1
|
Riddell MC, Lewis DM, Turner LV, Lal RA, Shahid A, Zaharieva DP. Refining Insulin on Board with netIOB for Automated Insulin Delivery. J Diabetes Sci Technol 2024:19322968241267820. [PMID: 39143692 DOI: 10.1177/19322968241267820] [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: 08/16/2024]
Abstract
Automated insulin delivery (AID) systems enhance glucose management by lowering mean glucose level, reducing hyperglycemia, and minimizing hypoglycemia. One feature of most AID systems is that they allow the user to view "insulin on board" (IOB) to help confirm a recent bolus and limit insulin stacking. This metric, along with viewing glucose concentrations from a continuous glucose monitoring system, helps the user understand bolus insulin action and the future "threat" of hypoglycemia. However, the current presentation of IOB in AID systems can be misleading, as it does not reflect true insulin action or automatic, dynamic insulin adjustments. This commentary examines the evolution of IOB from a bolus-specific metric to its contemporary use in AID systems, highlighting its limitations in capturing real-time insulin modulation during varying physiological states.
Collapse
Affiliation(s)
- Michael C Riddell
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | | | - Lauren V Turner
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - Rayhan A Lal
- Stanford Diabetes Research Center, Stanford, CA, USA
| | - Arsalan Shahid
- CeADAR-Ireland's Centre for Applied AI, University College Dublin, Dublin, Ireland
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
2
|
Khan AB, Tariq A. Comment on: Glucometrics and device satisfaction in children and adolescents with type 1 diabetes using different treatment modalities: A multicenter real-world observational study. Diabetes Res Clin Pract 2024; 214:111787. [PMID: 39032660 DOI: 10.1016/j.diabres.2024.111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Abdul Basit Khan
- Ayub Medical College, Abbottabad, Street#7 Phul Gulaab Road Al-Mansoor Town Abbottabad, KPK, Pakistan.
| | - Abeera Tariq
- Ayub Medical College, Hayatabad, Peshawar, KPK, Pakistan
| |
Collapse
|
3
|
Forlenza GP, DeSalvo DJ, Aleppo G, Wilmot EG, Berget C, Huyett LM, Hadjiyianni I, Méndez JJ, Conroy LR, Ly TT, Sherr JL. Real-World Evidence of Omnipod ® 5 Automated Insulin Delivery System Use in 69,902 People with Type 1 Diabetes. Diabetes Technol Ther 2024; 26:514-525. [PMID: 38375861 DOI: 10.1089/dia.2023.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: The Omnipod® 5 Automated Insulin Delivery System was associated with favorable glycemic outcomes for people with type 1 diabetes (T1D) in two pivotal clinical trials. Real-world evidence is needed to explore effectiveness in nonstudy conditions. Methods: A retrospective analysis of the United States Omnipod 5 System users (aged ≥2 years) with T1D and sufficient data (≥90 days of data; ≥75% of days with ≥220 continuous glucose monitor readings/day) available in Insulet Corporation's device and person-reported datasets as of July 2023 was performed. Target glucose setting usage (i.e., 110-150 mg/dL in 10 mg/dL increments) was summarized and glycemic outcomes were examined. Subgroup analyses of those using the lowest average glucose target (110 mg/dL) and stratification by baseline characteristics (e.g., age, prior therapy, health insurance coverage) were conducted. Results: In total, 69,902 users were included. Multiple and higher glucose targets were more commonly used in younger age groups. Median percentage of time in range (TIR; 70-180 mg/dL) was 68.8%, 61.3%, and 53.6% for users with average glucose targets of 110, 120, and 130-150 mg/dL, respectively, with minimal time <70 mg/dL (all median <1.13%). Among those with an average glucose target of 110 mg/dL (n = 37,640), median TIR was 65.0% in children and adolescents (2-17 years) and 69.9% in adults (≥18 years). Subgroup analyses of users transitioning from Omnipod DASH or multiple daily injections and of Medicaid/Medicare users demonstrated favorable glycemic outcomes among these groups. Conclusion: These glycemic outcomes from a large and diverse sample of nearly 70,000 children and adults demonstrate effective use of the Omnipod 5 System under real-world conditions.
