrinology 2022; 18:27-34. [PMID: 35949359 PMCID: PMC9354504 DOI: 10.17925/ee.2022.18.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
Automated insulin delivery (AID) systems play an important role in the management of type 1 diabetes mellitus (T1DM). These systems include three components: a continuous glucose monitor (CGM), an insulin pump and an algorithm that adjusts the pump based on the CGM sensor glucose readings. They are not fully automated and still require the user to administer bolus insulin doses for food. Some AID systems have automatic correction boluses, while others only have automatic basal or background insulin adjustments. As CGM has become more accurate and the technology has evolved, AID systems have demonstrated improved glycaemic outcomes. The clinical evaluation of AID systems in randomized controlled trials and real-world studies have shown their utility in helping glycaemic management. In this review, we compare AID systems that are commercially available in the US and summarize the literature, with a special focus on time in range in T1DM. The review also discusses new AID systems on the horizon and explores considerations for personalized care.
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130
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Wan XX, Zhang DY, Khan MA, Zheng SY, Hu XM, Zhang Q, Yang RH, Xiong K. Stem Cell Transplantation in the Treatment of Type 1 Diabetes Mellitus: From Insulin Replacement to Beta-Cell Replacement. Front Endocrinol (Lausanne) 2022; 13:859638. [PMID: 35370989 PMCID: PMC8972968 DOI: 10.3389/fendo.2022.859638] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune disease that attacks pancreatic β-cells, leading to the destruction of insulitis-related islet β-cells. Islet β-cell transplantation has been proven as a curative measure in T1DM. However, a logarithmic increase in the global population with diabetes, limited donor supply, and the need for lifelong immunosuppression restrict the widespread use of β-cell transplantation. Numerous therapeutic approaches have been taken to search for substitutes of β-cells, among which stem cell transplantation is one of the most promising alternatives. Stem cells have demonstrated the potential efficacy to treat T1DM by reconstitution of immunotolerance and preservation of islet β-cell function in recent research. cGMP-grade stem cell products have been used in human clinical trials, showing that stem cell transplantation has beneficial effects on T1DM, with no obvious adverse reactions. To better achieve remission of T1DM by stem cell transplantation, in this work, we explain the progression of stem cell transplantation such as mesenchymal stem cells (MSCs), human embryonic stem cells (hESCs), and bone marrow hematopoietic stem cells (BM-HSCs) to restore the immunotolerance and preserve the islet β-cell function of T1DM in recent years. This review article provides evidence of the clinical applications of stem cell therapy in the treatment of T1DM.
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Affiliation(s)
- Xin-Xing Wan
- Department of Endocrinology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Dan-Yi Zhang
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, China
| | - Md. Asaduzzaman Khan
- The Research Centre for Preclinical Medicine, Southwest Medical University, Luzhou, China
| | - Sheng-Yuan Zheng
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xi-Min Hu
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Qi Zhang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Rong-Hua Yang
- Department of Burn and Plastic Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Kun Xiong, ; Rong-Hua Yang,
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Changsha, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
- *Correspondence: Kun Xiong, ; Rong-Hua Yang,
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131
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Ma R, An X, Shao R, Zhang Q, Sun S. Recent advancement in noninvasive glucose monitoring and closed-loop management system for diabetes. J Mater Chem B 2022; 10:5537-5555. [DOI: 10.1039/d2tb00749e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diabetes can cause many complications, which has become one of the most common diseases that may lead to death. Currently, the number of diabetics continues increasing year by year. Thus,...
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132
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Choi MS, Lee S, Kim J, Kim G, Park SM, Kim JH. Do-It-Yourself Open Artificial Pancreas System in Children and Adolescents with Type 1 Diabetes Mellitus: Real-World Data. Diabetes Metab J 2022; 46:154-159. [PMID: 34813691 PMCID: PMC8831819 DOI: 10.4093/dmj.2021.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 11/08/2022] Open
Abstract
Few studies have been conducted among Asian children and adolescents with type 1 diabetes mellitus (T1DM) using do-it-yourself artificial pancreas system (DIY-APS). We evaluated real-world data of pediatric T1DM patients using DIY-APS. Data were obtained for 10 patients using a DIY-APS with algorithms. We collected sensor glucose and insulin delivery data from each participant for a period of 4 weeks. Average glycosylated hemoglobin was 6.2%±0.3%. The mean percentage of time that glucose level remained in the target range of 70 to 180 mg/dL was 82.4%±7.8%. Other parameters including time above range, time below range and mean glucose were also within the recommended level, similar to previous commercial and DIY-APS studies. However, despite meeting the target range, unadjusted gaps were still observed between the median basal setting and temporary basal insulin, which should be handled by healthcare providers.
