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Grunberger G, Sherr J, Allende M, Blevins T, Bode B, Handelsman Y, Hellman R, Lajara R, Roberts VL, Rodbard D, Stec C, Unger J. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract 2021; 27:505-537. [PMID: 34116789 DOI: 10.1016/j.eprac.2021.04.008] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. METHODS The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. MAIN OUTCOME MEASURES Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. RESULTS This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base. RECOMMENDATIONS Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. CONCLUSIONS Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of care, and offer a personalized approach to self-management. Furthermore, diabetes technology can improve the efficiency and effectiveness of clinical decision-making. Successful integration of these technologies into care requires knowledge about the functionality of devices in this rapidly changing field. This information will allow health care professionals to provide necessary education and training to persons accessing these treatments and have the required expertise to interpret data and make appropriate treatment adjustments.
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Affiliation(s)
| | - Jennifer Sherr
- Yale University School of Medicine, New Haven, Connecticut
| | - Myriam Allende
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia
| | | | - Richard Hellman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - David Rodbard
- Biomedical Informatics Consultants, LLC, Potomac, Maryland
| | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Jeff Unger
- Unger Primary Care Concierge Medical Group, Rancho Cucamonga, California
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Schiel R, Bambauer R, Steveling A. Technology in Diabetes Treatment: Update and Future. Artif Organs 2018; 42:1017-1027. [PMID: 30334582 DOI: 10.1111/aor.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
Worldwide the number of people with diabetes mellitus is increasing. There are estimations that diabetes is one of the leading causes of death. The most important goals for the treatment of diabetes are self-management of the disease and an optimal quality of diabetes control. In the therapy new technologies, like real-time continuous interstitial glucose monitoring, continuous subcutaneous insulin infusion (CSII), electronic tools for the monitoring of therapeutic approaches, automated bolus calculators for insulin and electronic tools for education and information of patients, have become widespread and play important roles. All these efforts are related to the interaction between patients, caregivers, scientists or researchers and industry. The presentation of different aspects of new technological approaches in the present article should give more information about different technologies. However, because of the rather quickly appearance of new technologies, the presentation can only be a spotlight. Further studies are mandatory to analyze the effects and long-term benefits of each technology and electronic device.
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Affiliation(s)
- Ralf Schiel
- MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Ostseebad Heringsdorf, Germany
| | - Rolf Bambauer
- Formely Institute for Blood Purification, Homburg, Germany
| | - Antje Steveling
- Ernst-Moritz-Arndt-University, Internal Medicine A, Greifswald, Germany
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Abstract
Over the last century, there has been a dramatic change in the nature of therapeutic, biologically active molecules available to treat disease. Therapies have evolved from extracted natural products towards rationally designed biomolecules, including small molecules, engineered proteins and nucleic acids. The use of potent drugs which target specific organs, cells or biochemical pathways, necessitates new tools which can enable controlled delivery and dosing of these therapeutics to their biological targets. Here, we review the miniaturisation of drug delivery systems from the macro to nano-scale, focussing on controlled dosing and controlled targeting as two key parameters in drug delivery device design. We describe how the miniaturisation of these devices enables the move from repeated, systemic dosing, to on-demand, targeted delivery of therapeutic drugs and highlight areas of focus for the future.
