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Yang Q, Zeng B, Hao J, Yang Q, Sun F. Real-world glycaemic outcomes of automated insulin delivery in type 1 diabetes: A meta-analysis. Diabetes Obes Metab 2024; 26:3753-3763. [PMID: 38888056 DOI: 10.1111/dom.15718] [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] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
AIM To evaluate the real-world effectiveness of automated insulin delivery (AID) systems in patients with type 1 diabetes (T1D). MATERIALS AND METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for studies published up until 2 March 2024. We included pragmatic randomized controlled trials (RCTs), cohort studies, and before-after studies that compared AID systems with conventional insulin therapy in real-world settings and reported continuous glucose monitoring outcomes. Percent time in range (TIR; 3.9-10 mmol/L), time below range (TBR; <3.9 mmol/L), time above range (TAR; >10 mmol/L), and glycated haemoglobin (HbA1c) level were extracted. Data were summarized as mean differences (MDs) with 95% confidence interval. RESULTS A total of 23 before-after studies (101 704 participants) were included in the meta-analysis. AID systems were associated with an increased percentage of TIR (11.61%, 10.47 to 12.76; p < 0.001). The favourable effect of AID systems was consistently observed when used continuously for 6 (11.76%) or 12 months (11.33%), and in both children (12.16%) and adults (11.04%). AID systems also showed favourable effects on TBR (-0.53%, -0.63 to -0.42), TAR (-9.65%, -10.63 to -8.67) and HbA1c level (-0.42%, -0.47 to -0.37) when compared with previous treatments. CONCLUSIONS Similar improvements in glycaemic parameters were observed in real-world settings in RCTs using AID systems in T1D. AID systems benefit both children and adults by increasing TIR for both short- and long-term interventions.
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Affiliation(s)
- Qin Yang
- Department of Cardiology, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Baoqi Zeng
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Emergency, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Jiayi Hao
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
- Xinjiang Medical University, Xinjiang, China
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2
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Bano A, Künzler J, Wehrli F, Kastrati L, Rivero T, Llane A, Valz Gris A, Fraser AG, Stettler C, Hovorka R, Laimer M, Bally L. Clinical evidence for high-risk CE-marked medical devices for glucose management: A systematic review and meta-analysis. Diabetes Obes Metab 2024. [PMID: 39143655 DOI: 10.1111/dom.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
AIMS To conduct a systematic review and meta-analysis, within the Coordinating Research and Evidence for Medical Devices (CORE-MD) project, evaluating CE-marked high-risk devices for glucose management. MATERIALS AND METHODS We identified interventional and observational studies evaluating the efficacy and safety of eight automated insulin delivery (AID) systems, two implantable insulin pumps, and three implantable continuous glucose monitoring (CGM) devices. We meta-analysed randomized controlled trials (RCTs) comparing AID systems with other treatments. RESULTS A total of 182 studies published between 2009 and 2024 were included, comprising 166 studies on AID systems, six on insulin pumps, and 10 on CGM devices; 26% reported industry funding; 18% were pre-market; 37% had a comparator group. Of the studies identified, 29% were RCTs, 24% were non-randomized trials, and 47% were observational studies. The median (interquartile range) sample size was 48 (28-102), age 34.8 (14-44.2) years, and study duration 17.5 (12-26) weeks. AID systems lowered glycated haemoglobin by 0.5 percentage points (absolute mean difference [MD] = -0.5; 21 RCTs; I2 = 86%) and increased time in target range for sensor glucose level by 13.4 percentage points (MD = 13.4; 14 RCTs; I2 = 90%). At least one safety outcome was assessed in 71% of studies. CONCLUSIONS High-risk devices for glucose monitoring or insulin dosing, in particular AID systems, improve glucose control safely, but evidence on diabetes-related end-organ damage is lacking due to short study durations. Methodological heterogeneity highlights the need for developing standards for future pre- and post-market investigations of diabetes-specific high-risk medical devices.
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Affiliation(s)
- Arjola Bano
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Juri Künzler
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Faina Wehrli
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lum Kastrati
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Tania Rivero
- Medical Library, University Library of Bern, University of Bern, Bern, Switzerland
| | | | - Angelica Valz Gris
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roman Hovorka
- Wellcome Trust, MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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WANG YY, YING HM, TIAN F, QIAN XL, Zhou ZF. Three months use of Hybrid Closed Loop Systems improves glycated hemoglobin levels in adolescents and children with type 1 diabetes: A meta-analysis. PLoS One 2024; 19:e0308202. [PMID: 39133688 PMCID: PMC11318905 DOI: 10.1371/journal.pone.0308202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Longer outpatient studies have demonstrated that hybrid closed loop (HCL) use has led to a concomitant reduction in glycated hemoglobin(HbA1c) by 0.3%-0.7%. However, reports have also indicated that HbA1c levels are not declined in the long-term use of HCL. Therefore, we wonder that 3 months use of HCL could improve glycated hemoglobin levels in adolescents and children with T1D. METHODS Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words "Pediatrics or Child or Adolescent", "Insulin Infusion Systems" and "Diabetes Mellitus" from inception to 17th March 2024 to evaluate the performance of HCL on HbA1c in adolescents, and children with T1D. RESULTS Nine studies involving 927 patients were identified. Three months use of HCL show a beneficial effect on HbA1c management (p <0.001) as compared to standard of care in adolescents and children with T1D, without evidence of heterogeneity between articles (I2 = 40%, p = 0.10). HCL did significantly increase the overall average percentage of hypoglycemic time between 70 and 180 mg/dL (TIR) (p <0.001; I2 = 51%). HCL did not show a beneficial effect on hypoglycemic time <70 mg/dL and <54 mg/dL (p >0.05). The overall percentage of hyperglycemic time was significantly decreased in HCL group compared to the control group when it was defined as >180 mg/dL (p <0.001; I2 = 83%), >250 mg/dL (p = 0.007, I2 = 86%) and >300 mg/dL (p = 0.005; I2 = 76%). The mean glucose level was significantly decreased by HCL (p <0.001; I2 = 58%), however, no significant difference was found in coefficient of variation of sensor glucose (p = 0.82; I2 = 71%) and daily insulin dose (p = 0.94; I2 <0.001) between the HCL group and the control group. CONCLUSIONS HCL had a beneficial effect on HbA1c management and TIR without increased hypoglycemic time as compared to standard of care in adolescents and children with T1D when therapy duration of HCL was not less than three months. TRIAL NUMBER AND REGISTRY URL CRD42022367493; https://www.crd.york.ac.uk/PROSPERO, Principal investigator: Zhen-feng Zhou, Date of registration: October 30, 2022.
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Affiliation(s)
- Yuan-yuan WANG
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Hui-min YING
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Fang TIAN
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Xiao-lu QIAN
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Zhen-feng Zhou
- Department of Anesthesiology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People’s Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China
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Soliman Y, Everett K, Shulman R, Austin PC, Lipscombe LL, Booth GL, Weisman A. Persistent disparities in insulin pump uptake despite a universal pump programme for type 1 diabetes in Ontario, Canada. Diabetes Obes Metab 2024. [PMID: 39056219 DOI: 10.1111/dom.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
AIM To evaluate associations between social disadvantage and insulin pump use among adults with type 1 diabetes (T1D) in the context of a universal publicly funded insulin pump programme in Ontario, Canada, and to ascertain whether social disparities in insulin pump programme enrolment have decreased over time. METHODS Population-based cross-sectional studies were conducted using administrative healthcare data in Ontario, Canada. First, among adults aged older than 18 years diagnosed with T1D before 31 March 2021, logistic regression was used to assess the association between neighbourhood social disadvantage (Ontario marginalization index quintiles) and insulin pump use. Second, among all paediatric and adult applicants to the insulin pump programme from 1 September 2006 to 31 March 2022, ordinal logistic regression was used to evaluate associations between year of insulin pump initiation and social disadvantage. RESULTS Among 27 453 adults with T1D, 60% used insulin pumps. Greater social disadvantage was associated with lower odds of insulin pump use (adjusted odds ratio [OR] 0.44 [95% confidence interval {CI} 0.39-0.48] for greatest vs. lowest social disadvantage quintile). Among 21 002 paediatric and adult applicants to the insulin pump programme, social disparities in pump use decreased in the first 3 years of the programme, plateaued until 2020, then increased from 2020 to 2022, with no change in the odds of being in a higher social deprivation quintile for 2022 relative to 2007 (OR 1.09 [95% CI 0.83-1.44]). CONCLUSIONS Despite a universal pump programme for individuals with T1D, disparities by social disadvantage persist. Residual financial and non-financial barriers must be addressed to promote equitable insulin pump uptake.
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Affiliation(s)
- Youstina Soliman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rayzel Shulman
- ICES, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- IHPME, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- IHPME, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- IHPME, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- IHPME, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- IHPME, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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5
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Rimon MTI, Hasan MW, Hassan MF, Cesmeci S. Advancements in Insulin Pumps: A Comprehensive Exploration of Insulin Pump Systems, Technologies, and Future Directions. Pharmaceutics 2024; 16:944. [PMID: 39065641 PMCID: PMC11279469 DOI: 10.3390/pharmaceutics16070944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Insulin pumps have transformed the way diabetes is managed by providing a more accurate and individualized method of delivering insulin, in contrast to conventional injection routines. This research explores the progression of insulin pumps, following their advancement from initial ideas to advanced contemporary systems. The report proceeds to categorize insulin pumps according to their delivery systems, specifically differentiating between conventional, patch, and implantable pumps. Every category is thoroughly examined, emphasizing its unique characteristics and capabilities. A comparative examination of commercially available pumps is provided to enhance informed decision making. This section provides a thorough analysis of important specifications among various brands and models. Considered factors include basal rate and bolus dosage capabilities, reservoir size, user interface, and compatibility with other diabetes care tools, such as continuous glucose monitoring (CGM) devices and so on. This review seeks to empower healthcare professionals and patients with the essential information to improve diabetes treatment via individualized pump therapy options. It provides a complete assessment of the development, categorization, and full specification comparisons of insulin pumps.
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Affiliation(s)
| | | | | | - Sevki Cesmeci
- Department of Mechanical Engineering, Georgia Southern University, Statesboro, GA 30458, USA
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Schoelwer MJ, DeBoer MD, Breton MD. Use of diabetes technology in children. Diabetologia 2024:10.1007/s00125-024-06218-0. [PMID: 38995398 DOI: 10.1007/s00125-024-06218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/13/2024]
Abstract
Children with type 1 diabetes and their caregivers face numerous challenges navigating the unpredictability of this complex disease. Although the burden of managing diabetes remains significant, new technology has eased some of the load and allowed children with type 1 diabetes to achieve tighter glycaemic management without fear of excess hypoglycaemia. Continuous glucose monitor use alone improves outcomes and is considered standard of care for paediatric type 1 diabetes management. Similarly, automated insulin delivery (AID) systems have proven to be safe and effective for children as young as 2 years of age. AID use improves not only blood glucose levels but also quality of life for children with type 1 diabetes and their caregivers and should be strongly considered for all youth with type 1 diabetes if available and affordable. Here, we review key data on the use of diabetes technology in the paediatric population and discuss management issues unique to children and adolescents.
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Affiliation(s)
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
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7
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Wang YY, Ying HM, Tian F, Qian XL, Zhou ZF, Zhou CC. Automated insulin delivery in children with type 1 diabetes during physical activity: a meta-analysis. J Pediatr Endocrinol Metab 2024; 37:505-515. [PMID: 38700489 DOI: 10.1515/jpem-2024-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the performance of the automated insulin delivery (AID) in adolescents, and children with type 1 diabetes (T1D) during physical activity. METHODS Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words "Child", "Insulin Infusion Systems", and "Diabetes Mellitus" from inception to 17th March 2024 to evaluate the performance of the AID in adolescents, and children with T1D during physical activity. RESULTS Twelve studies involving 514 patients were identified. AID did not show a beneficial effect on duration of hypoglycemia<70 mg/dL during study period (p>0.05; I2=96 %) and during the physical activity (p>0.99). Percentage of sensor glucose values in TIR was higher in AID than the non-AID pumps during study period (p<0.001; I2=94 %). The duration of hyperglycemic time was significantly decreased in AID group compared to the non-AID pumps group during study period (p<0.05; I2>50 %). CONCLUSIONS AID improved TIR and decreased the duration of hyperglycemic time, but did not appear to have a significant beneficial effect on the already low post-exercise duration of hypoglycemia achievable by open loop or sensor-augmented pumps in adolescents and children with T1D during physical activity; further research is needed to confirm the beneficial effect of AID on duration of hypoglycemia.