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Affiliation(s)
- Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Jiwon Kim
- Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
- Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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De Ridder F, Charleer S, Jacobs S, Bolsens N, Ledeganck KJ, Van Aken S, Vanbesien J, Gies I, Casteels K, Massa G, Lysy PA, Logghe K, Lebrethon MC, Depoorter S, Gillard P, De Block C, den Brinker M. Effect of nationwide reimbursement of real-time continuous glucose monitoring on HbA1c, hypoglycemia and quality of life in a pediatric type 1 diabetes population: The RESCUE-pediatrics study. Front Pediatr 2022; 10:991633. [PMID: 36275049 PMCID: PMC9582657 DOI: 10.3389/fped.2022.991633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Real-time continuous glucose monitoring (RT-CGM) can improve metabolic control and quality of life (QoL), but long-term real-world data in children with type 1 diabetes (T1D) are scarce. Over a period of 24 months, we assessed the impact of RT-CGM reimbursement on glycemic control and QoL in children/adolescents with T1D treated with insulin pumps. RESEARCH DESIGN AND METHODS We conducted a multicenter prospective observational study. Primary endpoint was the change in HbA1c. Secondary endpoints included change in time in hypoglycemia, QoL, hospitalizations for hypoglycemia and/or ketoacidosis and absenteeism (school for children, work for parents). RESULTS Between December 2014 and February 2019, 75 children/adolescents were followed for 12 (n = 62) and 24 months (n = 50). Baseline HbA1c was 7.2 ± 0.7% (55 ± 8mmol/mol) compared to 7.1 ± 0.8% (54 ± 9mmol/mol) at 24 months (p = 1.0). Participants with a baseline HbA1c ≥ 7.5% (n = 27, mean 8.0 ± 0.3%; 64 ± 3mmol/mol) showed an improvement at 4 months (7.6 ± 0.7%; 60 ± 8mmol/mol; p = 0.009) and at 8 months (7.5 ± 0.6%; 58 ± 7mmol/mol; p = 0.006), but not anymore thereafter (endpoint 24 months: 7.7 ± 0.9%; 61 ± 10mmol/mol; p = 0.2). Time in hypoglycemia did not change over time. QoL for parents and children remained stable. Need for assistance by ambulance due to hypoglycemia reduced from 8 to zero times per 100 patient-years (p = 0.02) and work absenteeism for parents decreased from 411 to 214 days per 100 patient-years (p = 0.03), after 24 months. CONCLUSION RT-CGM in pump-treated children/adolescents with T1D showed a temporary improvement in HbA1c in participants with a baseline HbA1c ≥ 7.5%, without increasing time in hypoglycemia. QoL was not affected. Importantly, RT-CGM reduced the need for assistance by ambulance due to hypoglycemia and reduced work absenteeism for parents after 24 months. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov], identifier [NCT02601729].
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Affiliation(s)
- Francesca De Ridder
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium.,Fund for Scientific Research (FWO), Brussels, Belgium
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Seppe Jacobs
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Nancy Bolsens
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Sara Van Aken
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Jesse Vanbesien
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Massa
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Philippe A Lysy
- Department of Pediatrics, University Hospital Saint-Luc, Brussels, Belgium
| | - Karl Logghe
- Department of Pediatrics, General Hospital Delta, Roeselare, Belgium
| | | | - Sylvia Depoorter
- Department of Pediatrics, General Hospital Sint-Jan Bruges, Bruges, Belgium
| | - Pieter Gillard
- Fund for Scientific Research (FWO), Brussels, Belgium.,Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Christophe De Block
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Marieke den Brinker
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital (UZA), Antwerp, Belgium
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134
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Tommerdahl KL, Shapiro ALB, Nehus EJ, Bjornstad P. Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates. Pediatr Nephrol 2022; 37:79-93. [PMID: 33852054 PMCID: PMC8527882 DOI: 10.1007/s00467-021-05050-7] [Citation(s) in RCA: 16] [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] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022]
Abstract
The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy, and neuropathy. Pediatric populations with type 1 (T1D) and type 2 (T2D) diabetes are classically underdiagnosed with microvascular complications, and this leads to both undertreatment and insufficient attention to the mitigation of risk factors that could help attenuate further progression of complications and decrease the likelihood for long-term morbidity and mortality. This narrative review aims to present a comprehensive summary of the epidemiology, risk factors, symptoms, screening practices, and treatment options, including future opportunities for treatment advancement, for microvascular complications in youth with T1D and T2D. We seek to uniquely focus on the inherent challenges of managing pediatric populations with diabetes and discuss the similarities and differences between microvascular complications in T1D and T2D, while presenting a strong emphasis on the importance of early identification of at-risk youth. Further investigation of possible treatment mechanisms for microvascular complications in youth with T1D and T2D through dedicated pediatric outcome trials is necessary to target the brief window where early pathological vascular changes may be significantly attenuated.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L B Shapiro
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward J Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Petter Bjornstad
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA.
- Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Bode B, Carlson A, Liu R, Hardy T, Bergenstal R, Boyd J, Morrett S, Ignaut D. Ultrarapid Lispro Demonstrates Similar Time in Target Range to Lispro with a Hybrid Closed-Loop System. Diabetes Technol Ther 2021; 23:828-836. [PMID: 34270335 DOI: 10.1089/dia.2021.0184] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Automated insulin delivery systems are associated with improved glycemic outcomes for patients with diabetes. Ultrarapid lispro (URLi), which has an accelerated pharmacokinetic profile and shows superior postprandial glucose control compared to lispro (Humalog®), is a potential candidate for use in these systems. Methods: In this double-blind, crossover trial over two 4-week treatment periods, we evaluated URLi in a hybrid closed-loop system using the Medtronic MiniMed™ 670G system (670G). After a 2-week lead-in on lispro, 42 adults with type 1 diabetes were randomized to 1 of 2 treatment sequences of URLi and lispro delivered via the 670G. Primary endpoint was the percentage of time with glucose values within target range 3.9-10.0 mmol/L (70-180 mg/dL; %TIR). Results: Both treatments achieved %TIR over the 24-h period that was above the 70% minimum recommended by the International Consensus Guidance: URLi, 77.0%; lispro, 77.8%; P = 0.339. %Time <3.0 mmol/L (54 mg/dL) was similar between treatments (URLi, 0.3%; lispro, 0.4%; P = 0.548) and %time <3.9 mmol/L (70 mg/dL) was lower with URLi (1.5%) versus lispro (2.2%); P = 0.009, while %time >10.0 mmol/L (180 mg/dL) was higher with URLi (21.5% [309.4 min] vs. 19.9% [287.2 min]; P = 0.088). Mean sensor glucose was significantly higher with URLi versus lispro with least squares mean difference of 0.17 mmol/L or 3.0 mg/dL (P = 0.011) between treatments. Insulin dose, %time in Auto Mode per week, and pump settings were similar between treatments. No serious adverse events (AEs) (including severe hypoglycemia) or discontinuations occurred, and the incidence of treatment-emergent AEs was similar between treatments. Although the overall incidence and rate of unplanned infusion set changes were similar between treatments, a significantly higher rate of unplanned infusion set changes due to infusion site reactions was seen during URLi treatment compared with lispro: 0.12 versus 0.00 events/30 days (P = 0.063). Conclusions: URLi demonstrated good glycemic control that was comparable to lispro and showed a similar safety profile to lispro with the 670G hybrid closed-loop system. Trial registration: ClinicalTrials.gov, NCT03760640.
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Affiliation(s)
- Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Anders Carlson
- International Diabetes Center, Minneapolis, Minnesota, USA
| | - Rong Liu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Thomas Hardy
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | | | - Scott Morrett
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Debra Ignaut
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
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136
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Messer LH, Berget C, Pyle L, Vigers T, Cobry E, Driscoll KA, Forlenza GP. Real-World Use of a New Hybrid Closed Loop Improves Glycemic Control in Youth with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:837-843. [PMID: 34096789 PMCID: PMC8819505 DOI: 10.1089/dia.2021.0165] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To describe real-world outcomes for youth using the Tandem t:slim X2 insulin pump with Control-IQ technology ("Control-IQ") for 6 months at a large pediatric clinic. Methods: Youth with type 1 diabetes, who started Control-IQ for routine care, were prospectively followed. Data on system use and glycemic control were collected before Control-IQ start, and at 1, 3, and 6 months after start. Mixed models assessed change across time; interactions with baseline hemoglobin A1c (HbA1c) and age were tested. Results: In 191 youth (median age 14, 47% female, and median HbA1c 7.6%), percent time with glucose levels 70-180 mg/dL (time-in-range [TIR]) improved from 57% at baseline to 66% at 6 months (P < 0.001). The proportion of participants reaching TIR target (>70%) doubled from 23.5% at baseline to 47.8% at 3 months, sustaining at 46.7% at 6 months (P < 0.001). Glucose management indicator (approximation of HbA1c) improved from 7.5% at baseline to 7.1% at 3 months and 7.2% at 6 months (P < 0.001). Those with higher baseline HbA1c experienced the most substantial improvements in glycemic control. Percent time using the Control-IQ feature was 86.4% at 6 months, and <4% of cohort discontinued use. Conclusion: The Control-IQ system clinically and significantly improved glycemic control in a large sample of youth. System use was high at 6 months, with only a small proportion discontinuing use, indicating potential for sustaining results long term.