Collapse
Affiliation(s)
- Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel J DeSalvo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma G Wilmot
- Translational Medical Sciences, University of Nottingham, School of Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Cari Berget
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | - Trang T Ly
- Insulet Corporation, Acton, Massachusetts, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Wilkinson TM, de Bock M. Analysis of "Hybrid Closed Loop Using a Do-It-Yourself Artificial Pancreas System in Adults With Type 1 Diabetes". J Diabetes Sci Technol 2024; 18:897-898. [PMID: 37850586 PMCID: PMC11307214 DOI: 10.1177/19322968231208216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
In an article in Journal of Diabetes Science and Technology, Nanayakkara and colleagues assessed the glycemic efficacy and safety of AndroidAPS, an open-source automated delivery (AID) system, in a crossover randomized controlled trial. Although the trial included only 20 participants during a relatively short 4-week intervention period, glycemic outcomes attained were similar to commercial AID systems and there were no safety concerns. Validation of open-source AID systems in studies such as this should help address clinician hesitancy regarding these systems, and affirms the role of patient-centered innovation and self-management in diabetes care.
Collapse
Affiliation(s)
- Tom M. Wilkinson
- Department of Paediatrics, University of Otago, Christchurch, Christchurch, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, Christchurch, New Zealand
| |
Collapse
|
5
|
Nanayakkara N, Sharifi A, Burren D, Elghattis Y, Jayarathna DK, Cohen N. Hybrid Closed Loop Using a Do-It-Yourself Artificial Pancreas System in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:889-896. [PMID: 36788715 PMCID: PMC11307222 DOI: 10.1177/19322968231153882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE There is increasing use of open-source artificial pancreas systems (APS) in the management of Type 1 diabetes. Our aim was to assess the safety and efficacy of the automated insulin delivery system AndroidAPS (AAPS), compared with stand-alone pump therapy in people with type 1 diabetes. The primary outcome was the difference in the percentage of time in range (TIR, 70-180 mg/dL). Secondary aims included mean sensor glucose value and percent continuous glucose monitor (CGM) time below range (TBR, <70 mg/dL). RESEARCH DESIGN AND METHODS This open-label single-center randomized crossover study (ANZCTR, Australian New Zealand clinical trial registry, ANZCTR-ACTRN12620001191987) comprised 20 participants with type 1 diabetes on established pump therapy, assigned to either stand-alone insulin pump therapy or the open-source AAPS hybrid closed-loop system for four weeks, with crossover to the alternate arm for the following four weeks. The CGM outcome parameters were measured by seven-day CGM at baseline and the final week of each four-week study arm. RESULTS Twenty participants were recruited (60% women), aged 45.8 ± 15.9 years, with mean diabetes duration of 23.9 ± 13.2 years, baseline glycated hemoglobin (HbA1c) 7.5% ± 0.5% (58 ± 6 mmol/mol) and mean TIR 62.3% ± 12.9%. The change in TIR from baseline for AAPS compared with stand-alone pump therapy was 18.6% (11.4-25.9), (P < .001), TIR 76.6% ± 11.7%, 58.0% ± 15.6%, for AAPS and stand-alone pump, respectively. Time glucose <54 mg/dL was not increased (mean = -2.0%, P = .191). No serious adverse events or episodes of severe hypoglycemia were recorded. CONCLUSIONS This clinical trial of the open-source AAPS hybrid closed-loop system performed in an at-home setting demonstrated comparable safety to stand-alone pump therapy. The glycemic outcomes of AAPS were superior with improved TIR, and there was no significant difference in TBR compared with stand-alone pump therapy.