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Affiliation(s)
- Yuan-Yuan Wang
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, P.R. China
| | - Hui-Min Ying
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, P.R. China
| | - Fang Tian
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, P.R. China
| | - Xiao-Lu Qian
- Department of Endocrinology, 631689 Xixi Hospital of Hangzhou , Hangzhou, Zhejiang Province, P.R. China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, P.R. China
| | - Chun-Cong Zhou
- Department of Urolithiasis and Anorectal Surgery, Ningbo No. 2 Hospital, Ningbo, Zhejiang Province, P.R. China
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Benhalima K, Beunen K, Van Wilder N, Ballaux D, Vanhaverbeke G, Taes Y, Aers XP, Nobels F, Marlier J, Lee D, Cuypers J, Preumont V, Siegelaar SE, Painter RC, Laenen A, Gillard P, Mathieu C. Comparing advanced hybrid closed loop therapy and standard insulin therapy in pregnant women with type 1 diabetes (CRISTAL): a parallel-group, open-label, randomised controlled trial. Lancet Diabetes Endocrinol 2024; 12:390-403. [PMID: 38697182 DOI: 10.1016/s2213-8587(24)00089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Advanced hybrid closed loop (AHCL) therapy can improve glycaemic control in pregnant women with type 1 diabetes. However, data are needed on the efficacy and safety of AHCL systems as these systems, such as the MiniMed 780G, are not currently approved for use in pregnant women. We aimed to investigate whether the MiniMed 780G can improve glycaemic control with less hypoglycaemia in pregnant women with type 1 diabetes. METHODS CRISTAL was a double-arm, parallel-group, open-label, randomised controlled trial conducted in secondary and tertiary care specialist endocrinology centres at 12 hospitals (11 in Belgium and one in the Netherlands). Pregnant women aged 18-45 years with type 1 diabetes were randomly assigned (1:1) to AHCL therapy (MiniMed 780G) or standard insulin therapy (standard of care) at a median of 10·1 (IQR 8·6-11·6) weeks of gestation. Randomisation was done centrally with minimisation dependent on baseline HbA1c, insulin administration method, and centre. Participants and study teams were not masked to group allocation. The primary outcome was proportion of time spent in the pregnancy-specific target glucose range (3·5-7·8 mmol/L), measured by continuous glucose monitoring (CGM) at 14-17 weeks, 20-23 weeks, 26-29 weeks, and 33-36 weeks. Key secondary outcomes were overnight time in target range, and time below glucose range (<3·5 mmol/L) overall and overnight. Analyses were conducted on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov (NCT04520971). FINDINGS Between Jan 15, 2021 and Sept 30, 2022, 101 participants were screened, and 95 were randomly assigned to AHCL therapy (n=46) or standard insulin therapy (n=49). 43 patients assigned to AHCL therapy and 46 assigned to standard insulin therapy completed the study. At baseline, 91 (95·8%) participants used insulin pumps, and the mean HbA1c was 6·5% (SD 0·6). The mean proportion of time spent in the target range (averaged over four time periods) was 66·5% (SD 10·0) in the AHCL therapy group compared with 63·2% (12·4) in the standard insulin therapy group (adjusted mean difference 1·88 percentage points [95% CI -0·82 to 4·58], p=0·17). Overnight time in the target range was higher (adjusted mean difference 6·58 percentage points [95% CI 2·31 to 10·85], p=0·0026), and time below range overall (adjusted mean difference -1·34 percentage points [95% CI, -2·19 to -0·49], p=0·0020) and overnight (adjusted mean difference -1·86 percentage points [95% CI -2·90 to -0·81], p=0·0005) were lower with AHCL therapy than with standard insulin therapy. Participants assigned to AHCL therapy reported higher treatment satisfaction. No unanticipated safety events occurred with AHCL therapy. INTERPRETATION In pregnant women starting with tighter glycaemic control, AHCL therapy did not improve overall time in target range but improved overnight time in target range, reduced time below range, and improved treatment satisfaction. These data suggest that the MiniMed 780G can be safely used in pregnancy and provides some additional benefits compared with standard insulin therapy; however, it will be important to refine the algorithm to better align with pregnancy requirements. FUNDING Diabetes Liga Research Fund and Medtronic.
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Affiliation(s)
- Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, UZ Leuven, Leuven, Belgium.
| | - Kaat Beunen
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Nancy Van Wilder
- Department of Endocrinology, University Hospital Brussels, Jette, Belgium
| | - Dominique Ballaux
- Department of Endocrinology, Vitaz Campus Sint-Niklaas Moerland, Sint-Niklaas, Belgium
| | - Gerd Vanhaverbeke
- Department of Endocrinology, General Hospital Groeninge Kortrijk, Kortrijk, Belgium
| | - Youri Taes
- Department of Endocrinology, General Hospital Sint-Jan Brugge, Brugge, Belgium
| | - Xavier-Philippe Aers
- Department of Endocrinology, General Hospital Delta Campus Rumbeke, Roeselare, Belgium
| | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - Dahae Lee
- Department of Endocrinology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Joke Cuypers
- Department of Endocrinology, General Hospital Turnhout Campus Sint-Jozef, Turnhout, Belgium
| | - Vanessa Preumont
- Department of Endocrinology, University Hospital Saint-Luc, Brussel, Belgium
| | - Sarah E Siegelaar
- Department of Endocrinologyand Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Rebecca C Painter
- Department of Obstetrics & Gynecology, Amsterdam University Medical Centres, Amsterdam, Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, UZ Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, UZ Leuven, Leuven, Belgium
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Boucsein A, Zhou Y, Haszard JJ, Jefferies CA, Wiltshire EJ, Styles SE, Crocket HR, Galland BC, Pasha M, Petrovski G, Paul RG, de Bock MI, Wheeler BJ. Protocol for a prospective, multicenter, parallel-group, open-label randomized controlled trial comparing standard care with Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control: the CO-PILOT trial. J Diabetes Metab Disord 2024; 23:1397-1407. [PMID: 38932805 PMCID: PMC11196497 DOI: 10.1007/s40200-024-01397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/04/2024] [Indexed: 06/28/2024]
Abstract
Purpose Advanced hybrid closed loop (AHCL) systems have the potential to improve glycemia and reduce burden for people with type 1 diabetes (T1D). Children and youth, who are at particular risk for out-of-target glycemia, may have the most to gain from AHCL. However, no randomized controlled trial (RCT) specifically targeting this age group with very high HbA1c has previously been attempted. Therefore, the CO-PILOT trial (Closed lOoP In chiLdren and yOuth with Type 1 diabetes and high-risk glycemic control) aims to evaluate the efficacy and safety of AHCL in this group. Methods A prospective, multicenter, parallel-group, open-label RCT, comparing MiniMed™ 780G AHCL to standard care (multiple daily injections or continuous subcutaneous insulin infusion). Eighty participants aged 7-25 years with T1D, a current HbA1c ≥ 8.5% (69 mmol/mol), and naïve to automated insulin delivery will be randomly allocated to AHCL or control (standard care) for 13 weeks. The primary outcome is change in HbA1c between baseline and 13 weeks. Secondary outcomes include standard continuous glucose monitor glycemic metrics, psychosocial factors, sleep, platform performance, safety, and user experience. This RCT will be followed by a continuation phase where the control arm crosses over to AHCL and all participants use AHCL for a further 39 weeks to assess longer term outcomes. Conclusion This study will evaluate the efficacy and safety of AHCL in this population and has the potential to demonstrate that AHCL is the gold standard for children and youth with T1D experiencing out-of-target glucose control and considerable diabetes burden. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 14 November 2022 (ACTRN12622001454763) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1284-8452). Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01397-4.
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Affiliation(s)
- Alisa Boucsein
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Yongwen Zhou
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China (USTC), 230001 Hefei, Anhui China
| | | | - Craig A. Jefferies
- Starship Child Health, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Liggins Institute, Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Esko J. Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Sara E. Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Hamish R. Crocket
- Te Huatakia Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | | | - Ryan G. Paul
- Te Huatakia Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Martin I. de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
- Te Whatu Ora Southern, Dunedin, New Zealand
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10
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Luo X, Xie J, Yang L, Cui Y. An intelligent wearable artificial pancreas patch based on a microtube glucose sensor and an ultrasonic insulin pump. Talanta 2024; 273:125879. [PMID: 38490022 DOI: 10.1016/j.talanta.2024.125879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
In order to improve the living standards of diabetes patients and reduce the negative health effects of this disease, the medical community has been actively searching for more effective treatments. In recent years, an artificial pancreas has emerged as an important approach to managing diabetes. Despite these recent advances, meeting the requirements for miniaturized size, accurate sensing and large-volume pumping capability remains a great challenge. Here, we present a novel miniaturized artificial pancreas based on a long microtube sensor integrated with an ultrasonic pump. Our device meets the requirements of achieving both accurate sensing and high pumping capacity. The artificial pancreas is constructed based on a long microtube that is low cost, painless and simple to operate, where the exterior of the microtube is fabricated as a glucose sensor for detecting diabetes and the interior of the microtube is used as a channel for delivering insulin through an ultrasonic pump. This work successfully achieved closed-loop control of blood glucose and treatment of diabetes in rats. It is expected that this work can open up new methodologies for the development of microsystems, and advance the management approach for diabetes patients.
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Affiliation(s)
- Xiaojin Luo
- School of Materials Science and Engineering, Peking University, Beijing, 100871, PR China
| | - Jiaye Xie
- School of Materials Science and Engineering, Peking University, Beijing, 100871, PR China
| | - Li Yang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, PR China.
| | - Yue Cui
- School of Materials Science and Engineering, Peking University, Beijing, 100871, PR China.
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11
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Zamponi V, Haxhi J, Pugliese G, Faggiano A, Mazzilli R. Diabetes technology and sexual health: which role? J Endocrinol Invest 2024; 47:1315-1321. [PMID: 37987916 PMCID: PMC11142995 DOI: 10.1007/s40618-023-02237-7] [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] [Received: 09/07/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this review is to evaluate the effects of new technology used in the management of diabetes mellitus (DM), including the use of continuous glucose monitoring (CGM) and the administration of insulin through continuous subcutaneous insulin infusion (CSII), on male and female sexual function. METHODS This narrative review was performed for all available prospective, retrospective and review articles, published up to June 2023 in PubMed. Data were extracted from the text and from the tables of the manuscript. RESULTS Sexual dysfunctions are an underestimated comorbidity of DM in both male and female. Although erectile dysfunction (ED) is recognized by the guidelines as a complication of DM, female sexual dysfunction (FSD) is poorly investigated in clinical setting. In addition to the complications of DM, the different types of therapies can also influence male and female sexual response. Furthermore, insulin therapy can be administered through multiple-daily injections (MDI) or a CSII. The new technologies in the field of DM allow better glycemic control which results in a reduction in the occurrence or aggravation of complications of DM. Despite this evidence, few data are available on the impact of new technologies on sexual dysfunctions. CONCLUSIONS The use of DM technology might affect sexual function due to the risk of a worse body image, as well as discomfort related to CSII disconnection during sexual activity. However, the use is related to an improved metabolic control, which, in the long-term associates to a reduction in all diabetes complications, including sexual function.
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Affiliation(s)
- V Zamponi
- Endocrine-Metabolic Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, via di Grottarossa, 1035-1039, Rome, Italy
| | - J Haxhi
- Endocrine-Metabolic Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, via di Grottarossa, 1035-1039, Rome, Italy
| | - G Pugliese
- Endocrine-Metabolic Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, via di Grottarossa, 1035-1039, Rome, Italy
| | - A Faggiano
- Endocrine-Metabolic Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, via di Grottarossa, 1035-1039, Rome, Italy
| | - R Mazzilli
- Endocrine-Metabolic Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, via di Grottarossa, 1035-1039, Rome, Italy.
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12
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Ng SM, Wright NP, Yardley D, Campbell F, Randell T, Trevelyan N, Ghatak A, Hindmarsh PC. Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes, time-in-range, and quality of life in children and young people with type 1 diabetes. BMC Med 2024; 22:175. [PMID: 38659016 PMCID: PMC11044460 DOI: 10.1186/s12916-024-03396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Hybrid closed-loop (HCL) systems seamlessly interface continuous glucose monitoring (CGM) with insulin pumps, employing specialised algorithms and user-initiated automated insulin delivery. This study aimed to assess the efficacy of HCLs at 12 months post-initiation on glycated haemoglobin (HbA1c), time-in-range (TIR), hypoglycaemia frequency, and quality of life measures among children and young people (CYP) with type 1 diabetes mellitus (T1DM) and their caregivers in a real-world setting. Conducted between August 1, 2021, and December 10, 2022, the prospective recruitment took place in eight paediatric diabetes centres across England under the National Health Service England's (NHSE) HCL pilot real-world study. A cohort of 251 CYP (58% males, mean age 12.3 years) with T1DM participated (89% white, 3% Asian, 4% black, 3% mixed ethnicity, and 1% other). The study utilised three HCL systems: (1) Tandem Control-IQ AP system, which uses the Tandem t:slim X2 insulin pump (Tandem Diabetes Care, San Diego, CA, USA) with the Dexcom G6® CGM (Dexcom, San Diego, CA, USA) sensor; (2) Medtronic MiniMed™ 780G with the Guardian 4 sensor (Medtronic, Northridge, CA, USA); and (3) the CamAPS FX (CamDiab, Cambridge, UK) with the Ypsomed insulin pump (Ypsomed Ltd, Escrick, UK) and Dexcom G6® CGM.All systems were fully funded by the NHS. Results demonstrated significant improvements in HbA1c (average reduction at 12 months 7 mmol/mol; P < 0.001), time-in-range (TIR) (average increase 13.4%; P < 0.001), hypoglycaemia frequency (50% reduction), hypoglycaemia fear, and quality of sleep (P < 0.001) among CYP over a 12-month period of HCL usage. Additionally, parents and carers experienced improvements in hypoglycaemia fear and quality of sleep after 6 and 12 months of use. In addition to the improvements in glycaemic management, these findings underscore the positive impact of HCL systems on both the well-being of CYP with T1DM and the individuals caring for them.