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Affiliation(s)
- Laurel H. Messer
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
- Address correspondence to: Laurel H. Messer, PhD, RN, Barbara Davis Center, University of Colorado Anschutz, 1775 Aurora Ct, MS A140, Aurora, CO 80045, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Timothy Vigers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Erin Cobry
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
| | | | - Gregory P. Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Anschutz, Aurora, Colorado, USA
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137
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Janez A, Battelino T, Klupa T, Kocsis G, Kuricová M, Lalić N, Stoian AP, Prázný M, Rahelić D, Šoupal J, Tankova T, Zelinska N. Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe. Diabetes Ther 2021; 12:3107-3135. [PMID: 34694585 PMCID: PMC8586062 DOI: 10.1007/s13300-021-01160-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/18/2021] [Indexed: 01/23/2023] Open
Abstract
In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Tadej Battelino
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Kraków, Poland
| | - Győző Kocsis
- Department of Medicine and Oncology, Semmelweis University Budapest, Budapest, Hungary
| | - Miriam Kuricová
- Pediatric Department, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
- Department of Children and Adolescents, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovakia
| | - Nebojša Lalić
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Prázný
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jan Šoupal
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Nataliya Zelinska
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine
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Abraham MB, de Bock M, Smith GJ, Dart J, Fairchild JM, King BR, Ambler GR, Cameron FJ, McAuley SA, Keech AC, Jenkins A, Davis EA, O’Neal DN, Jones TW. Effect of a Hybrid Closed-Loop System on Glycemic and Psychosocial Outcomes in Children and Adolescents With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:1227-1235. [PMID: 34633418 PMCID: PMC8506294 DOI: 10.1001/jamapediatrics.2021.3965] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Hybrid closed-loop (HCL) therapy has improved glycemic control in children and adolescents with type 1 diabetes; however, the efficacy of HCL on glycemic and psychosocial outcomes has not yet been established in a long-term randomized clinical trial. OBJECTIVE To determine the percentage of time spent in the target glucose range using HCL vs current conventional therapies of continuous subcutaneous insulin infusion or multiple daily insulin injections with or without continuous glucose monitoring (CGM). DESIGN, SETTING, AND PARTICIPANTS This 6-month, multicenter, randomized clinical trial included 172 children and adolescents with type 1 diabetes; patients were recruited between April 18, 2017, and October 4, 2019, in Australia. Data were analyzed from July 25, 2020, to February 26, 2021. INTERVENTIONS Eligible participants were randomly assigned to either the control group for conventional therapy (continuous subcutaneous insulin infusion or multiple daily insulin injections with or without CGM) or the intervention group for HCL therapy. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of time in range (TIR) within a glucose range of 70 to 180 mg/dL, measured by 3-week masked CGM collected at the end of the study in both groups. Secondary outcomes included CGM metrics for hypoglycemia, hyperglycemia, and glycemic variability and psychosocial measures collected by validated questionnaires. RESULTS A total of 135 patients (mean [SD] age, 15.3 [3.1] years; 76 girls [56%]) were included, with 68 randomized to the control group and 67 to the HCL group. Patients had a mean (SD) diabetes duration of 7.7 (4.3) years and mean hemoglobin A1c of 64 (11) mmol/mol, with 110 participants (81%) receiving continuous subcutaneous insulin infusion and 72 (53%) receiving CGM. In the intention-to-treat analyses, TIR increased from a mean (SD) of 53.1% (13.0%) at baseline to 62.5% (12.0%) at the end of the study in the HCL group and from 54.6% (12.5%) to 56.1% (12.2%) in the control group, with a mean adjusted difference between the 2 groups of 6.7% (95% CI, 2.7%-10.8%; P = .002). Hybrid closed-loop therapy also reduced the time that patients spent in a hypoglycemic (<70 mg/dL) range (difference, -1.9%; 95% CI, -2.5% to -1.3%) and improved glycemic variability (coefficient of variation difference, -5.7%; 95% CI, -10.2% to -0.9%). Hybrid closed-loop therapy was associated with improved diabetes-specific quality of life (difference, 4.4 points; 95% CI, 0.4-8.4 points), with no change in diabetes distress. There were no episodes of severe hypoglycemia or diabetic ketoacidosis in either group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, 6 months of HCL therapy significantly improved glycemic control and quality of life compared with conventional therapy in children and adolescents with type 1 diabetes. TRIAL REGISTRATION ANZCTR identifier: ACTRN12616000753459.