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Affiliation(s)
- Derfogail Delcassian
- a David H. Koch Institute for Integrative Cancer Research , Massachusetts Institute of Technology , Cambridge , MA , USA.,b Department of Anaesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA.,c Division of Regenerative Medicine and Cellular Therapies, School of Pharmacy , University of Nottingham , Nottingham , UK
| | - Asha K Patel
- a David H. Koch Institute for Integrative Cancer Research , Massachusetts Institute of Technology , Cambridge , MA , USA.,d Division of Cancer and Stem Cells, School of Medicine, and Division of Advanced Materials and Healthcare Technologies, School of Pharmacy , University of Nottingham , Nottingham , UK
| | - Abel B Cortinas
- a David H. Koch Institute for Integrative Cancer Research , Massachusetts Institute of Technology , Cambridge , MA , USA.,e Department of Chemical Engineering , Massachusetts Institute of Technology , Cambridge , MA , USA
| | - Robert Langer
- a David H. Koch Institute for Integrative Cancer Research , Massachusetts Institute of Technology , Cambridge , MA , USA.,e Department of Chemical Engineering , Massachusetts Institute of Technology , Cambridge , MA , USA.,f Institute for Medical Engineering and Science , Massachusetts Institute of Technology , Cambridge , MA , USA.,g Media Lab , Massachusetts Institute of Technology , Cambridge , MA , USA
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Vallejo Mora MDR, Carreira M, Anarte MT, Linares F, Olveira G, González Romero S. Bolus Calculator Reduces Hypoglycemia in the Short Term and Fear of Hypoglycemia in the Long Term in Subjects with Type 1 Diabetes (CBMDI Study). Diabetes Technol Ther 2017; 19:402-409. [PMID: 28594575 PMCID: PMC5563860 DOI: 10.1089/dia.2017.0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In a previous study we demonstrated improvement in metabolic control and reduction in hypoglycemia in people with type 1 diabetes on multiple daily injections, after having used a bolus calculator for 4 months. OBJECTIVE To demonstrate whether (1) extending its use (2) or introducing it in the control group, previously subjected to treatment intensification, could further improve metabolic control and related psychological issues. METHODS After the previous clinical trial, in which the subjects were randomized either to treatment with the calculator or to control group for 4 months, both groups used the calculator during an additional 4-month period. RESULTS In the previous control group, after using the device, HbA1c did not improve (7.86% ± 0.87% vs. 8.01% ± 0.93%, P 0.215), although a significant decrease in postprandial hypoglycemia was observed (2.3 ± 2 vs. 1.1 ± 1.2/2 weeks, P 0.002). In the group in which the treatment was extended from 4 to 8 months, HbA1c did not improve either (7.61 ± 0.58 vs. 7.73 ± 0.65, P 0.209); however this group had a greater perceived treatment satisfaction (12.03 ± 4.26 vs. 13.71 ± 3.75, P 0.007) and a significant decrease in fear of hypoglycemia (28.24 ± 8.18 basal vs. 25.66 ± 8.02 at 8 months, P 0.026). CONCLUSIONS The extension in the use of the calculator or its introduction in a previously intensified control group did not improve metabolic control, although it did confirm a decrease in hypoglycemic episodes in the short term, while the extension of its use to 8 months was associated with a reduction in fear of hypoglycemia and greater treatment satisfaction.
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Affiliation(s)
- María del Rosario Vallejo Mora
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mónica Carreira
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Málaga Spain
| | - María Teresa Anarte
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Málaga Spain
| | - Francisca Linares
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gabriel Olveira
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Stella González Romero
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Vallejo-Mora MDR, Carreira-Soler M, Linares-Parrado F, Olveira G, Rojo-Martínez G, Domínguez-López M, Ruiz-de-Adana-Navas MS, González-Romero MS. The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes. J Diabetes 2017; 9:24-33. [PMID: 26848934 DOI: 10.1111/1753-0407.12382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/05/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. METHODS A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. RESULTS In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7 %] vs -4 mmol/mol [-0.4 %], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c <58 mmol/mol [7.5 %]) in the Cb group (from 16.7 % to 40.5 %), but not in the Co group. The incidence of hypoglycemic events was reduced slightly but significantly only in the Cb group. There was no change in the fear of hypoglycemia at the end of the study. The bolus calculator was well accepted. CONCLUSIONS In T1D, adding a bolus calculator to intensive MDI resulted in a significant improvement in metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group.