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Affiliation(s)
- Sze May Ng
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
- Paediatric Department, Mersey and West Lancashire Teaching Hospitals, Ormskirk, L39 2AZ, UK.
| | | | - Diana Yardley
- Children's Diabetes Team, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fiona Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham, UK
| | | | | | - Peter C Hindmarsh
- Children and Young People's Diabetes Service, University College London Hospitals NHS Foundation Trust, London, UK
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13
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Folk S, Zappe J, Wyne K, Dungan KM. Comparative Effectiveness of Hybrid Closed-Loop Automated Insulin Delivery Systems Among Patients with Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241234948. [PMID: 38557128 DOI: 10.1177/19322968241234948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical trials have demonstrated the efficacy and safety of hybrid closed-loop (HCL) systems, yet few studies have compared outcomes in the real-world setting. METHOD This retrospective study analyzed patients from an academic endocrinology practice between January 1, 2018, and November 18, 2022. The inclusion criteria were diagnosis code for type I diabetes (T1D), >18 years of age, new to any HCL system [Medtronic 670G/770G (MT), Tandem Control IQ (CIQ), or Omnipod 5 (OP5)], and availability of a pump download within three months. The outcomes included %time in range (TIR) of 70 to 180 mg/dL, %time below range (TBR) <70 mg/dL at 90 days, and HbA1c for 91 to 180 days. RESULT Of the 176 participants, 47 were MT, 74 CIQ, and 55 OP5. Median (25%, 75%) change in HbA1c was -0.1 (-0.8, 0.3), -0.6 (-1.1, -0.15), and -0.55 (-0.98, 0)% for MT, CIQ, and OP5, respectively, (P = .04). TIR was 70 (57, 76), 67 (59, 75), and 68 (60, 76)% (P = .95) at 90 days while TBR was 2 (1, 3), 1 (0, 2), and 1 (0, 1)%, respectively, (P = .002). The %time in automated delivery was associated with TIR and change in HbA1c. After controlling other factors including %time in automated delivery, HCL type was not an independent predictor of change in HbA1c nor TIR but remained a significant predictor of TBR. CONCLUSION There were significant reductions in HbA1c in CIQ and OP5. TIR was similar across pumps, but TBR was highest with MT. The %time in automated delivery likely explains differences in change in HbA1c but not TBR between HCL systems.
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Affiliation(s)
- Sara Folk
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janet Zappe
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kathleen Wyne
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kathleen M Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH, USA
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Tatulashvili S, Dreves B, Meyer L, Cosson E, Joubert M. Carbohydrate counting knowledge and ambulatory glucose profile in persons living with type 1 diabetes. Diabetes Res Clin Pract 2024; 210:111592. [PMID: 38437987 DOI: 10.1016/j.diabres.2024.111592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
CONTEXT The amount of consumed carbohydrates is the strongest factor influencing glucose levels during the four hours following a meal. Our aim was to evaluate the association between carbohydrate counting knowledge and continuous glucose monitoring (CGM) parameters in patients with type 1 diabetes (T1D) using different insulin regimens. METHOD In this multicenter prospective study, the GluciQuizz questionnaire was used to evaluate carbohydrate knowledge. CGM data for the 14 days preceding completion of the questionnaire were analyzed. The primary endpoint was evaluation of the correlation between the GluciQuizz total score and time in range (TIR) in the study population. RESULTS The mean age of the 170 participants was 40.7 ± 14.8 years and duration of T1D 18.8 ± 12.1 years. The mean GluciQuizz total score for all participants was 66 ± 13 %. Mean TIR was 58.6 ± 18.7 %. GluciQuizz total score positively correlated with TIR (r = 0.3001; p < 0.0001). This correlation was observed in CSII users (r = 0.2526; p < 0.05) but not in MDI (r = 0.2510; p = 0.1134) and HCL users (r = -0.1065; p = 0.4914). TIR was also negatively correlated with the mean carb count error in all study participants (r = -0.2317; p < 0.01). CONCLUSION In conclusion, as the Gluciquizz score was associated with metabolic control, this easy-to-use self-administered questionnaire could be used widely on a routine basis to assess the carbohydrate knowledge of T1D patients and to offer them targeted education tailored to their needs.
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Affiliation(s)
- Sopio Tatulashvili
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Sorbonne Paris Nord, CINFO, CRNH-IDF, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN); Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
| | | | | | - Emmanuel Cosson
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Sorbonne Paris Nord, CINFO, CRNH-IDF, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN); Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
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15
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Kumar S, Sanap SN, Pandey P, Khopade A, Sawant KK. Glucagon: Delivery advancements for hypoglycemia management. Int J Pharm 2024; 652:123785. [PMID: 38224759 DOI: 10.1016/j.ijpharm.2024.123785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
As the 100th anniversary of glucagon's discovery approaches, we reflect on the remarkable journey of understanding its pivotal role in glucose regulation. Advancements in glucagon delivery systems for managing hypoglycemia are unfolding with promise, albeit accompanied by formulation and implementation challenges. Recent developments include non-injectable methods like BAQSIMI® (Nasal glucagon) offers a user-friendly option, but stability, bioavailability, and rapid onset remain formulation hurdles. Closed-loop systems, combining glucagon with insulin, aim to automate glucose control, demanding stable and precise formulations compatible with complex algorithms. However, achieving co-delivery harmony and effective dual-hormone responses poses substantial challenges. Ogluo® and Gvoke HypoPen® are auto-injector pens, a ready-to-use solution that can rapidly control hypoglycemia and eliminate the need for mixing powder and liquid. GlucaGen® Hypokit® and Glucagon Emergency Kits are traditional deliveries that possess complexity during administration and are still widely used in clinical practice. In addition to this advancement, we have covered the recent patents and clinical trials of glucagon delivery. The synergy of patent innovation and clinical validation offers a glimpse into the transformative potential of glucagon delivery yet underscores the intricate path toward widespread adoption and improved diabetes care. Finally, this review will help the formulation scientist, clinicians, healthcare providers, and patient to manage hypoglycemia using glucagon.
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Affiliation(s)
- Samarth Kumar
- Formulation Research & Development-Non Orals, Sun Pharmaceutical Industries Ltd, Vadodara 390020, Gujrat, India; Faculty of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India.
| | - Sachin N Sanap
- Formulation Research & Development-Non Orals, Sun Pharmaceutical Industries Ltd, Vadodara 390020, Gujrat, India
| | - Prachi Pandey
- Krishna School of Pharmacy & Research, KPGU, Vadodara, Gujarat, India
| | - Ajay Khopade
- Formulation Research & Development-Non Orals, Sun Pharmaceutical Industries Ltd, Vadodara 390020, Gujrat, India
| | - Krutika K Sawant
- Faculty of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India.
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Freckmann G, Schauer S, Beltzer A, Waldenmaier D, Buck S, Baumstark A, Jendrike N, Link M, Zschornack E, Haug C, Pleus S. Continuous Glucose Profiles in Healthy People With Fixed Meal Times and Under Everyday Life Conditions. J Diabetes Sci Technol 2024; 18:407-413. [PMID: 35876145 PMCID: PMC10973852 DOI: 10.1177/19322968221113341] [Citation(s) in RCA: 2] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increased use of continuous glucose monitoring (CGM) and automated insulin delivery systems raises the question about therapeutic targets for glucose profiles in people with diabetes. This study aimed to assess averaged pre- and postprandial glucose profiles in people without diabetes to provide guidance for normal glucose patterns in clinical practice. For that, number and timing of meal intake were predefined. MATERIAL AND METHODS To assess glucose traces in 36 participants without diabetes (mean age = 23.7 ± 5.7 years), CGM was performed for up to 14 days, starting with a run-in phase (first 3 days, excluded from analysis) followed by 4 days with fixed meal times at 8:00 am, 1:00 pm, and 6:00 pm and the remaining 7 days spent under everyday life conditions. Data from two simultaneously worn CGM sensors were averaged and adjusted to capillary plasma-equivalent glucose values. Glucose data were evaluated through descriptive statistics. RESULTS Median glucose concentration on days with fixed meal times and under everyday life conditions was 95.0 mg/dL (91.6-99.1 mg/dL, interquartile range) and 98.1 mg/dL (93.7-100.8 mg/dL), respectively. On days with fixed meal times, mean premeal glucose was 92.8 ± 9.4 mg/dL, and mean peak postmeal glucose was 143.3 ± 23.5 mg/dL. CONCLUSIONS By defining the time of meal intake, a clear pattern of distinct postprandial glucose excursions in participants without diabetes could be demonstrated and analyzed. The presented glucose profiles might be helpful as an estimate for adequate clinical targets in people with diabetes.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sebastian Schauer
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Anne Beltzer
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sina Buck
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Annette Baumstark
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Nina Jendrike
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Manuela Link
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Eva Zschornack
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Hölzen L, Schultes B, Meyhöfer SM, Meyhöfer S. Hypoglycemia Unawareness-A Review on Pathophysiology and Clinical Implications. Biomedicines 2024; 12:391. [PMID: 38397994 PMCID: PMC10887081 DOI: 10.3390/biomedicines12020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Hypoglycemia is a particular problem in people with diabetes while it can also occur in other clinical circumstances. Hypoglycemia unawareness describes a condition in which autonomic and neuroglycopenic symptoms of hypoglycemia decrease and hence are hardly perceivable. A failure to recognize hypoglycemia in time can lead to unconsciousness, seizure, and even death. The risk factors include intensive glycemic control, prior episodes of severe hypoglycemia, long duration of diabetes, alcohol consumption, exercise, renal failure, and sepsis. The pathophysiological mechanisms are manifold, but mainly concern altered brain glucose sensing, cerebral adaptations, and an impaired hormonal counterregulation with an attenuated release of glucagon, epinephrine, growth hormone, and other hormones, as well as impaired autonomous and neuroglycopenic symptoms. Physiologically, this counterregulatory response causes blood glucose levels to rise. The impaired hormonal counterregulatory response to recurrent hypoglycemia can lead to a vicious cycle of frequent and poorly recognized hypoglycemic episodes. There is a shift in glycemic threshold to trigger hormonal counterregulation, resulting in hypoglycemia-associated autonomic failure and leading to the clinical syndrome of hypoglycemia unawareness. This clinical syndrome represents a particularly great challenge in diabetes treatment and, thus, prevention of hypoglycemia is crucial in diabetes management. This mini-review provides an overview of hypoglycemia and the associated severe complication of impaired hypoglycemia awareness and its symptoms, pathophysiology, risk factors, consequences, as well as therapeutic strategies.
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Affiliation(s)
- Laura Hölzen
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany
| | - Bernd Schultes
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Metabolic Center St. Gallen, friendlyDocs Ltd., 9016 St. Gallen, Switzerland
| | - Sebastian M. Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Svenja Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany; (L.H.); (B.S.)
- Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, 23562 Lübeck, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
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18
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Lei M, Chen D, Ling P, Wang C, Yang D, Deng H, Yang X, Xu W, Yan J. Effect of artificial pancreas system use on glycaemic control among pregnant women with type 1 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024; 26:673-681. [PMID: 37953389 DOI: 10.1111/dom.15357] [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] [Received: 08/27/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
AIM To assess the efficacy of artificial pancreas systems (APS) use among pregnant women with type 1 diabetes mellitus (T1DM) by conducting a meta-analysis. METHODS We searched five databases, including EMBASE, Web of Science, PubMed, Cochrane Library and SCOPUS, for literature on APS use among pregnant women with T1DM before October 9, 2023. The primary endpoint was 24-hour time in range (TIR; 3.5-7.8 mmol/L). Secondary endpoints included glycaemic metrics for 24-hour (mean blood glucose [MBG], time above range [TAR], time below range [TBR]), and overnight TIR and TBR. RESULTS We identified four randomized controlled trials involving 164 participants; one study with 16 participants focused on overnight APS use, and the other three focused on 24-hour APS use. Compared with standard care, APS exhibited a favourable effect on 24-hour TIR (standard mean difference [SMD] = 0.53, 95% confidence interval [CI] 0.25, 0.80, P < 0.001), overnight TIR (SMD = 0.67, 95% CI 0.39, 0.95, P < 0.001), and overnight TBR (<3.5 mmol/L; SMD = -0.49, 95% CI -0.77, -0.21 P < 0.001), while there was no significant difference in 24-hour TAR, 24-hour TBR, or MBG between the two groups. We further conducted subgroup analyses after removing the trial focused on overnight APS use and showed that 24-hour APS use reduced not only the 24-hour TIR (SMD = 0.41, 95% CI 0.12, 0.71; P = 0.007) but also the 24-hour TBR (<2.8 mmol/L; SMD = -0.77, 95% CI -1.32, -0.23, P = 0.006). CONCLUSION Our findings suggest that APS might improve 24-hour TIR and overnight glycaemic control, and 24-hour APS use also significantly reduced 24-hour TBR (2.8 mmol/L) among pregnant women with T1DM.