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Affiliation(s)
- Mary B. Abraham
- Children’s Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia,Division of Paediatrics, University of Western Australia Medical School, Perth, Australia
| | - Martin de Bock
- Children’s Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia,Division of Paediatrics, University of Western Australia Medical School, Perth, Australia
| | - Grant J. Smith
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia
| | - Julie Dart
- Children’s Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia
| | - Janice M. Fairchild
- Department of Endocrinology and Diabetes, Women’s and Children’s Hospital, Adelaide, Australia
| | - Bruce R. King
- Department of Endocrinology and Diabetes, John Hunter Children’s Hospital, Newcastle, Australia
| | - Geoffrey R. Ambler
- Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Fergus J. Cameron
- Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, Australia
| | - Sybil A. McAuley
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia,Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anthony C. Keech
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Alicia Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia,Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia,National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Elizabeth A. Davis
- Children’s Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia,Division of Paediatrics, University of Western Australia Medical School, Perth, Australia
| | - David N. O’Neal
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia,Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Timothy W. Jones
- Children’s Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia,Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia,Division of Paediatrics, University of Western Australia Medical School, Perth, Australia
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139
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Kurtzhals P, Gough SCL. The contributions of insulin to science in medicine. Diabet Med 2021; 38:e14623. [PMID: 34133769 PMCID: PMC9292759 DOI: 10.1111/dme.14623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022]
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140
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Thabit H, Lal R, Leelarathna L. Automated insulin dosing systems: Advances after a century of insulin. Diabet Med 2021; 38:e14695. [PMID: 34547133 PMCID: PMC8763058 DOI: 10.1111/dme.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
The daily complexities of insulin therapy and glucose variability in type 1 diabetes still pose significant challenges, despite advancements in modern insulin analogues. Minimising hypoglycaemia and optimising time spent within target glucose range are recommended to reduce the risk of diabetes-related complications and distress. Access to structured education and adjuvant diabetes technologies, such as insulin pumps and glucose sensors, are recommended by National Institute for Health and Care Excellence (NICE) to enable people with type 1 diabetes achieve their glycaemic goals. One hundred years after the discovery of insulin, automated insulin dosing (AID, a.k.a. closed loop or artificial pancreas) systems are a reality with a number of systems available and being used in usual clinical practice. Evidence from randomised clinical trials and real-world prospective studies support efficacy, effectiveness and safety of AID systems. Qualitative evaluations reveal treatment satisfaction and positive effects on quality of life. Current insulin-only AID systems still require carbohydrate and activity announcement (hybrid closed loop) due to the inherent pharmacokinetic limitations of rapid-acting insulin analogies. Ultra-rapid acting insulin and adjunctive use of other therapies (e.g. glucagon, pramlitide) are being evaluated to achieve full closed loop. Open-source AID (OS-AID) systems have been developed by the diabetes community, driven by a desire for safety and to accelerate technological advancement. In addition to effectiveness and safety, real-world prospective studies suggest that OS-AID systems fulfil unmet needs of commercially approved systems. The development, ongoing challenges and expectations of AID are outlined in this review.
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Affiliation(s)
- Hood Thabit
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine & Paediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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141
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Pauley ME, Berget C, Messer LH, Forlenza GP. Barriers to Uptake of Insulin Technologies and Novel Solutions. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:339-354. [PMID: 34803408 PMCID: PMC8594891 DOI: 10.2147/mder.s312858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetes-related technology has undergone great advancement in recent years. These technological devices are more commonly utilized in the type 1 diabetes population, which requires insulin as the primary treatment modality. Available devices include insulin pumps, continuous glucose monitors, and hybrid systems referred to as automated insulin delivery systems or hybrid closed-loop systems, which combine those two devices along with software algorithms to achieve advanced therapeutic capabilities, including automatic modulation of insulin delivery based on sensor-derived glucose levels to minimize abnormal glucose trends. Use of diabetes technology is associated with significant positive health and psychosocial outcomes, yet utilization rates are generally lacking across both adult and pediatric type 1 diabetes populations in the United States and other countries. There are consistent themes in existing barriers to technology uptake reported by individuals with type 1 diabetes or parents of children with type 1 diabetes, including physical burdens associated with wearing the devices, concerns in navigating the technology and the devices’ abilities to meet user expectations, high cost, inadequate resources within the healthcare team to support device use, disparities in technology access, and psychosocial barriers. It is important to understand the common barriers to uptake of not only the automated insulin delivery systems but also their component devices (insulin pumps and continuous glucose monitors) to fully support individuals in utilizing these devices and optimizing health benefits. The purpose of this article is to summarize the current automated insulin delivery devices that are available for use in management of type 1 diabetes, review common barriers to uptake of those systems and their component devices, and provide expert opinion on existing and future solutions to identified barriers.