Collapse
Affiliation(s)
- Natalie Nanayakkara
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Amin Sharifi
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, VIC, Australia
| | - David Burren
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yasser Elghattis
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dulari K Jayarathna
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Neale Cohen
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Kovatchev B, Castillo A, Pryor E, Kollar LL, Barnett CL, DeBoer MD, Brown SA. Neural-Net Artificial Pancreas: A Randomized Crossover Trial of a First-in-Class Automated Insulin Delivery Algorithm. Diabetes Technol Ther 2024; 26:375-382. [PMID: 38277161 PMCID: PMC11305265 DOI: 10.1089/dia.2023.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Background: Automated insulin delivery (AID) is now integral to the clinical practice of type 1 diabetes (T1D). The objective of this pilot-feasibility study was to introduce a new regulatory and clinical paradigm-a Neural-Net Artificial Pancreas (NAP)-an encoding of an AID algorithm into a neural network that approximates its action and assess NAP versus the original AID algorithm. Methods: The University of Virginia Model-Predictive Control (UMPC) algorithm was encoded into a neural network, creating its NAP approximation. Seventeen AID users with T1D were recruited and 15 participated in two consecutive 20-h hotel sessions, receiving in random order either NAP or UMPC. Their demographic characteristics were ages 22-68 years old, duration of diabetes 7-58 years, gender 10/5 female/male, White Non-Hispanic/Black 13/2, and baseline glycated hemoglobin 5.4%-8.1%. Results: The time-in-range (TIR) difference between NAP and UMPC, adjusted for entry glucose level, was 1 percentage point, with absolute TIR values of 86% (NAP) and 87% (UMPC). The two algorithms achieved similar times <70 mg/dL of 2.0% versus 1.8% and coefficients of variation of 29.3% (NAP) versus 29.1 (UMPC)%. Under identical inputs, the average absolute insulin-recommendation difference was 0.031 U/h. There were no serious adverse events on either controller. NAP had sixfold lower computational demands than UMPC. Conclusion: In a randomized crossover study, a neural-network encoding of a complex model-predictive control algorithm demonstrated similar performance, at a fraction of the computational demands. Regulatory and clinical doors are therefore open for contemporary machine-learning methods to enter the AID field. Clinical Trial Registration number: NCT05876273.
Collapse
Affiliation(s)
- Boris Kovatchev
- Address correspondence to: Boris Kovatchev, PhD, Center for Diabetes Technology, University of Virginia School of Medicine, 560 Ray C Hunt Drive, Charlottesville, VA 22903, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
CHO TED, GOWDA VRUSHAB, SCHULZRINNE HENNING, MILLER BRIANJ. Integrated Devices: A New Regulatory Pathway to Promote Revolutionary Innovation. Milbank Q 2024; 102:367-382. [PMID: 38253988 PMCID: PMC11176405 DOI: 10.1111/1468-0009.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/03/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Policy Points Current medical device regulatory frameworks date back half a century and are ill suited for the next generation of medical devices that involve a significant software component. Existing Food and Drug Administration efforts are insufficient because of a lack of statutory authority, whereas international examples offer lessons for improving and harmonizing domestic medical device regulatory policy. A voluntary alternative pathway built upon two-stage review with individual component review followed by holistic review for integrated devices would provide regulators with new tools to address a changing medical device marketplace.
Collapse
Affiliation(s)
- TED CHO
- University of CaliforniaSan FranciscoCaliforniaUSA
| | | | | | - BRIAN J. MILLER
- The Johns Hopkins University School of MedicineBaltimoreUSA
- The Johns Hopkins Carey Business School
- American Enterprise Institute
| |
Collapse
|
9
|
Landau Z, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Jacobi-Polishook T, Ben Ari T, Abiri S, Haim A, Nir J, Rachmiel M, Pinhas-Hamiel O. A comparison of the usage of an open-source automated insulin delivery system and the MiniMed™ 780 G system in children and adolescents with type 1 diabetes in real-world settings: the AWeSoMe study group. Endocrine 2024; 84:943-950. [PMID: 38225516 DOI: 10.1007/s12020-024-03683-w] [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: 09/09/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE In recent years there has been a noticeable increase in the use of advanced hybrid closed-loop systems (AHCLs) for managing type 1 diabetes (T1D) among youth. However, there is a lack of comparison between the open-source automated insulin delivery (AID) system and the MiniMed™ 780 G system (780 G). METHODS In this multi-center study, we retrospectively compared selected glycemic ranges of 26 individuals who used open-source AID and 20 individuals who used 780 G (age 11.3 years [IQR 9.3, 12.9] and 13.4 years [IQR 10.9, 16.5], respectively, p = 0.069) from system initiation to the most recent visit. RESULTS At baseline, the median HbA1c was significantly lower and the time below range (TBR)<54mg/dL was significantly higher in the open-source AID group compared to the 780 G group (6.8% [IQR 6.4, 7.1] vs. 7.4% [IQR 6.9, 8.6], p = 0.006 and (1.0% [IQR 0.5, 2.8] vs. 0.0% [0.0, 1.0], p = 0.014), respectively; the median time in range (TIR70-180mg/dL) was similar (p = 0.068). After a median duration of 10.9 months on AHCLs the reduction of HbA1c was similar ( ~ 0.3%). The time spent in the hypoglycemic ranges was longer among users of the open-source AID compared to 780 G (TBR54-70mg/dL 4.2% [IQR 2.6, 7.3] vs. 2.0% [1.0, 4.0], p = 0.005) and TBR<54mg/dL 1.1% [IQR 0.4, 2.3] vs. 0.0 [0.0, 1.0], p = 0.001). CONCLUSIONS Both AHCLs similarly improved HbA1c and TIR70-180mg/dL. The open-source AID youth had better glycemic control but spent longer time in the hypoglycemic range. These findings must be considered when choosing the use of AHCL technologies.