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Affiliation(s)
- Mengyun Lei
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Danrui Chen
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Ling
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaofan Wang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xubin Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Henry Z, Villar Fimbel S, Bendelac N, Perge K, Thivolet C. Beneficial effects of automated insulin delivery over one-year follow-up in real life for youths and adults with type 1 diabetes irrespective of patient characteristics. Diabetes Obes Metab 2024; 26:557-566. [PMID: 37905353 DOI: 10.1111/dom.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
AIM To investigate glycaemic outcomes in youths and adults with type 1 diabetes with either MiniMed™ 780G or Tandem t:slim X2™ control-IQ automated insulin delivery (AID) systems and to evaluate clinical factors that migrate, mitigate the achievement of therapeutic goals. MATERIALS AND METHODS This retrospective, real-world, observational study was conducted in a specialized university type 1 diabetes centre with patients observed for 3-12 months post-initiation of an AID system. Primary outcomes were the percentage time in the target glucose range [TIR70-180 mg/dl (3.9-10 mmol/L)] as measured by continuous glucose monitoring, mean glucose management indicator (GMI) and glycated haemoglobin (HbA1c) levels. RESULTS Our study cohort consisted of 48 adolescents and 183 adults (55% females) aged 10-77 years. The mean (95% confidence interval) TIR70-180 mg/dl after 30 days was higher than baseline and by 14% points after 360 days with 71.33% (69.4-73.2) (n = 123, p < .001). HbA1c levels decreased by 0.7% and GMI by 0.6% after 360 days. The proportion of time spent <70 mg/dl (3.9 mmol/L) was not significantly different from baseline. During follow-up, 780G users had better continuous glucose monitoring results than control-IQ users but similar HbA1c levels, and an increased risk of weight gain. Age at onset influenced TIR70-180 mg/dl in univariate analysis but there was no significant relationship after adjusting on explanatory variables. Baseline body mass index did not influence the performance of AID systems. CONCLUSIONS This analysis showed the beneficial effects of two AID systems for people with type 1 diabetes across a broad spectrum of participant characteristics. Only half of the participants achieved international recommendations for glucose control with TIR70-180 mg/dl >70%, HbA1c levels or GMI <7%, which outlines the need to maintain strong educational and individual strategies.
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Affiliation(s)
- Zoé Henry
- Centre for Diabetes DIAB-eCARE, Hospices Civils de Lyon, Lyon, France
| | | | - Nathalie Bendelac
- Centre for Diabetes DIAB-eCARE, Hospices Civils de Lyon, Lyon, France
- Department of paediatric Endocrinology and Diabetes, Hospices Civils de Lyon, Bron, France
| | - Kevin Perge
- Department of paediatric Endocrinology and Diabetes, Hospices Civils de Lyon, Bron, France
| | - Charles Thivolet
- Centre for Diabetes DIAB-eCARE, Hospices Civils de Lyon, Lyon, France
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20
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Subramanian S, Khan F, Hirsch IB. New advances in type 1 diabetes. BMJ 2024; 384:e075681. [PMID: 38278529 DOI: 10.1136/bmj-2023-075681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Type 1 diabetes is an autoimmune condition resulting in insulin deficiency and eventual loss of pancreatic β cell function requiring lifelong insulin therapy. Since the discovery of insulin more than 100 years ago, vast advances in treatments have improved care for many people with type 1 diabetes. Ongoing research on the genetics and immunology of type 1 diabetes and on interventions to modify disease course and preserve β cell function have expanded our broad understanding of this condition. Biomarkers of type 1 diabetes are detectable months to years before development of overt disease, and three stages of diabetes are now recognized. The advent of continuous glucose monitoring and the newer automated insulin delivery systems have changed the landscape of type 1 diabetes management and are associated with improved glycated hemoglobin and decreased hypoglycemia. Adjunctive therapies such as sodium glucose cotransporter-1 inhibitors and glucagon-like peptide 1 receptor agonists may find use in management in the future. Despite these rapid advances in the field, people living in under-resourced parts of the world struggle to obtain necessities such as insulin, syringes, and blood glucose monitoring essential for managing this condition. This review covers recent developments in diagnosis and treatment and future directions in the broad field of type 1 diabetes.
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Affiliation(s)
- Savitha Subramanian
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Farah Khan
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Irl B Hirsch
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
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21
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Benhalima K, Jendle J, Beunen K, Ringholm L. Automated Insulin Delivery for Pregnant Women With Type 1 Diabetes: Where do we stand? J Diabetes Sci Technol 2024:19322968231223934. [PMID: 38197363 DOI: 10.1177/19322968231223934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Automated insulin delivery (AID) systems mimic an artificial pancreas via a predictive algorithm integrated with continuous glucose monitoring (CGM) and an insulin pump, thereby providing AID. Outside of pregnancy, AID has led to a paradigm shift in the management of people with type 1 diabetes (T1D), leading to improvements in glycemic control with lower risk for hypoglycemia and improved quality of life. As the use of AID in clinical practice is increasing, the number of women of reproductive age becoming pregnant while using AID is also expected to increase. The requirement for lower glucose targets than outside of pregnancy and for frequent adjustments of insulin doses during pregnancy may impact the effectiveness and safety of AID when using algorithms for non-pregnant populations with T1D. Currently, the CamAPS® FX is the only AID approved for use in pregnancy. A recent randomized controlled trial (RCT) with CamAPS® FX demonstrated a 10% increase in time in range in a pregnant population with T1D and a baseline glycated hemoglobin (HbA1c) ≥ 48 mmol/mol (6.5%). Off-label use of AID not approved for pregnancy are currently also being evaluated in ongoing RCTs. More evidence is needed on the impact of AID on maternal and neonatal outcomes. We review the current evidence on the use of AID in pregnancy and provide an overview of the completed and ongoing RCTs evaluating AID in pregnancy. In addition, we discuss the advantages and challenges of the use of current AID in pregnancy and future directions for research.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Jendle
- Diabetes Endocrinology and Metabolism Research Centre, School of Medicine, Örebro University, Örebro, Sweden
| | - Kaat Beunen
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Amer BE, Yaqout YE, Abozaid AM, Afifi E, Aboelkhier MM. Does fully closed-loop automated insulin delivery improve glycaemic control in patients with type 2 diabetes? A meta-analysis of randomized controlled trials. Diabet Med 2024; 41:e15196. [PMID: 37567739 DOI: 10.1111/dme.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 08/13/2023]
Abstract
AIMS This meta-analysis investigated the efficacy and safety of fully closed-loop automated insulin delivery (AID) in patients with type 2 diabetes. MATERIALS AND METHODS We systemically searched PubMed, Scopus, Web of Science, and Cochrane Central from inception until April 26, 2023. We included randomized controlled trials (RCTs) comparing fully closed-loop AID versus conventional insulin therapy. The outcomes were pooled as the mean difference (MD) and risk ratio with 95% confidence interval (CI) in the random effect model. Our primary outcome was the proportion of time in the target glucose range (5.6-10 mmol/L, 3.9-10 mmol/L, or 3.9-8 mmol/L, depending on the study). Key secondary outcomes included the proportion of time spent in hyperglycaemia or hypoglycaemia. RESULTS We included seven RCTs (three crossover and four parallel design), compromising 390 patients. Our analysis showed that compared to the control group, fully closed-loop AID increased the proportion of time spent within the target glucose range by additional 337 min per 24 h (MD = 23.39%, 95% CI [16.64%, 30.14%], p < 0.01), additional 108 min overnight (MD = 22.40%, 95% CI [12.88%, 31.91%], p < 0.01), and additional 258 min during the daytime period (MD = 26.85%, 95% CI [21.06%, 32.63%], p < 0.01). Compared to the control group, the overall time in hyperglycaemia was shortened by 326 min per 24 h (MD = -22.67%, 95% CI [-30.87%, -14.46%], p < 0.01). There was no significant difference between the two groups in terms of overall, overnight, and daytime periods spent in hypoglycaemia. CONCLUSIONS Our meta-analysis suggests that fully closed-loop AID may improve glycaemic control in patients with type 2 diabetes, particularly for those with more challenging diabetes management. Further research is required to establish the feasibility of implementing these systems in clinical practice. [Correction added on 26 August 2023 after first online publication: Under Results, the first sentence "We included seven RCTs (three crossover and one parallel designs)" has been changed to "We included seven RCTs (three crossover and four parallel designs)".].
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Affiliation(s)
- Basma Ehab Amer
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Yasmeen Essam Yaqout
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Mohamed Abozaid
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eslam Afifi
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Menna M Aboelkhier
- Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA
- Faculty of Science, Cairo University, Cairo, Egypt
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Lyons RE, Abdul Wahab R, Goh SY, Breen C, Rhynehart A, O'Scannail M, Kelly HJ, Neff K, O'Shea D, Canavan R, Wan Mahmood WA. Real-world glycaemic outcomes in patients with type 1 diabetes using glucose sensors-Experience from a single centre in Dublin. Endocrinol Diabetes Metab 2024; 7:e469. [PMID: 38268307 PMCID: PMC10794155 DOI: 10.1002/edm2.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS To evaluate changes in glycated haemoglobin (HbA1 c) and sensor-based glycaemic metrics after glucose sensor commencement in adults with T1D. METHODS We performed a retrospective observational single-centre study on HbA1 c, and sensor-based glycaemic data following the initiation of continuous glucose monitoring (CGM) in adults with T1D (n = 209). RESULTS We observed an overall improvement in HbA1 c from 66 (59-78) mmol/mol [8.2 (7.5-9.3)%] pre-sensor to 60 (53-71) mmol/mol [7.6 (7.0-8.6)%] on-sensor (p < .001). The pre-sensor HbA1 c improved from 66 (57-74) mmol/mol [8.2 (7.4-8.9)%] to 62 (54-71) mmol/mol [7.8 (7.1-8.7)%] within the first year of usage to 60 (53-69) mmol/mol [7.6 (7.0-8.4)%] in the following year (n = 121, p < .001). RT-CGM-user had a significant improvement in HbA1 c (Dexcom G6; p < .001, r = 0.33 and Guardian 3; p < .001, r = 0.59) while a non-significant reduction was seen in FGM-user (Libre 1; p = .279). Both MDI (p < .001, r = 0.33) and CSII group (p < .001, r = 0.41) also demonstrated significant HbA1 c improvement. Patients with pre-sensor HbA1 c of ≥64 mmol/mol [8.0%] (n = 125), had attenuation of pre-sensor HbA1 c from 75 (68-83) mmol/mol [9.0 (8.4-9.7)%] to 67 (59-75) mmol/mol [8.2 (7.6-9.0)%] (p < .001, r = 0.44). Altogether, 25.8% of patients achieved the recommended HbA1 c goal of ≤53 mmol/mol and 16.7% attained the recommended ≥70% time in range (3.9-10.0 mmol/L). CONCLUSIONS Our study demonstrated that minimally invasive glucose sensor technology in adults with T1D is associated with improvement in glycaemic outcomes. However, despite significant improvements in HbA1 c, achieving the recommended goals for all glycaemic metrics remained challenging.
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Affiliation(s)
- Robert E. Lyons
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Roshaida Abdul Wahab
- Diabetes Complications Research Centre, Conway InstituteUniversity College DublinDublinIreland
| | - Sue Yee Goh
- School of MedicineUniversity College DublinDublinIreland
| | - Cathy Breen
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Amanda Rhynehart
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Mary O'Scannail
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Hannah Jade Kelly
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Karl Neff
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
| | - Donal O'Shea
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
- Diabetes Complications Research Centre, Conway InstituteUniversity College DublinDublinIreland
| | - Ronan Canavan
- Endocrinology and Diabetes UnitSt. Columcille's HospitalDublinIreland
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24
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Do QD, Hásková A, Radovnická L, Konečná J, Horová E, Parkin CG, Grunberger G, Prázný M, Šoupal J. Comparison of Control-IQ and open-source AndroidAPS automated insulin delivery systems in adults with type 1 diabetes: The CODIAC study. Diabetes Obes Metab 2024; 26:78-84. [PMID: 37743832 DOI: 10.1111/dom.15289] [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] [Received: 06/04/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
AIM To compare open-source AndroidAPS (AAPS) and commercially available Control-IQ (CIQ) automated insulin delivery (AID) systems in a prospective, open-label, single-arm clinical trial. METHODS Adults with type 1 diabetes who had been using AAPS by their own decision entered the first 3-month AAPS phase then were switched to CIQ for 3 months. The results of this treatment were compared with those after the 3-month AAPS phase. The primary endpoint was the change in time in range (% TIR; 70-80 mg/dL). RESULTS Twenty-five people with diabetes (mean age 34.32 ± 11.07 years; HbA1c 6.4% ± 3%) participated in this study. CIQ was comparable with AAPS in achieving TIR (85.72% ± 7.64% vs. 84.24% ± 8.46%; P = .12). Similarly, there were no differences in percentage time above range (> 180 and > 250 mg/dL), mean sensor glucose (130.3 ± 13.9 vs. 128.3 ± 16.9 mg/dL; P = .21) or HbA1c (6.3% ± 2.1% vs. 6.4% ± 3.1%; P = .59). Percentage time below range (< 70 and < 54 mg/dL) was significantly lower using CIQ than AAPS. Even although participants were mostly satisfied with CIQ (63.6% mostly agreed, 9.1% strongly agreed), they did not plan to switch to CIQ. CONCLUSIONS The CODIAC study is the first prospective study investigating the switch between open-source and commercially available AID systems. CIQ and AAPS were comparable in achieving TIR. However, hypoglycaemia was significantly lower with CIQ.