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Affiliation(s)
- Meghan E Pauley
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laurel H Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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142
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Lane WS, Weinrib SL, Lawrence MJ, Lane BC, Jarrett RT. Basal Insulin Degludec and Glycemic Control Compared to Aspart Via Insulin Pump in Type 1 Diabetes (BIGLEAP): A Single-Center, Open-Label, Randomized, Crossover Trial. Endocr Pract 2021; 28:165-172. [PMID: 34763071 DOI: 10.1016/j.eprac.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We compared the efficacy of the second-generation basal insulin degludec (IDeg) to that of insulin aspart via pump using continuous glucose monitoring in patients with well-controlled type 1 diabetes. METHODS In this 40-week, single-center, randomized, crossover-controlled trial, adults with well-controlled type 1 diabetes (hemoglobin A1C of <7.5% [<58 mmol/mol]) (N = 52) who were using an insulin pump and continuous glucose monitoring were randomized to 1 of 2 treatments for a 20-week period: a single daily injection of IDeg with bolus aspart via pump or a continuous subcutaneous insulin infusion (CSII) with aspart, followed by crossover to the other treatment. The primary endpoint was time in range (70-180 mg/dL) during the final 2 weeks of each treatment period. RESULTS Fifty-two patients were randomized and completed both treatment periods. The time in range for IDeg and CSII was 71.5% and 70.9%, respectively (P = .553). The time in level 1 hypoglycemia for the 24-hour period with IDeg and CSII was 2.19% and 1.75%, respectively (P = .065). The time in level 2 hypoglycemia for the 24-hour period with IDeg and CSII was 0.355% and 0.271%, respectively (P = .212), and the nocturnal period was 0.330% and 0.381%, respectively (P = .639). The mean standard deviation of blood glucose levels for the 24-hour period for IDeg and CSII was 52.4 mg/dL and 51.0 mg/dL, respectively (P = .294). The final hemoglobin A1C level for each treatment was 7.04% (53 mmol/mol) with IDeg, and 6.95% (52 mmol/mol) with CSII (P = .288). Adverse events were similar between treatments. CONCLUSION We observed similar glycemic control between IDeg and insulin aspart via CSII for basal insulin coverage in patients with well-controlled type 1 diabetes.
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Affiliation(s)
- Wendy S Lane
- Mountain Diabetes and Endocrine Center, Asheville, North Carolina.
| | | | | | - Benjamin C Lane
- Department of Data Science, Vanderbilt University, Nashville, Tennessee
| | - Ryan T Jarrett
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
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143
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Pinnaro CT, Tansey MJ. The Evolution of Insulin Administration in Type 1 Diabetes. JOURNAL OF DIABETES MELLITUS 2021; 11:249-277. [PMID: 37745178 PMCID: PMC10516284 DOI: 10.4236/jdm.2021.115021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Insulin has been utilized in the treatment of type 1 diabetes (T1D) for 100 years. While there is still no cure for T1D, insulin administration has undergone a remarkable evolution which has contributed to improvements in quality of life and life expectancy in individuals with T1D. The advent of faster-acting and longer-acting insulins allowed for the implementation of insulin regimens more closely resembling normal insulin physiology. These improvements afforded better glycemic control, which is crucial for limiting microvascular complications and improving T1D outcomes. Suspension of insulin delivery in response to actual and forecasted hypoglycemia has improved quality of life and mitigated hypoglycemia without compromising glycemic control. Advances in continuous glucose monitoring (CGM) and insulin pumps, efforts to model glucose and insulin kinetics, and the application of control theory to T1D have made the automation of insulin delivery a reality. This review will summarize the past, present, and future of insulin administration in T1D.