Collapse
Affiliation(s)
- Zohar Landau
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yael Lebenthal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noah Levek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Talia Jacobi-Polishook
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Tal Ben Ari
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Shirly Abiri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Alon Haim
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Judith Nir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Marianna Rachmiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| |
Collapse
|
10
|
Forlenza GP, Tabatabai I, Lewis DM. Point-Counterpoint: The Need for Do-It-Yourself (DIY) Open Source (OS) AID Systems in Type 1 Diabetes Management. Diabetes Technol Ther 2024. [PMID: 38669472 DOI: 10.1089/dia.2024.0073] [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: 04/28/2024]
Abstract
In the last decade, technology developed by people with diabetes and their loved ones has added to the options for diabetes management. One such example is that of automated insulin delivery (AID) algorithms, which were created and shared as open source by people living with type 1 diabetes (T1D) years before commercial systems were first available. Now, numerous options for commercial systems exist in some countries, yet tens of thousands of people with diabetes are still choosing Open-Source AID (OS-AID), previously called "do-it-yourself" (DIY) systems, which are noncommercial versions of these open-source AID systems. In this article, we provide point and counterpoint perspectives regarding (1) safety and efficacy, (2) regulation and support, (3) user choice and flexibility, (4) access and affordability, and (5) patient and provider education, for open source and commercial AID systems. The perspectives reflected here include that of a person living with T1D who uses and has developed OS-AID systems, a physician-researcher based in the United States who conducts clinical trials to support development of commercial AID systems and supports people with diabetes using all types of AID, and an endocrinologist with T1D who uses both systems and treats people with diabetes using all types of AID.
Collapse
Affiliation(s)
- Gregory P Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ideen Tabatabai
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | |
Collapse
|
11
|
Yang Z, Chan YM, Chan DSH, Wu C, Wang Z, Jiang Y, Liu D, Xia Z, Zhang L, Cai Y, Wong CY. A Biomineralized Bifunctional Patient-Friendly Nanosystem for Sustained Glucose Monitoring and Control in Diabetes. SMALL METHODS 2024:e2400159. [PMID: 38697928 DOI: 10.1002/smtd.202400159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Indexed: 05/05/2024]
Abstract
Regular blood glucose monitoring and control is necessary for people with type 1 or advanced type 2 diabetes, yet diagnosing and treating patients with diabetes in an accurate, sustained and patient-friendly manner remains limited. Here, a glucose-responsive bifunctional nanosystem (PGOxMns) is constructed via one-pot biomineralisation of manganese dioxide with glucose oxidase and ε-poly-L-lysine. Under hyperglycaemic conditions, the cascade reactions that occur when glucose interacts with PGOxMns can trigger the production of Mn(II), which enhances the magnetic resonance imaging signal. Simultaneously, manganese dioxide catalyses the decomposition of toxic hydrogen peroxide into oxygen, which also maintains glucose oxidase (GOx) activity. In an in vivo model of diabetes, PGOxMns is used to monitor glucose levels (0-20 mm) and allowed identification of diabetic mice via T1-weighted MRI. Furthermore, PGOxMns is found to have a high insulin-loading capacity (83.6%), likely due to its positive charge. A single subcutaneous injection of insulin-loaded nanosystem (Ins-PGOxMns) into diabetic mice resulted in a rapid and efficient response to a glucose challenge and prolonged blood glucose level control (< 200 mg dL-1) for up to 50 h. Overall, this proof-of-concept study demonstrates the feasibility of using biomineralised nanosystems to develop patient-friendly strategies for glucose monitoring and control.