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Affiliation(s)
- Quoc Dat Do
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Aneta Hásková
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Lucie Radovnická
- 1st Faculty of Medicine Charles University, Prague, Czech Republic
- Department of Internal Medicine, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Judita Konečná
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Eva Horová
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | | | | | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Jan Šoupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
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25
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Hafez SH, Mohammed NA, Yahia Mahdy Shalby A, Eltaher Hamed Abdulrahman E, Farhan AlQarni A, Ayed Alhamami F, Fahd Alshehri H, Khalid Hussein M, Mustafa Abd Alganny M, Saied Harfoush M. The Path From Awareness to Action: Exploring Diabetic Patients' Awareness and Attitudes and Barriers to Utilization of Artificial Pancreas in the Beheira Governorate, Egypt. Cureus 2024; 16:e52703. [PMID: 38384620 PMCID: PMC10879912 DOI: 10.7759/cureus.52703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Background and objective There is scarce data on diabetic patients' awareness, attitude, and barriers to utilization regarding the artificial pancreas. In light of this, the current study aimed to explore the awareness, attitudes, and perceived barriers to utilization of the artificial pancreas experienced by diabetic patients. Methods A cross-sectional study design was employed to achieve the aim of the study. The study was conducted in Damanhur city, the Beheira Governorate, Egypt. The convenience sampling technique was used to include 385 diabetic patients. The researchers designed an interview questionnaire comprising four parts to collect data about knowledge, attitudes, and barriers to utilization. Results The findings showed that 61% of the participants had a satisfactory level of overall knowledge. Regarding overall attitude, 64.1% of participants exhibited a positive attitude toward the artificial pancreas. The data indicated that 37.7% of participants identified the associated high cost as a significant barrier. Additionally, 23.3% expressed concerns about the lack of healthcare provider support, 21.5% had reservations regarding maintenance, and 17.5% felt limited by their technical skills. Conclusions The study revealed a notable satisfactory level of knowledge and attitudes among about two-thirds of participants regarding the artificial pancreas. Concerns about the high cost emerged as a predominant barrier followed by a lack of healthcare provider support. Empowering both healthcare providers and patients through ongoing educational initiatives can play a pivotal role in fostering a positive attitude and addressing concerns related to artificial pancreas technology.
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Affiliation(s)
- Sameer H Hafez
- Community Health Nursing, Beni-Suef University, Beni-Suef, EGY
- Community and Mental Health Nursing, Najran University, Najran, SAU
| | - Noha A Mohammed
- Community Health Nursing, Beni-Suef University, Beni-Suef, EGY
| | - Abeer Yahia Mahdy Shalby
- Medical and Surgical Nursing, Benha University, Benha, EGY
- Faculty of Nursing, College of Nursing, Najran University, Najran, SAU
| | | | | | | | | | | | | | - Mohamed Saied Harfoush
- Nursing, College of Applied Medical Sciences, Buraydah College, Qassim, SAU
- Community Health Nursing, Faculty of Nursing, Damanhour University, Damanhour, EGY
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26
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Rossi A, Montefusco L, Reseghetti E, Pastore IF, Rossi G, Usuelli V, Loretelli C, Boci D, Ben Nasr M, D'Addio F, Bucciarelli L, Argenti S, Morpurgo P, Lunati ME, Fiorina P. Daytime hypoglycemic episodes during the use of an advanced hybrid closed loop system. Diabetes Res Clin Pract 2023; 206:111011. [PMID: 37956944 DOI: 10.1016/j.diabres.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
AIMS The use of advanced hybrid closed loop systems is spreading due to the beneficial effects on glycometabolic control obtained in patients with type 1 diabetes. However, hypoglycemic episodes can be sometimes a matter of concern. We aim to compare the hypoglycemic risk of an advanced hybrid closed loop system and a predictive low glucose suspend sensor augmented pump. METHODS In this retrospective three months observational study, we included 30 patients using Medtronic Minimed™ 780G advanced hybrid closed loop system and 30 patients using a Medtronic Minimed™ predictive low glucose suspend sensor augmented pump. RESULTS The advanced hybrid closed loop system reduced the time spent above 180 mg/dL threshold and increased the time in range as compared to the predictive low glucose suspend. No severe hypoglycemia occurred in both groups and no differences were observed in the percentage of time spent below 70 mg/dl and 54 mg/dl glucose threshold. Nevertheless, more hypoglycemic episodes were recorded during daytime, but not in nighttime, with the use of the advanced hybrid closed loop system. CONCLUSIONS Our results confirmed the general improvement of glycemic outcomes obtained with the advanced hybrid closed loop system; however more hypoglycemic episodes during daytime were evident.
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Affiliation(s)
- Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elia Reseghetti
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | - Giada Rossi
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Vera Usuelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Cristian Loretelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Denisa Boci
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Moufida Ben Nasr
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Francesca D'Addio
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | | | - Sabrina Argenti
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy; Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
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27
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Zeng B, Gao L, Yang Q, Jia H, Sun F. Automated Insulin Delivery Systems in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-analysis of Outpatient Randomized Controlled Trials. Diabetes Care 2023; 46:2300-2307. [PMID: 38011519 DOI: 10.2337/dc23-0504] [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: 03/22/2023] [Accepted: 07/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The glycemic control of automated insulin delivery (AID) systems in outpatient children and adolescents with type 1 diabetes (T1D) has not been systematically evaluated. PURPOSE To evaluate the efficacy and safety of AID systems in children and adolescents in outpatient settings. DATA SOURCES PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched until 4 May 2023. This study was registered with PROSPERO (2023, CRD42023395252). STUDY SELECTION Randomized controlled trials that compared AID systems with conventional insulin therapy in outpatient children and adolescents with T1D and reported continuous glucose monitoring outcomes were selected. DATA EXTRACTION Percent time in range (TIR) (3.9-10 mmol/L), time below range (TBR) (<3.9 mmol/L), and time above range (TAR) (>10 mmol/L) were extracted. Data were summarized as mean differences (MDs) with 95% CIs. DATA SYNTHESIS Twenty-five trials (1,345 participants) were included in the meta-analysis. AID systems were associated with an increased percentage of TIR (MD, 11.38% [95% CI 9.01-13.76], P < 0.001; high certainty). The favorable effect was consistent whether AID was used over 3 months (10.46% [8.71-12.20]) or 6 months (10.87% [7.11-14.63]). AID systems had a favorable effect on the proportion of TBR (-0.59% [-1.02 to -0.15], P = 0.008; low certainty) or TAR (-12.19% [-14.65 to -9.73], P < 0.001; high certainty) compared with control treatment. LIMITATIONS Substantial heterogeneity was observed in most analyses. CONCLUSIONS AID systems are more effective than conventional insulin therapy for children and adolescents with T1D in outpatient settings. The favorable effect is consistent both in the short term and long term.
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Affiliation(s)
- Baoqi Zeng
- Central Laboratory, Peking University Binhai Hospital, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Le Gao
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Jia
- Drug Clinical Trial Institution, Peking University Binhai Hospital, Tianjin, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Health, Beijing, China
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28
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Messer LH, Breton MD. Therapy Settings Associated with Optimal Outcomes for t:slim X2 with Control-IQ Technology in Real-World Clinical Care. Diabetes Technol Ther 2023; 25:877-882. [PMID: 37751154 DOI: 10.1089/dia.2023.0308] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Objective: To determine insulin dosing parameters that are associated with and predict optimal outcomes for people using t:slim X2 with Control-IQ technology (CIQ). Methods: Retrospective deidentified data from CIQ users were analyzed to determine the effect of Correction Factor, Carbohydrate-to-Insulin (C:I) Ratio, and basal rate settings (standardized by total daily insulin [TDI]) on glycemic control. We performed an associative analysis followed by linear regressions to determine the relative importance of the settings and confounding variables (e.g., age or number of user-initiated boluses) in predicting consensus glycemic outcomes. Results: Data from 20,764 individuals were analyzed (median age 39 years [interquartile range 19, 59], 55% female, TDI 46.4 U [33-65.2]). More aggressive Correction Factor settings, C:I ratio settings, and basal programs were all strongly associated with higher time in range (TIR, 70-180 mg/dL) and to a lesser degree to higher time <70 mg/dL. In linear regression, more aggressive Correction Factor predicted higher TIR, lower coefficient of variation, and importantly had only negligible impact on time below range. Higher basal rate settings and lower C:I ratio predicted increased TIR as well as increased hypoglycemia. The most important predictor in all glycemic outcomes was the average number of user-given boluses per day. Conclusion: Basal rates, C:I ratios, and Correction Factor settings all impact glycemic outcomes in CIQ users in usual clinical care. The correction Factor setting may be the most impactful "lever to pull" for clinicians and CIQ users to optimize TIR while not increasing hypoglycemia.
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Affiliation(s)
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
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Caldara R, Tomajer V, Monti P, Sordi V, Citro A, Chimienti R, Gremizzi C, Catarinella D, Tentori S, Paloschi V, Melzi R, Mercalli A, Nano R, Magistretti P, Partelli S, Piemonti L. Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge. Front Immunol 2023; 14:1323439. [PMID: 38077372 PMCID: PMC10701551 DOI: 10.3389/fimmu.2023.1323439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Type 1 diabetes (T1D) presents a persistent medical challenge, demanding innovative strategies for sustained glycemic control and enhanced patient well-being. Beta cells are specialized cells in the pancreas that produce insulin, a hormone that regulates blood sugar levels. When beta cells are damaged or destroyed, insulin production decreases, which leads to T1D. Allo Beta Cell Transplantation has emerged as a promising therapeutic avenue, with the goal of reinstating glucose regulation and insulin production in T1D patients. However, the path to success in this approach is fraught with complex immunological hurdles that demand rigorous exploration and resolution for enduring therapeutic efficacy. This exploration focuses on the distinct immunological characteristics inherent to Allo Beta Cell Transplantation. An understanding of these unique challenges is pivotal for the development of effective therapeutic interventions. The critical role of glucose regulation and insulin in immune activation is emphasized, with an emphasis on the intricate interplay between beta cells and immune cells. The transplantation site, particularly the liver, is examined in depth, highlighting its relevance in the context of complex immunological issues. Scrutiny extends to recipient and donor matching, including the utilization of multiple islet donors, while also considering the potential risk of autoimmune recurrence. Moreover, unanswered questions and persistent gaps in knowledge within the field are identified. These include the absence of robust evidence supporting immunosuppression treatments, the need for reliable methods to assess rejection and treatment protocols, the lack of validated biomarkers for monitoring beta cell loss, and the imperative need for improved beta cell imaging techniques. In addition, attention is drawn to emerging directions and transformative strategies in the field. This encompasses alternative immunosuppressive regimens and calcineurin-free immunoprotocols, as well as a reevaluation of induction therapy and recipient preconditioning methods. Innovative approaches targeting autoimmune recurrence, such as CAR Tregs and TCR Tregs, are explored, along with the potential of stem stealth cells, tissue engineering, and encapsulation to overcome the risk of graft rejection. In summary, this review provides a comprehensive overview of the inherent immunological obstacles associated with Allo Beta Cell Transplantation. It offers valuable insights into emerging strategies and directions that hold great promise for advancing the field and ultimately improving outcomes for individuals living with diabetes.
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Affiliation(s)
- Rossana Caldara
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tomajer
- Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Monti
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Citro
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raniero Chimienti
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Gremizzi
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Davide Catarinella
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Tentori
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vera Paloschi
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raffella Melzi
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Mercalli
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rita Nano
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Magistretti
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Partelli
- Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Piemonti
- Clinic Unit of Regenerative Medicine and Organ Transplants, IRCCS Ospedale San Raffaele, Milan, Italy
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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Elbarbary NS, Ismail EAR. MiniMed 780G™ advanced hybrid closed-loop system performance in Egyptian patients with type 1 diabetes across different age groups: evidence from real-world users. Diabetol Metab Syndr 2023; 15:205. [PMID: 37845757 PMCID: PMC10580510 DOI: 10.1186/s13098-023-01184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Advanced hybrid closed loop (AHCL) system provides both automated basal rate and correction boluses to keep glycemic values in a target range. OBJECTIVES To evaluate the real-world performance of the MiniMed™ 780G system among different age groups of Egyptian patients with type 1diabetes. METHODS One-hundred seven AHCL system users aged from 3 to 71 years were enrolled. Data uploaded by patients were aggregated and analyzed. The mean glucose management indicator (GMI), percentage of time spent within glycemic ranges (TIR), time below range (TBR) and time above range (TAR) were determined. RESULTS Six months after initiating Auto Mode, patients spent a mean of 85.31 ± 22.04% of the time in Auto Mode (SmartGuard) and achieved a mean GMI of 6.95 ± 0.58% compared with 7.9 ± 2.1% before AHCL initiation (p < 0.001). TIR 70-180 mg/dL was increased post-AHCL initiation from 63.48 ± 10.14% to 81.54 ± 8.43% (p < 0.001) while TAR 180-250 mg/dL, TAR > 250 mg/dL, TBR < 70 mg/dL and TBR < 54 mg/dL were significantly decreased (p < 0.001). After initiating AHCL, TIR was greater in children and adults compared with adolescents (82.29 ± 7.22% and 83.86 ± 9.24% versus 78.4 ± 7.34%, respectively; p < 0.05). The total daily dose of insulin was increased in all age groups primarily due to increased system-initiated insulin delivery including auto correction boluses and basal insulin. CONCLUSIONS MiniMed™ 780G system users across different age groups achieved international consensus-recommended glycemic control with no serious adverse effects even in challenging age group as children and adolescents.
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Affiliation(s)
- Nancy Samir Elbarbary
- Department of Pediatrics, Faculty of medicine, Ain shams University, 25 Ahmed Fuad St. Saint Fatima, Cairo, 11361, Egypt.