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Affiliation(s)
- María Del Rosario Vallejo-Mora
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Medicine and Dermatology Department, School of Medicine, Málaga University, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
- Health District of Primary Care, Sevilla, Spain
| | - Mónica Carreira-Soler
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Personality, Evaluation and Psychological Treatment, School of Psychology, Barcelona, Spain
| | - Francisca Linares-Parrado
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gabriel Olveira
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- Medicine and Dermatology Department, School of Medicine, Málaga University, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Gemma Rojo-Martínez
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Marta Domínguez-López
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
| | - María Soledad Ruiz-de-Adana-Navas
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - María Stella González-Romero
- Endocrinology and Nutrition Department, Málaga Institute of Biomedical Investigation (IBIMA), Málaga Regional University Hospital, Barcelona, Spain
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
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Knight BA, McIntyre HD, Hickman IJ, Noud M. Qualitative assessment of user experiences of a novel smart phone application designed to support flexible intensive insulin therapy in type 1 diabetes. BMC Med Inform Decis Mak 2016; 16:119. [PMID: 27629774 PMCID: PMC5024512 DOI: 10.1186/s12911-016-0356-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/20/2016] [Indexed: 11/16/2022] Open
Abstract
Background Modern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis. Automated bolus calculators assist with these calculations, add additional functionality to protect against hypoglycaemia and enhance the record keeping process, however uptake and use depends on the devices meeting the needs of the user. We aimed to obtain user feedback on the usability of a mobile phone bolus calculator application in adults with T1DM to inform future development of mobile phone diabetes support applications. Methods Adults with T1DM who had previously received education in flexible MDI therapy were invited to participate. Eligible respondents attended app education and one month later participated in a focus group to provide feedback on the features of the app in relation to usability for patient-based flexible MDI and future app development. Results Seven adults participated in the app training and follow up interview. App features that support dose adjustment to reduce hypoglycaemia risk and features that enable greater efficiency in dose calculation, record keeping and report generation were highly valued. Conclusions Adults who are self managing flexible MDI found the Rapidcalc mobile phone app to be a useful self-management tool and additional features to further improve usability, such as connectivity with BG meter and food databases, shortcut options to economise data entry and web based storage of data, were identified. Further work is needed to ascertain specific features and benefit for those with lower health literacy.
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Affiliation(s)
- Brigid A Knight
- Queensland Diabetes and Endocrine Centre, Mater Health Services, Brisbane, Australia. .,Lady Cilento Children's Hospital, Brisbane, Australia.
| | - H David McIntyre
- Queensland Diabetes and Endocrine Centre, Mater Health Services, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia.,Mothers and Babies Theme, Mater Research Institute - University of Queensland, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Mater Research Institute, University of Queensland, Brisbane, Australia.,Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Marina Noud
- Queensland Diabetes and Endocrine Centre, Mater Health Services, Brisbane, Australia.,Lady Cilento Children's Hospital, Brisbane, Australia
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Ziegler R, Rees C, Jacobs N, Parkin CG, Lyden MR, Petersen B, Wagner RS. Frequent use of an automated bolus advisor improves glycemic control in pediatric patients treated with insulin pump therapy: results of the Bolus Advisor Benefit Evaluation (BABE) study. Pediatr Diabetes 2016; 17:311-8. [PMID: 26073672 DOI: 10.1111/pedi.12290] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The relationship between frequency and sustained bolus advisor (BA) use and glycemic improvement has not been well characterized in pediatric populations. OBJECTIVE The objective of this study is to assess the impact of frequent and persistent BA use on glycemic control among pediatric type 1 diabetes patients. METHODS In this 6-month, single-center, retrospective cohort study, 104 children [61 girls, mean age: 12.7 yr, mean HbA1c 8.0 (1.6)% [64 (17.5) mmol/mol]], treated with the Accu-Chek Aviva Combo insulin pump, were observed. Frequency of BA use, HbA1c, hypoglycemia (<70 mg/dL), therapy changes, mean blood glucose, and glycemic variability (standard deviation) was assessed at baseline and month 6. Sub-analyses of the