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Affiliation(s)
- Catherina T Pinnaro
- University of Iowa Stead Family Department of Pediatrics
- Fraternal Order of Eagles Diabetes Research Center
| | - Michael J Tansey
- University of Iowa Stead Family Department of Pediatrics
- Fraternal Order of Eagles Diabetes Research Center
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144
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Banach Ł, Williams GT, Fossey JS. Insulin Delivery Using Dynamic Covalent Boronic Acid/Ester‐Controlled Release. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202100118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Łukasz Banach
- School of Chemistry University of Birmingham Edgbaston Birmingham West Midlands B15 2TT UK
| | - George T. Williams
- School of Chemistry University of Birmingham Edgbaston Birmingham West Midlands B15 2TT UK
| | - John S. Fossey
- School of Chemistry University of Birmingham Edgbaston Birmingham West Midlands B15 2TT UK
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145
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Gandhi GY, Mooradian AD. Clinical Considerations for Insulin Therapy in Older Adults with Type 1 Diabetes. Drugs Aging 2021; 39:23-37. [PMID: 34664212 DOI: 10.1007/s40266-021-00900-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes represents an autoimmune condition with a strong inherited background, and its incidence is increasing worldwide. About 25% of such cases are diagnosed in adulthood, some even as late as the ninth decade of life. The number of older adults with type 1 diabetes is increasing due to improvements in care and decreased mortality rate. However, there is a lack of clinical trials in people older than 70 years of age with type 1 diabetes complicated with comorbidities, frailty, and dependency. The management of type 1 diabetes and the goals of therapy should be individualized based on the patient's health status and life expectancy. In healthier older adults, insulin treatment regimens (multiple daily insulin injections or insulin pump therapy) that approximate the normal physiology of insulin secretion should be used to achieve lower glycemic goals, while reducing the risk of hypoglycemia with frequent glucose monitoring (preferably using continuous glucose monitoring systems). For frail individuals with poor health, simpler insulin regimens and less stringent glycemic targets would be more appropriate. Poor cognition, vision and hearing, impaired mobility, depression, and chronic pain can interfere with complex insulin regimens. In these individuals, the principal goals of therapy are to reduce the acute effects of hyperglycemia, minimize hypoglycemia risk, and optimize quality of life. The newer insulin preparations and technological advances in insulin delivery and blood glucose monitoring have enhanced the management of type 1 diabetes in all age groups.
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Affiliation(s)
- Gunjan Y Gandhi
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA
| | - Arshag D Mooradian
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA.
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Abstract
In this review, we bring our personal experiences to showcase insulin from its breakthrough discovery as a life-saving drug 100 years ago to its uncovering as the autoantigen and potential cause of type 1 diabetes and eventually as an opportunity to prevent autoimmune diabetes. The work covers the birth of insulin to treat patients, which is now 100 years ago, the development of human insulin, insulin analogues, devices, and the way into automated insulin delivery, the realization that insulin is the primary autoimmune target of type 1 diabetes in children, novel approaches of immunotherapy using insulin for immune tolerance induction, the possible limitations of insulin immunotherapy, and an outlook how modern vaccines could remove the need for another 100 years of insulin therapy.
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147
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The Closed-Loop System Improved the Control of a Pregnant Patient with Type 1 Diabetes Mellitus. Case Rep Endocrinol 2021; 2021:7310176. [PMID: 34594581 PMCID: PMC8478568 DOI: 10.1155/2021/7310176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/11/2021] [Indexed: 11/20/2022] Open
Abstract
Objective Closed-loop insulin systems represent a technological advance in diabetes management but have rarely been studied in pregnancy. We report a case of a patient with type 1 diabetes mellitus who was previously a user of the Paradigm VEO pump and then migrated to Medtronic 670G. Research Design and Methods. We reviewed the case of a G1P0 patient with type 1 diabetes, treated with the Medtronic 670G system during pregnancy; a comparison with current literature was done. Results The patient achieved improved glycemic control as measured by time spent in different ranges as follows: <70 mg/dL, 8–4% and 70–180 mg/dL, 83–94%. Secondary outcomes included reduction of stress, anxiety, fear of hypoglycemia, and the psychological burden related to the disease. There were no obstetric or neonatal complications. Conclusion The Medtronic 670G closed-loop system was used safely in a pregnant woman; nevertheless, further research is needed to validate this system in this patient population.