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Marin-Garaundo E, Torre-Beteta RL, Munive-Degregori A, Alvitez J, Barja-Ore J, Mayta-Tovalino F. Use of Artificial Pancreas in the Management of Diabetes Mellitus: A Bibliometric Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:332-338. [PMID: 37970460 PMCID: PMC10634467 DOI: 10.4103/sjmms.sjmms_12_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 11/17/2023]
Abstract
Objectives To describe the trends and characteristics of the worldwide scientific production on the use of artificial pancreas (AP) in the management of diabetes mellitus (DM). Materials and Methods Scientific papers published between 2017 and 2022 were retrieved from the Scopus database using relevant keywords. Only original articles, reviews, and short surveys were included. The metadata were exported to the SciVal software for retrieving quantitative data and the main characteristics such as journals, authors, institutions, journal metrics by quartiles, subcategories, and collaborative networks were extracted. Results A total of 642 articles were included after applying the inclusion/exclusion criteria: original articles, 489; reviews, 151; and short surveys, 2. The most common type of collaboration was at the national level (38.3%; citations per publication: 22.3; field-weighted citation index [FWCI]: 2.2) followed by international collaboration (29.4%; citations per publication: 19.6; FWCI: 1.94). More than 70% of articles in each year were published in journals listed in Q1. Two journals, Diabetes Technology and Therapeutics and Journal of Diabetes Science and Technology, accounted for about 22% of all publications. Six of the top 10 universities were from the United States, with The University of Virginia having the most publications (n = 54; 59 authors; citations per publication: 38.4; FWCI: 3.73). Conclusions The findings of this study highlight that most research on this topic is published in high-quality journals and has a good citation impact. Notably, most research has been conducted in developed countries, thereby indicating the need for research efforts in this field from developing countries.
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Affiliation(s)
- Eileen Marin-Garaundo
- Academic Department, Faculty of Health Sciences, School of Human Medicine, Universidad Cientifica Del Sur, Peru
| | - Rosario La Torre-Beteta
- Academic Department, Faculty of Health Sciences, School of Human Medicine, Universidad Cientifica Del Sur, Peru
| | | | - Juan Alvitez
- Postgraduate Department, Universidad Nacional Federico Villarreal, Lima, Peru
| | - John Barja-Ore
- Academic Department, Universidad Privada Del Norte, Lima, Peru
| | - Frank Mayta-Tovalino
- Academic Department, Faculty of Health Sciences, School of Human Medicine, Universidad Cientifica Del Sur, Peru
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Godoi A, Reis Marques I, Padrão EMH, Mahesh A, Hespanhol LC, Riceto Loyola Júnior JE, de Souza IAF, Moreira VCS, Silva CH, Miyawaki IA, Oommen C, Gomes C, Silva AC, Advani K, de Sa JR. Glucose control and psychosocial outcomes with use of automated insulin delivery for 12 to 96 weeks in type 1 diabetes: a meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2023; 15:190. [PMID: 37759290 PMCID: PMC10537468 DOI: 10.1186/s13098-023-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Glycaemic control of Type 1 Diabetes Mellitus (T1DM) remains a challenge due to hypoglycaemic episodes and the burden of insulin self-management. Advancements have been made with the development of automated insulin delivery (AID) devices, yet, previous reviews have only assessed the use of AID over days or weeks, and potential benefits with longer time of AID use in this population remain unclear. METHODS We performed a systematic review and meta-analysis of randomised controlled trials comparing AID (hybrid and fully closed-loop systems) to usual care (sensor augmented pumps, multiple daily insulin injections, continuous glucose monitoring and predictive low-glucose suspend) for adults and children with T1DM with a minimum duration of 3 months. We searched PubMed, Embase, Cochrane Central, and Clinicaltrials.gov for studies published up until April 4, 2023. Main outcomes included time in range 70-180 mg/dL as the primary outcome, and change in HbA1c (%, mmol/mol), glucose variability, and psychosocial impact (diabetes distress, treatment satisfaction and fear of hypoglycaemia) as secondary outcomes. Adverse events included diabetic ketoacidosis (DKA) and severe hypoglycaemia. Statistical analyses were conducted using mean differences and odds ratios. Sensitivity analyses were performed according to age, study duration and type of AID device. The protocol was registered in PROSPERO, CRD42022366710. RESULTS We identified 25 comparisons from 22 studies (six crossover and 16 parallel designs) including a total of 2376 participants (721 in adult studies, 621 in paediatric studies, and 1034 in combined studies) which were eligible for analysis. Use of AID devices ranged from 12 to 96 weeks. Patients using AID had 10.87% higher time in range [95% CI 9.38 to 12.37; p < 0.0001, I2 = 87%) and 0.37% (4.77 mmol/mol) lower HbA1c (95% CI - 0.49% (- 6.39 mmol/mol) to - 0.26 (- 3.14 mmol/mol); p < 0·0001, I2 = 77%]. AID systems decreased night hypoglycaemia, time in hypoglycaemia and hyperglycaemia and improved patient distress, with no increase in the risk of DKA or severe hypoglycaemia. No difference was found regarding treatment satisfaction or fear of hypoglycaemia. Among children, there was no difference in glucose variability or time spent in hypoglycaemia between the use of AID systems or usual care. In sensitivity analyses, results remained consistent with the overall analysis favouring AID. CONCLUSION The use of AID systems over 12 weeks, regardless of technical or clinical differences, improved glycaemic outcomes and diabetes distress without increasing the risk of adverse events in adults and children with T1DM.
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Affiliation(s)
- Amanda Godoi
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF144YS, UK.
| | | | | | | | | | | | | | | | | | | | | | - Cintia Gomes
- Federal University of Santa Maria, Santa Maria, Brazil
| | - Ariadne C Silva
- UniEvangelica University Centre of Anapolis, Anapolis, Brazil
| | | | - Joao Roberto de Sa
- Endocrinology Division, ABC School of Medicine and Federal University of Sao Paulo, Paulista School of Medicine, São Paulo, Brazil
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Mewes D, Wäldchen M, Knoll C, Raile K, Braune K. Variability of Glycemic Outcomes and Insulin Requirements Throughout the Menstrual Cycle: A Qualitative Study on Women With Type 1 Diabetes Using an Open-Source Automated Insulin Delivery System. J Diabetes Sci Technol 2023; 17:1304-1316. [PMID: 35254146 PMCID: PMC10563528 DOI: 10.1177/19322968221080199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of hormone dynamics throughout the menstrual cycle on insulin sensitivity represents a currently under-researched area. Despite therapeutic and technological advances, self-managing insulin therapy remains challenging for women with type 1 diabetes (T1D). METHODS To investigate perceived changes in glycemic levels and insulin requirements throughout the menstrual cycle and different phases of life, we performed semi-structured interviews with 12 women with T1D who are using personalized open-source automated insulin delivery (AID) systems. Transcripts were analyzed using thematic analysis with an inductive, hypothesis-generating approach. RESULTS Participants reported significant differences between the follicular phase, ovulation, and luteal phase of the menstrual cycle and also during puberty, pregnancy, and menopause. All participants reported increased comfort and safety since using AID, but were still required to manually adjust their therapy according to their cycle. A lack of information and awareness and limited guidance by health care providers were frequently mentioned. Although individual adjustment strategies exist, achieving optimum outcomes was still perceived as challenging. CONCLUSIONS This study highlights that scientific evidence, therapeutic options, and professional guidance on female health-related aspects in T1D are insufficient to date. Further efforts are required to better inform people with T1D, as well as for health care professionals, researchers, medical device manufacturers, and regulatory bodies to better address female health needs in therapeutic advances.
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Affiliation(s)
- Darius Mewes
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Mandy Wäldchen
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Christine Knoll
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- School of Sociology, University College Dublin, Dublin, Ireland
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Katarina Braune
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Urbano F, Farella I, Brunetti G, Faienza MF. Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy. Int J Mol Sci 2023; 24:11980. [PMID: 37569354 PMCID: PMC10418611 DOI: 10.3390/ijms241511980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood, with a progressively increasing incidence. T1D management requires lifelong insulin treatment and ongoing health care support. The main goal of treatment is to maintain blood glucose levels as close to the physiological range as possible, particularly to avoid blood glucose fluctuations, which have been linked to morbidity and mortality in patients with T1D. Indeed, the guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend a glycated hemoglobin (HbA1c) level < 53 mmol/mol (<7.0%) for young people with T1D to avoid comorbidities. Moreover, diabetic disease strongly influences the quality of life of young patients who must undergo continuous monitoring of glycemic values and the administration of subcutaneous insulin. In recent decades, the development of automated insulin delivery (AID) systems improved the metabolic control and the quality of life of T1D patients. Continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) devices connected to smartphones represent a good therapeutic option, especially in young children. In this literature review, we revised the mechanisms of the currently available technologies for T1D in pediatric age and explored their effect on short- and long-term diabetes-related comorbidities, quality of life, and life expectation.
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Affiliation(s)
- Flavia Urbano
- Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy;
| | - Ilaria Farella
- Clinica Medica “A. Murri”, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Giacomina Brunetti
- Department of Biosciences, Biotechnologies, and Environment, University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy;
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Ekhlaspour L, Raghinaru D, Forlenza GP, Isganaitis E, Kudva YC, Lam DW, Levister C, O’Malley G, Church MM, Lum JW, Buckingham B, Brown SA. Outcomes in Pump- and CGM-Baseline Use Subgroups in the International Diabetes Closed-Loop Trial. J Diabetes Sci Technol 2023; 17:935-942. [PMID: 35473359 PMCID: PMC10347978 DOI: 10.1177/19322968221089361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We investigated the potential benefits of automated insulin delivery (AID) among individuals with type 1 diabetes (T1D) in sub-populations of baseline device use determined by continuous glucose monitor (CGM) use status and insulin delivery via multiple daily injections (MDI) or insulin pump. MATERIALS AND METHODS In a six-month randomized, multicenter trial, 168 individuals were assigned to closed-loop control (CLC, Control-IQ, Tandem Diabetes Care), or sensor-augmented pump (SAP) therapy. The trial included a two- to eight-week run-in phase to train participants on study devices. The participants were stratified into four subgroups: insulin pump and CGM (pump+CGM), pump-only, MDI and CGM (MDI+CGM), and MDI users without CGM (MDI-only) users. We compared glycemic outcomes among four subgroups. RESULTS At baseline, 61% were pump+CGM users, 18% pump-only users, 10% MDI+CGM users, and 11% MDI-only users. Mean time in range 70-180 mg/dL (TIR) improved from baseline in the four subgroups using CLC: pump+CGM, 62% to 73%; pump-only, 61% to 70%; MDI+CGM, 54% to 68%; and MDI-only, 61% to 69%. The reduction in time below 70 mg/dL from baseline was comparable among the four subgroups. No interaction effect was detected with baseline device use for TIR (P = .67) or time below (P = .77). On the System Usability Questionnaire, scores were high at 26 weeks for all subgroups: pump+CGM: 87.2 ± 12.1, pump-only: 89.4 ± 8.2, MDI+CGM 87.2 ± 9.3, MDI: 78.1 ± 15. CONCLUSIONS There was a consistent benefit in patients with T1D when using CLC, regardless of baseline insulin delivery modality or CGM use. These data suggest that this CLC system can be considered across a wide range of patients.
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Affiliation(s)
- Laya Ekhlaspour
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Gregory P. Forlenza
- Barbara Davis Center for Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Elvira Isganaitis
- Research Division, Joslin Diabetes Center, Inc., Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David W. Lam
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camilla Levister
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grenye O’Malley
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mei Mei Church
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - John W. Lum
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Bruce Buckingham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sue A. Brown
- University of Virginia Center for Diabetes Technology, Charlottesville, VA, USA
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Nwokolo M, Hovorka R. The Artificial Pancreas and Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:1614-1623. [PMID: 36734145 PMCID: PMC10271231 DOI: 10.1210/clinem/dgad068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
Diabetes technologies represent a paradigm shift in type 1 diabetes care. Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGM) improve glycated hemoglobin (HbA1c) levels, enhance time in optimal glycemic range, limit severe hypoglycemia, and reduce diabetes distress. The artificial pancreas or closed-loop system connects these devices via a control algorithm programmed to maintain target glucose, partially relieving the person living with diabetes of this constant responsibility. Automating insulin delivery reduces the input required from those wearing the device, leading to better physiological and psychosocial outcomes. Hybrid closed-loop therapy systems, requiring user-initiated prandial insulin doses, are the most advanced closed-loop systems commercially available. Fully closed-loop systems, requiring no user-initiated insulin boluses, and dual hormone systems have been shown to be safe and efficacious in the research setting. Clinical adoption of closed-loop therapy remains in early stages despite recent technological advances. People living with diabetes, health care professionals, and regulatory agencies continue to navigate the complex path to equitable access. We review the available devices, evidence, clinical implications, and barriers regarding these innovatory technologies.
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Affiliation(s)
- Munachiso Nwokolo
- Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Emerson H, Guy M, McConville R. Offline reinforcement learning for safer blood glucose control in people with type 1 diabetes. J Biomed Inform 2023; 142:104376. [PMID: 37149275 DOI: 10.1016/j.jbi.2023.104376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
The widespread adoption of effective hybrid closed loop systems would represent an important milestone of care for people living with type 1 diabetes (T1D). These devices typically utilise simple control algorithms to select the optimal insulin dose for maintaining blood glucose levels within a healthy range. Online reinforcement learning (RL) has been utilised as a method for further enhancing glucose control in these devices. Previous approaches have been shown to reduce patient risk and improve time spent in the target range when compared to classical control algorithms, but are prone to instability in the learning process, often resulting in the selection of unsafe actions. This work presents an evaluation of offline RL for developing effective dosing policies without the need for potentially dangerous patient interaction during training. This paper examines the utility of BCQ, CQL and TD3-BC in managing the blood glucose of the 30 virtual patients available within the FDA-approved UVA/Padova glucose dynamics simulator. When trained on less than a tenth of the total training samples required by online RL to achieve stable performance, this work shows that offline RL can significantly increase time in the healthy blood glucose range from 61.6±0.3% to 65.3±0.5% when compared to the strongest state-of-art baseline (p<0.001). This is achieved without any associated increase in low blood glucose events. Offline RL is also shown to be able to correct for common and challenging control scenarios such as incorrect bolus dosing, irregular meal timings and compression errors. The code for this work is available at: https://github.com/hemerson1/offline-glucose.