adolescent patient use (12 months) and longitudinal use (24 months) were also conducted. RESULTS Seventy-one patients reported high frequency (HF) device use (≥50%); 33 reported low frequency (LF) use (<50%) during the study. HF users achieved lower mean (SE) HbA1c levels than LF users: 7.5 (0.1)% [59 (1.1) mmol/mol] vs. 8.0 (0.2)% [64 (2.2) mmol/mol], p = 0.0252. No between-group differences in the percentage of hypoglycemia values were seen at 6 months. HF users showed less glycemic variability (84.0 vs. 94.7, p = 0.0045) than LF users. More HF patients reached HbA1c target of <7.5 at 6 months 66.2% (+16.9) vs. 27.3% (-9.1), p = 0.0056. Similar HbA1c results were seen in adolescents and BA users at 24 months. CONCLUSION Frequent use of the Accu-Chek Aviva Combo insulin pump BA feature was associated with improved and sustained glycemic control with no increase in hypoglycemia in this pediatric population.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | - Christen Rees
- Roche Diagnostics Corporation, Indianapolis, IN, USA
| | - Nehle Jacobs
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
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Boizel R, Pinget M, Lachgar K, Parkin CG, Grulet H, Guillon-Metz F, Weissmann J. Clinical evaluation of the use of a multifunctional remotely controlled insulin pump: multicenter observational study. J Diabetes Sci Technol 2014; 8:1145-50. [PMID: 25107708 PMCID: PMC4455473 DOI: 10.1177/1932296814545670] [Citation(s) in RCA: 5] [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: 11/17/2022]
Abstract
Current insulin pumps now feature advanced functions for calculating insulin dosages, delivering insulin and analyzing data, however, the perceived usefulness of these functions in clinical settings has not been well studied. We assessed the use and patient perceptions of an insulin delivery system (Accu-Chek® Combo, Roche Diagnostics, Mannheim, Germany) that combines an insulin pump and a handheld multifunctional blood glucose meter with integrated remote control functions. This prospective, observational, multicenter study enrolled 74 type 1 diabetes patients within 13 weeks after starting use of the pump system. At 4 to 24 weeks, investigators collected usage data from the latest 14-day period. Seventy-two patients completed the evaluation, aged 39 ± 15 years, diabetes duration 16 ± 13 years, HbA1c 8.3 ± 1.6%. At follow-up, 62 (86.1%) patients used the remote control for ≥50% of all boluses, 20 (27.8%) used the bolus advisor for ≥50% of all boluses, and 42 (58.3%) viewed at least 1 of the e-logbook reports. More than 95% of users appraised the functions as easy-to-use and useful; median scores from VAS (0 = useless to 100 = indispensable) ranged from 72 to 85. A high percentage of study patients used the system's advanced features, especially the remote control feature for bolusing. Overall, patients assessed the functions as useful and easy to use. Results support the implementation of these smart capabilities in further insulin pump developments.
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Affiliation(s)
| | - Michel Pinget
- Hopitaux Universitaires de Strasbourg, Cedex, France
| | - Karim Lachgar
- Groupement Hospitalier Eaubonne Montmorency, Eaubonne, France
| | | | - Hervé Grulet
- Centre Hospitalier de Châlons-en-Champagne, Cedex France
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Tauschmann M, Hovorka R. Insulin pump therapy in youth with type 1 diabetes: toward closed-loop systems. Expert Opin Drug Deliv 2014; 11:943-55. [PMID: 24749563 DOI: 10.1517/17425247.2014.910192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Insulin pump technology has advanced considerably over the past three decades, leading to more favorable metabolic control and less hypoglycemic events when compared with multiple daily injection therapy. The use of insulin pumps is increasing, particularly in children and adolescents with type 1 diabetes. AREAS COVERED This review outlines recent developments in insulin pump therapy from a pediatric perspective. 'Smart' pumps, sensor-augmented pump therapy and threshold-suspend feature of insulin pumps are reviewed in terms of efficacy, safety and psychosocial impact. The current status of closed-loop systems focusing on clinical outcomes is highlighted. EXPERT OPINION Closed-loop insulin delivery is gradually progressing from bench to the clinical practice. Longer and larger studies in home settings are needed to expand on short- to medium-term outpatient evaluations. Predictive low glucose management and overnight closed-loop delivery may be the next applications to be implemented in daily routine. Further challenges include improvements of control algorithms, sensor accuracy, duration of insulin action, integration and size of devices and connectivity and usability. Gradual improvements and increasing sophistication of closed-loop components lie on the path toward unsupervised hands-off fully closed-loop system.
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Affiliation(s)
- Martin Tauschmann
- University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science , Cambridge , UK
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