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148
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Piemonti L. Felix dies natalis, insulin… ceterum autem censeo "beta is better". Acta Diabetol 2021; 58:1287-1306. [PMID: 34027619 DOI: 10.1007/s00592-021-01737-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
One hundred years after its discovery, insulin remains the life-saving therapy for many patients with diabetes. It has been a 100-years-old success story thanks to the fact that insulin therapy has continuously integrated the knowledge developed over a century. In 1982, insulin becomes the first therapeutic protein to be produced using recombinant DNA technology. The first "mini" insulin pump and the first insulin pen become available in 1983 and 1985, respectively. In 1996, the first generation of insulin analogues were produced. In 1999, the first continuous glucose-monitoring device for reading interstitial glucose was approved by the FDA. In 2010s, the ultra-long action insulins were introduced. An equally exciting story developed in parallel. In 1966. Kelly et al. performed the first clinical pancreas transplant at the University of Minnesota, and now it is a well-established clinical option. First successful islet transplantations in humans were obtained in the late 1980s and 1990s. Their ability to consistently re-establish the endogenous insulin secretion was obtained in 2000s. More recently, the possibility to generate large numbers of functional human β cells from pluripotent stem cells was demonstrated, and the first clinical trial using stem cell-derived insulin producing cell was started in 2014. This year, the discovery of this life-saving hormone turns 100 years. This provides a unique opportunity not only to celebrate this extraordinary success story, but also to reflect on the limits of insulin therapy and renew the commitment of the scientific community to an insulin free world for our patients.
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Affiliation(s)
- Lorenzo Piemonti
- San Raffaele Diabetes Research Institute, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Università Vita-Salute San Raffaele, Milan, Italy.
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Vomiting and hyperkalemia are novel clues for emergency room diagnosis of type 1 diabetic ketoacidosis: a retrospective comparison between diabetes types. Diabetol Int 2021; 13:272-279. [DOI: 10.1007/s13340-021-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
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150
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Beato-Víbora PI, Gallego-Gamero F, Ambrojo-López A, Gil-Poch E, Martín-Romo I, Arroyo-Díez FJ. Rapid Improvement in Time in Range After the Implementation of an Advanced Hybrid Closed-Loop System in Adolescents and Adults with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:609-615. [PMID: 33784187 DOI: 10.1089/dia.2021.0037] [Citation(s) in RCA: 57] [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: 12/18/2022]
Abstract
Background: Advanced hybrid closed-loop (AHCL) systems represent the next step of automation intended to maximize normoglycemia in people with type 1 diabetes (T1D). In the AHCL MiniMed 780G system, different algorithm glucose targets for insulin infusion are available and autocorrection boluses are delivered. The aim was to prospectively evaluate the impact of the implementation of this AHCL system in a clinical setting. Materials and Methods: T1D subjects using a sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS) were upgraded to AHCL. Baseline, every 3 days, 2-week and 1-month sensor and pump data were downloaded. Glucose target was set to 100 mg/dL and active insulin time to 2 h for all the subjects. Time in different glucose ranges was compared. Results: Fifty-two T1D subjects were included (age: 43 ± 12 years, 73% females, diabetes duration: 27 ± 11 years, HbA1c: 7.2% ± 0.9%, time in SAP-PLGS: 5 ± 2 years). Time in range (TIR) 70-180 mg/dL increased from 67.3% ± 13.6% at baseline to 79.6% ± 7.9% at 1 month (P = 0.001). Time in hyperglycemia >180 and >250 mg/dL decreased from 29.4% ± 15.1% to 17.3% ± 8.6% and from 6.9% ± 7.8% to 2.5% ± 2.4%, respectively (P = 0.001). No differences in time in hypoglycemia <70 or <54 mg/dL were found. Time in Auto Mode was 97% ± 4%, and autocorrection insulin was 31% ± 14% of bolus insulin. Four hours postprandial glucose was improved from 162 ± 26 mg/dL at baseline to 142 ± 16 mg/dL at 1 month (P = 0.001). No severe hypoglycemia or diabetic ketoacidosis episodes occurred. Conclusion: AHCL systems allow well-controlled T1D patients to rapidly increase their TIR. The most aggressive settings allow optimal outcomes in TIR, without increasing hypoglycemia frequency.
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Affiliation(s)
- Pilar Isabel Beato-Víbora
- Department of Endocrinology and Nutrition and Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain
| | - Fabiola Gallego-Gamero
- Department of Endocrinology and Nutrition and Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain
| | - Ana Ambrojo-López
- Department of Endocrinology and Nutrition and Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain
| | - Estela Gil-Poch
- Department of Paediatrics, Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain
| | - Irene Martín-Romo
- Department of Endocrinology and Nutrition and Diabetes Technology Unit, Badajoz University Hospital. Badajoz, Spain
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