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Affiliation(s)
- Harry Emerson
- University of Bristol, 1 Cathedral Square, Bristol, BS1 5TS, United Kingdom.
| | - Matthew Guy
- University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom.
| | - Ryan McConville
- University of Bristol, 1 Cathedral Square, Bristol, BS1 5TS, United Kingdom.
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Lawton J, Rankin D, Hartnell S, Lee T, Dover AR, Reynolds RM, Hovorka R, Murphy HR, Hart RI. Healthcare professionals' views about how pregnant women can benefit from using a closed-loop system: Qualitative study. Diabet Med 2023; 40:e15072. [PMID: 36807582 PMCID: PMC10947358 DOI: 10.1111/dme.15072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Interest is growing in how closed-loop systems can support attainment of within-target glucose levels amongst pregnant women with type 1 diabetes. We explored healthcare professionals' views about how, and why, pregnant women benefitted from using the CamAPS FX system during the AiDAPT trial. METHODS We interviewed 19 healthcare professionals who supported women using closed-loop during the trial. Our analysis focused on identifying descriptive and analytical themes relevant to clinical practice. RESULTS Healthcare professionals highlighted clinical and quality-of-life benefits to using closed-loop in pregnancy; albeit, they attributed some of these to the continuous glucose monitoring component. They emphasised that the closed-loop was not a panacea and that, to gain maximum benefit, an effective collaboration between themselves, the woman and the closed-loop was needed. Optimal performance of the technology, as they further noted, also required women to interact with the system sufficiently, but not excessively; a requirement that they felt some women had found challenging. Even where healthcare professionals felt that this balance was not achieved, they suggested that women had still benefitted from using the system. Healthcare professionals reported difficulties predicting how specific women would engage with the technology. In light of their trial experiences, healthcare professionals favoured an inclusive approach to closed-loop rollout in routine clinical care. CONCLUSIONS Healthcare professionals recommended that closed-loop systems be offered to all pregnant women with type 1 diabetes in the future. Presenting closed-loop systems to pregnant women and healthcare teams as one pillar of a three-party collaboration may help promote optimal use.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of EdinburghEdinburghUK
| | - David Rankin
- Usher Institute, Medical School, University of EdinburghEdinburghUK
| | - Sara Hartnell
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Tara Lee
- Norwich Medical SchoolNorwichUK
- Norfolk & Norwich University Hospital NHS Foundation TrustNorwichUK
| | - Anna R. Dover
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of EdinburghEdinburghUK
| | - Rebecca M. Reynolds
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of EdinburghEdinburghUK
- Centre for Cardiovascular ScienceUniversity of Edinburgh, Queen's Medical Research InstituteEdinburghUK
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic Science, University of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Helen R. Murphy
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Norwich Medical SchoolNorwichUK
- Norfolk & Norwich University Hospital NHS Foundation TrustNorwichUK
| | - Ruth I. Hart
- Usher Institute, Medical School, University of EdinburghEdinburghUK
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Peacock S, Frizelle I, Hussain S. A Systematic Review of Commercial Hybrid Closed-Loop Automated Insulin Delivery Systems. Diabetes Ther 2023; 14:839-855. [PMID: 37017916 PMCID: PMC10126177 DOI: 10.1007/s13300-023-01394-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Several different forms of automated insulin delivery systems (AID systems) have recently been developed and are now licensed for type 1 diabetes (T1D). We undertook a systematic review of reported trials and real-world studies for commercial hybrid closed-loop (HCL) systems. METHODS Pivotal, phase III and real-world studies using commercial HCL systems that are currently approved for use in type 1 diabetes were reviewed with a devised protocol using the Medline database. RESULTS Fifty-nine studies were included in the systematic review (19 for 670G; 8 for 780G; 11 for Control-IQ; 14 for CamAPS FX; 4 for Diabeloop; and 3 for Omnipod 5). Twenty were real-world studies, and 39 were trials or sub-analyses. Twenty-three studies, including 17 additional studies, related to psychosocial outcomes and were analysed separately. CONCLUSIONS These studies highlighted that HCL systems improve time In range (TIR) and arouse minimal concerns around severe hypoglycaemia. HCL systems are an effective and safe option for improving diabetes care. Real-world comparisons between systems and their effects on psychological outcomes require further study.
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Affiliation(s)
- Sofia Peacock
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Isolda Frizelle
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK.
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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Michou P, Gkiourtzis N, Christoforidis A, Kotanidou EP, Galli-Tsinopoulou A. The efficacy of automated insulin delivery systems in children and adolescents with Type 1 Diabetes Mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2023; 199:110678. [PMID: 37094750 DOI: 10.1016/j.diabres.2023.110678] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
AIMS Insulin administration is the treatment of choice for people with type 1 diabetes mellitus (T1D). Technological advances have led to the development of automated insulin delivery (AID) systems, aiming to optimize the quality of life of patients with T1D. We present a systematic review and meta-analysis of the current literature about the efficacy of AID systems in children and adolescents with T1D. METHODS We conducted a systematic literature search for randomized controlled trials (RCTs) until August 8th, 2022, investigating the efficacy of AID systems in the management of patients <21 years of age with T1D. A priori subgroup and sensitivity analyses based on different settings (free-living settings, type of AID system, parallel group or crossover design) were also conducted. RESULTS In total, 26 RCTs reporting a total of 915 children and adolescents with T1D were included in the meta-analysis. AID systems revealed statistically significant differences in the main outcomes, such as the proportion of time in the target glucose range (3.9-10 mmol/L) (p<0.00001), in hypoglycemia (<3.9 mmol/L) (p=0.003) and mean proportion of HbA1C (p=0.0007) compared to control group. CONCLUSIONS According to the present meta-analysis, AID systems are superior to insulin pump therapy, sensor-augmented pumps and multiple daily insulin injections. Most of the included studies have a high risk of bias because of allocation, blinding of patients and blinding of assessment. Our sensitivity analyses showed that patients <21 years of age with T1D can use AID systems, after proper education, following their daily activities. Further RCTs examining the effect of AID systems on nocturnal hypoglycemia, under free-living settings and studies examining the effect of dual-hormone AID systems are pending.
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Affiliation(s)
- Panagiota Michou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; Department of Pediatrics, Gennimatas General Hospital of Thessaloniki, Thessaloniki, Greece, 54635.
| | - Nikolaos Gkiourtzis
- 4th Department of Pediatrics, Papageorgiou General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 56429.
| | - Athanasios Christoforidis
- 1st Department of Pediatrics, Ippokrateio General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54643.
| | - Eleni P Kotanidou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54636.
| | - Asimina Galli-Tsinopoulou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54124; 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, 54636.
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Colasanto A, Savastio S, Pozzi E, Gorla C, Coïsson JD, Arlorio M, Rabbone I. The Impact of Different Types of Rice and Cooking on Postprandial Glycemic Trends in Children with Type 1 Diabetes with or without Celiac Disease. Nutrients 2023; 15:nu15071654. [PMID: 37049494 PMCID: PMC10096979 DOI: 10.3390/nu15071654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
The aims of this study were to evaluate: (i) the chemical and nutritional composition of rice before and after cooking and (ii) postprandial glycemic impacts in children and adolescents with type 1 diabetes (T1D) after eating two different types of rice (“Gigante Vercelli” white rice and “Artemide” black rice) or white rice cooked “risotto” style or boiled using an advanced hybrid closed loop (AHCL) system (Tandem Control-IQTM). General composition and spectrophotometric analyses of raw and cooked rice were performed. Eight T1D subjects (four males and four females, aged 11 ± 1.4 years), two with celiac disease (CD), using an AHCL system were enrolled. “Gigante Vercelli” white rice cooked as risotto or boiled and boiled “Artemide” rice were prepared by the same cook on two evenings. Continuous glucose monitoring metrics were evaluated for 12 h after meal consumption. Total dietary fiber was higher for both rice types after cooking compared with raw rice. Cooking as risotto increased polyphenols and antioxidants (p < 0.05) in both rice varieties, and total starch decreased after boiling (p < 0.05) in white rice. There was a significant peak in glycemia after consuming risotto and boiled white rice (p < 0.05), while the mean glycemic peak remained <180 mg/dL in individuals eating boiled Artemide rice. There were no significant differences in automatic basal or auto-bolus insulin deliveries by the AHCL according to different types of rice or cooking method. Our findings suggest that glycemic trends are impacted by the different chemical and nutritional profiles of rice but are nevertheless well controlled by AHCL systems.
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Burnside M, Haitana T, Crocket H, Lewis D, Meier R, Sanders O, Jefferies C, Faherty A, Paul R, Lever C, Price S, Frewen C, Jones S, Gunn T, Wheeler BJ, Pitama S, de Bock M, Lacey C. Interviews with Indigenous Māori with type 1 diabetes using open-source automated insulin delivery in the CREATE randomised trial. J Diabetes Metab Disord 2023. [PMCID: PMC10035484 DOI: 10.1007/s40200-023-01215-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Purpose Open-source automated insulin delivery (AID) is used by thousands of people with type 1 diabetes (T1D), but has unknown generalisability to marginalised ethnic groups. This study explored experiences of Indigenous Māori participants in the CREATE trial with use of an open-source AID system to identify enablers/barriers to health equity. Methods The CREATE randomised trial compared open-source AID (OpenAPS algorithm on an Android phone with a Bluetooth-connected pump) to sensor-augmented pump therapy. Kaupapa Māori Research methodology was used in this sub-study. Ten semi-structured interviews with Māori participants (5 children, 5 adults) and whānau (extended family) were completed. Interviews were recorded and transcribed, and data were analysed thematically. NVivo was used for descriptive and pattern coding. Results Enablers/barriers to equity aligned with four themes: access (to diabetes technologies), training/support, operation (of open-source AID), and outcomes. Participants described a sense of empowerment, and improved quality of life, wellbeing, and glycaemia. Parents felt reassured by the system’s ability to control glucose, and children were granted greater independence. Participants were able to use the open-source AID system with ease to suit whānau needs, and technical problems were manageable with healthcare professional support. All participants identified structures in the health system precluding equitable utilisation of diabetes technologies for Māori. Conclusion Māori experienced open-source AID positively, and aspired to use this therapy; however, structural and socio-economic barriers to equity were identified. This research proposes strength-based solutions which should be considered in the redesign of diabetes services to improve health outcomes for Māori with T1D. Trial Registration: The CREATE trial, encompassing this qualitative sub-study, was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000034932p) on the 20th January 2020. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01215-3.
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Affiliation(s)
- Mercedes Burnside
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Tracy Haitana
- grid.29980.3a0000 0004 1936 7830Department of Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
| | - Hamish Crocket
- grid.49481.300000 0004 0408 3579Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | | | - Renee Meier
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Olivia Sanders
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Craig Jefferies
- grid.414054.00000 0000 9567 6206Department of Paediatric Endocrinology, Starship Children’s Health, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
- grid.9654.e0000 0004 0372 3343Liggins Institute and Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Ann Faherty
- grid.414054.00000 0000 9567 6206Department of Paediatric Endocrinology, Starship Children’s Health, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Ryan Paul
- grid.49481.300000 0004 0408 3579Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | - Claire Lever
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | - Sarah Price
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | - Carla Frewen
- grid.29980.3a0000 0004 1936 7830Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Shirley Jones
- grid.29980.3a0000 0004 1936 7830Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Gunn
- Nightscout New Zealand, Hamilton, New Zealand
| | - Benjamin J. Wheeler
- grid.29980.3a0000 0004 1936 7830Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Pitama
- grid.29980.3a0000 0004 1936 7830Department of Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
| | - Martin de Bock
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
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Wang XS, Dunlop AD, McKeen JA, Feig DS, Donovan LE. Real-world use of Control-IQ™ technology automated insulin delivery in pregnancy: A case series with qualitative interviews. Diabet Med 2023; 40:e15086. [PMID: 36924086 DOI: 10.1111/dme.15086] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/13/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Most commercially available automated insulin delivery (AID) systems are not approved for pregnancy use. Information regarding use of the Tandem t:slim X2 insulin pump with Control-IQ™ technology in pregnancy is lacking. AIMS This case series aimed to explore glycaemic and qualitative experiences of four early adopters of Control-IQ technology in pregnancy. METHODS Participants used Control-IQ technology in pregnancy and postpartum and consented to analysis of glycaemic data and semi-structured interviews. RESULTS Case 1 began Control-IQ technology at 10 weeks gestation. Her pregnancy glucose time-in-range (3.5-7.8 mmol/L [63-140 mg/dL]) increased from 58.7% to 73.3% by third trimester. Cases 2-4 began using Control-IQ technology 0-2 months preconception. Pregnancy time-in-range glucose increased from 73.4% to 78.7%, 78% to 83.6%, and 46.5% to 71.9% between first and third trimesters, respectively. A mid-pregnancy decline in time-in-range glucose was observed in two of the four participants related to suboptimal pump setting adjustments and delays in sensor and infusion set replacement. No diabetic ketoacidosis or severe hypoglycaemia occurred. All participants reported reduced diabetes management burden and improved sleep with Control-IQ technology use. CONCLUSIONS Early adopters of Control-IQ technology safely used this system off-label in pregnancy and reported reduced diabetes management burden and improved sleep. The largest glycaemic improvements were observed among those with the lowest pregnancy time-in-range glucose at the beginning of pregnancy. Participants with low pregnancy glucose time-in-range increased their time-in-range with Control-IQ technology use and participants with high pregnancy glucose time-in-range maintained and increased their time-in-range with less diabetes management burden.
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Affiliation(s)
- Xinye Serena Wang
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
| | - Amy D Dunlop
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie A McKeen
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lois E Donovan
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Closed-loop insulin delivery in pregnant women with type 1 diabetes (CRISTAL): a multicentre randomized controlled trial - study protocol. BMC Pregnancy Childbirth 2023; 23:180. [PMID: 36927458 PMCID: PMC10018977 DOI: 10.1186/s12884-023-05481-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Despite increasing use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII, insulin pumps) in type 1 diabetes (T1D) in pregnancy, achieving recommended pregnancy glycaemic targets (3.5-7.8 mmol/L or 63-140 mg/dL) remains challenging. Consequently, the risk of adverse pregnancy outcomes remains high. Outside pregnancy, hybrid closed-loop (HCL) insulin delivery systems have led to a paradigm shift in the management of T1D, with 12% higher time in glucose target range (TIR) compared to conventional CSII. However, most commercially available HCL systems are currently not approved for use in pregnancy. This study aims to evaluate the efficacy, safety and cost-effectiveness of the MiniMed™ 780G HCL system (Medtronic) in T1D in pregnancy. METHODS In this international, open-label, randomized controlled trial (RCT), we will compare the MiniMed™ 780G HCL system to standard of care (SoC) in T1D in pregnancy. Women aged 18-45 years with T1D diagnosis of at least one year, HbA1c ≤ 86 mmol/mol (≤ 10%), and confirmed singleton pregnancy up to 11 weeks 6 days will be eligible. After providing written informed consent, all participants will wear a similar CGM system (Guardian™ 3 or Guardian™ 4 CGM) during a 10-day run-in phase. After the run-in phase, participants will be randomised 1:1 to 780G HCL (intervention) or SoC [control, continuation of current T1D treatment with multiple daily injections (MDI) or CSII and any type of CGM] stratified according to centre, baseline HbA1c (< 53 vs. ≥ 53 mmol/mol or < 7 vs. ≥ 7%), and method of insulin delivery (MDI or CSII). The primary outcome will be the time spent within the pregnancy glucose target range, as measured by the CGM at four time points in pregnancy: 14-17, 20-23, 26-29, and 33-36 weeks. Prespecified secondary outcomes will be overnight TIR, time below range (TBR: <3.5 mmol/L or < 63 mg/dL), and overnight TBR. Other outcomes will be exploratory. The planned sample size is 92 participants. The study will end after postpartum discharge from hospital. Analyses will be performed according to intention-to-treat as well as per protocol. DISCUSSION This large RCT will evaluate a widely used commercially available HCL system in T1D in pregnancy. Recruitment began in January 2021 and was completed in October 2022. Study completion is expected in May 2023. TRIAL REGISTRATION ClinicalTrials.gov: NCT04520971. Registration date: August 20, 2020. https://clinicaltrials.gov/ct2/show/NCT04520971.
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Petruzelkova L, Neuman V, Plachy L, Kozak M, Obermannova B, Kolouskova S, Pruhova S, Sumnik Z. First Use of Open-Source Automated Insulin Delivery AndroidAPS in Full Closed-Loop Scenario; Pancreas4ALL Randomized Pilot Study. Diabetes Technol Ther 2023; 25:315-323. [PMID: 36826996 DOI: 10.1089/dia.2022.0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Objective: We evaluated the safety and feasibility of open-source automated insulin delivery AndroidAPS in adolescents and young adults with type 1 diabetes (T1D) and compared its efficacy in three different scenarios: hybrid closed loop (HCL) with meal boluses, meal announcement only (MA), and full closed loop (FCL). Research Design and Methods: In an open-label, prospective, randomized crossover trial (clinicaltrials.gov NCT04835350), 16 adolescents with T1D (10 females) with mean age of 17 years (range 15-20), glycated hemoglobin 56 mmol/mol (range 43-75), and mean duration of diabetes 5.9 years (9-15) underwent three distinct 3-day periods of camp living, comparing the above-mentioned scenarios of AndroidAPS. We used modified and locked version of AndroidAPS 3.1.03, which was called Pancreas4ALL for study purposes. The order of MA and FCL periods was assigned randomly. The primary endpoints were feasibility and safety of the system represented by percentage of time of glucose control by the system and time in hypoglycemia below 3 mmol/L. Results: The glycemia was controlled by the system 95% time of the study and the proportion of time below 3 mmol/L did not exceed 1% over the whole study period (0.72%). The HCL scenario reached significantly higher percentage of time below 3 mmol/L (HCL 1.05% vs. MA 0.0% vs. FCL 0.0%; P = 0.05) compared to other scenarios. No difference was observed among the scenarios in the percentage of time between 3.9 and 10 mmol/L (HCL 83.3% vs. MA 79.85% vs. FCL 81.03%, P = 0.58) corresponding to mean glycemia (HCL 6.65 mmol/L vs. MA 7.34 mmol/L vs. FCL 7.05 mmol/L, P = 0.28). No difference was observed in the mean daily dose of insulin or in the daily carbohydrate intake. No serious adverse event occurred during the study period. Conclusions: Our pilot study showed that FCL might be a realistic mode of treatment for people with T1D.
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Affiliation(s)
- Lenka Petruzelkova
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lukas Plachy
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milos Kozak
- IT Department, CLOSED LOOP Systems and Sysop, Prague, Czech Republic
| | - Barbora Obermannova
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stanislava Kolouskova
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stepanka Pruhova
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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Furió-Novejarque C, Sanz R, Ritschel TKS, Reenberg AT, Ranjan AG, Nørgaard K, Díez JL, Jørgensen JB, Bondia J. Modeling the effect of glucagon on endogenous glucose production in type 1 diabetes: On the role of glucagon receptor dynamics. Comput Biol Med 2023; 154:106605. [PMID: 36731362 DOI: 10.1016/j.compbiomed.2023.106605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
This paper validates a glucoregulatory model including glucagon receptors dynamics in the description of endogenous glucose production (EGP). A set of models from literature are selected for a head-to-head comparison in order to evaluate the role of glucagon receptors. Each EGP model is incorporated into an existing glucoregulatory model and validated using a set of clinical data, where both insulin and glucagon are administered. The parameters of each EGP model are identified in the same optimization problem, minimizing the root mean square error (RMSE) between the simulation and the clinical data. The results show that the RMSE for the proposed receptors-based EGP model was lower when compared to each of the considered models (Receptors approach: 7.13±1.71 mg/dl vs. 7.76±1.45 mg/dl (p=0.066), 8.45±1.38 mg/dl (p=0.011) and 8.99±1.62 mg/dl (p=0.007)). This raises the possibility of considering glucagon receptors dynamics in type 1 diabetes simulators.
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Affiliation(s)
- Clara Furió-Novejarque
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camí de Vera, s/n, València, 46022, Spain.
| | - Ricardo Sanz
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camí de Vera, s/n, València, 46022, Spain.
| | - Tobias K S Ritschel
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Anker Engelunds Vej 1, Kgs. Lyngby, 2800, Denmark.
| | - Asbjørn Thode Reenberg
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Anker Engelunds Vej 1, Kgs. Lyngby, 2800, Denmark.
| | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark; Danish Diabetes Academy, Søndre Blvd. 29, Odense, 5000, Denmark.
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark.
| | - José-Luis Díez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camí de Vera, s/n, València, 46022, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Madrid, 28029, Spain.
| | - John Bagterp Jørgensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Anker Engelunds Vej 1, Kgs. Lyngby, 2800, Denmark.
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camí de Vera, s/n, València, 46022, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Madrid, 28029, Spain.
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48
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Parise M, Di Molfetta S, Graziano RT, Fiorentino R, Cutruzzolà A, Gnasso A, Irace C. A Head-to-Head Comparison of Two Algorithms for Adjusting Mealtime Insulin Doses Based on CGM Trend Arrows in Adult Patients with Type 1 Diabetes: Results from an Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3945. [PMID: 36900956 PMCID: PMC10002216 DOI: 10.3390/ijerph20053945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) users are encouraged to consider trend arrows before injecting a meal bolus. We evaluated the efficacy and safety of two different algorithms for trend-informed bolus adjustments, the Diabetes Research in Children Network/Juvenile Diabetes Research Foundation (DirectNet/JDRF) and the Ziegler algorithm, in type 1 diabetes. METHODS We conducted a cross-over study of type 1 diabetes patients using Dexcom G6. Participants were randomly assigned to either the DirectNet/JDRF or the Ziegler algorithm for two weeks. After a 7-day wash-out period with no trend-informed bolus adjustments, they crossed to the alternative algorithm. RESULTS Twenty patients, with an average age of 36 ± 10 years, completed this study. Compared to the baseline and the DirectNet/JDRF algorithm, the Ziegler algorithm was associated with a significantly higher time in range (TIR) and lower time above range and mean glucose. A separate analysis of patients on CSII and MDI revealed that the Ziegler algorithm provides better glucose control and variability than DirectNet/JDRF in CSII-treated patients. The two algorithms were equally effective in increasing TIR in MDI-treated patients. No severe hypoglycemic or hyperglycemic episode occurred during the study. CONCLUSIONS The Ziegler algorithm is safe and may provide better glucose control and variability than the DirectNet/JDRF over a two-week period, especially in patients treated with CSII.
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Affiliation(s)
- Martina Parise
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy
| | | | | | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
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49
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Sanz R, García P, Romero-Vivó S, Díez JL, Bondia J. Near-optimal feedback control for postprandial glucose regulation in type 1 diabetes. ISA TRANSACTIONS 2023; 133:345-352. [PMID: 36116963 DOI: 10.1016/j.isatra.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/19/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
This paper is focused on feedback control of postprandial glucose levels for patients with type 1 Diabetes Mellitus. There are two important limitations that make this a challenging problem. First, the slow subcutaneous insulin pharmacokinetics that introduces a significant lag into the control loop. Second, the positivity constraint on the control action, meaning that it is not possible to remove insulin from the body. In this paper, both issues are explicitly considered in the design process using the internal model control framework, to derive a near-optimal feedback controller. Optimality is understood here as minimizing the blood glucose peak after a meal intake and, at the same time, preventing glucose values below a prescribed threshold. It is shown how the proposed controller approaches the optimal closed-loop performance as a limit case. The theoretical results are supported by a numerical example and the feasibility of the overall strategy under uncertainties is illustrated using an extended version UVa/Padova metabolic simulator.
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Affiliation(s)
- R Sanz
- Instituto de Automática e Informática Industrial, Universitat Politècnica de València, 46022 València, Spain.
| | - P García
- Instituto de Automática e Informática Industrial, Universitat Politècnica de València, 46022 València, Spain.
| | - S Romero-Vivó
- Instituto de Matemática Multidisciplinar, Universitat Politècnica de València, 46022 València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - J L Díez
- Instituto de Automática e Informática Industrial, Universitat Politècnica de València, 46022 València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - J Bondia
- Instituto de Automática e Informática Industrial, Universitat Politècnica de València, 46022 València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
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50
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Ng SM, Wright NP, Yardley D, Campbell F, Randell T, Trevelyan N, Ghatak A, Hindmarsh PC. Real world use of hybrid-closed loop in children and young people with type 1 diabetes mellitus-a National Health Service pilot initiative in England. Diabet Med 2023; 40:e15015. [PMID: 36424877 DOI: 10.1111/dme.15015] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022]
Abstract
AIMS Hybrid closed-loop (HCL) systems are characterised by integrating continuous glucose monitoring (CGM) with insulin pumps that automate insulin delivery via specific algorithms and user-initiated insulin delivery. The aim of the study was to evaluate effectiveness of HCLs on HbA1c, time-in-range (TIR), hypoglycaemia frequency and quality of life measures in children and young people (CYP) with T1D, and their carers. METHODS Patients were recruited prospectively into the National Health Service (NHS) England real-world HCL observational study from the 1st of August 2021 to the 10th of December 2022 from eight paediatric diabetes centres in England. RESULTS There were 251 CYP (147 males, 58%) with T1DM recruited with a mean age at recruitment of 12.3 (SD 3.5) (range 2-19) years. Eighty nine per cent of the CYP were of white ethnicity, 3% Asian, 4% black and 3% mixed ethnicity, and 1% were recorded as others. The HCL systems used in the study were: (1) Tandem Control-IQ AP system, which uses the Tandem t:slim X2 insulin pump (Tandem Diabetes Care, San Diego, CA) with the Dexcom G6® CGM (Dexcom, San Diego, CA) sensor; (2) Medtronic MiniMed™ 780G (Medtronic, Northridge, CA) and (3) CamAPS FX (CamDiab, Cambridge, UK.) All systems were fully funded by the national health service. CONCLUSIONS The results of the NHS England Closed Loop Study in Children and Young People showed improvements in glycaemic control, TIR, frequency of hypoglycaemia, hypoglycaemia fear and quality of sleep for children and young people when using HCL for 6 months. Hypoglycaemia fear and quality of sleep were also improved for their parents and carers at 6 months.
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Affiliation(s)
- Sze May Ng
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK
| | | | - Diana Yardley
- Children's Diabetes Team, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fiona Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham, UK
| | | | | | - Peter C Hindmarsh
- Children and Young People's Diabetes Service, University College London Hospitals NHS Foundation Trust, London, UK
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