Collapse
Affiliation(s)
- Zhe Yang
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| | - Yuen-Man Chan
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| | - Daniel Shiu-Hin Chan
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| | - Chengnan Wu
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| | - Zimeng Wang
- Department of Mathematics and Information Technology, Education University of Hong Kong, Tai Po, New Territories, Hong Kong SAR, 999077, China
| | - Yuxin Jiang
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Guangdong, 524023, China
| | - Danyong Liu
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Guangdong, 524023, China
| | - Zhengyuan Xia
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Guangdong, 524023, China
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangdong, 510632, China
| | - Li Zhang
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| | - Yin Cai
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, 999077, China
| | - Chun-Yuen Wong
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, 999077, China
| |
Collapse
|
12
|
Fagerberg AR, Borch L, Kristensen K, Hjelle JS. Prevalence, Safety, and Metabolic Control Among Danish Children and Adolescents with Type 1 Diabetes Using Open-Source Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:287-297. [PMID: 38386435 PMCID: PMC11058411 DOI: 10.1089/dia.2023.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Background: Treatment of type 1 diabetes mellitus (T1DM) has become increasingly technical with rapid developments in integration of pumps and sensors to regulate insulin dosage, and patient-initiated solutions as open-source automated insulin delivery (OS-AID) systems, have gained popularity in people with diabetes. Studies have shown increased glycemic control and mental wellbeing in users of OS-AID systems. The aim of this study was to estimate the prevalence, the effect on metabolic control, the risk, and the effect on everyday life for users and their parents of OS-AID systems in Danish children and adolescents with T1DM. Methods: This retrospective cohort study recruited participants through pediatric diabetes outpatient clinics and social media. Surveys were distributed and current and retrospective data on glycemic control (HbA1c, time in range [TIR] etc.) were collected. Results: Fifty-six users of OS-AID systems out of 2950 Danish children and adolescents with T1DM were identified from all outpatient clinics in Denmark. Thirty-one responded on contact and were included (55% of the identified), median age 12 [interquartile range: 11-14] years, 51% females, and mean duration of use of OS-AID systems 2.37 ± 0.86 years. Glycemic control increased significantly with TIR increasing from mean 62.29% ± 13.68% to 70.12% ± 10.08%, *P < 0.01, and HbA1c decreasing from mean 50.13 ± 5.76 mmol/mol (6.7% ± 2.7%) to 47.86 ± 6.24 mmol/mol (6.5% ± 2.7%), **P < 0.05. No changes were found in safety parameters. Parents reported better quality of sleep evaluated by Pittsburgh Sleep Quality Index. Conclusion: This study is the first to provide knowledge on pediatric users of OS-AID systems in Denmark and found a prevalence of 1.89% for OS-AID systems, improved TIR, and no increased risk associated with use of OS-AID systems.
Collapse
Affiliation(s)
- Amanda R. Fagerberg
- Department of Pediatrics and Adolescent Medicine, Goedstrup Regional Hospital, Herning, Denmark
- Steno Diabetes Center Aarhus, Aarhus Univeristy Hospital, Aarhus, Denmark
| | - Luise Borch
- Department of Pediatrics and Adolescent Medicine, Goedstrup Regional Hospital, Herning, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus Univeristy Hospital, Aarhus, Denmark
| | - Jesper S. Hjelle
- Department of Pediatrics and Adolescent Medicine, Goedstrup Regional Hospital, Herning, Denmark
- Steno Diabetes Center Aarhus, Aarhus Univeristy Hospital, Aarhus, Denmark
| |
Collapse
|
13
|
Castorani V, Rigamonti A, Frontino G, Morotti E, Sandullo F, Scialabba F, Arrigoni F, Dionisi B, Foglino R, Morosini C, Olivieri G, Bonfanti R. Turning the tides: achieving rapid and safe glucose control in adolescents with suboptimally controlled type 1 diabetes using advanced hybrid closed loop systems. Front Endocrinol (Lausanne) 2024; 15:1243565. [PMID: 38628580 PMCID: PMC11019566 DOI: 10.3389/fendo.2024.1243565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/04/2024] [Indexed: 04/19/2024] Open
Abstract
Aim Many adolescents with T1D experience a decline in metabolic control due to erratic eating habits and subpar adherence to treatment regimens. The objective of our retrospective observational study was to assess the effect of the Tandem Control IQ (CIQ) advanced hybrid closed-loop (AHCL) system on a cohort of adolescents with suboptimal glucose control. Methods We retrospectively evaluated 20 non-adherent patients with T1D, who were inconsistently using Multiple Daily Injections (MDIs) and flash glucose monitoring and were subsequently started and on CIQ. Glucometrics and the Glucose Risk Index were assessed at baseline and after 2 weeks, 1 month, and 6 months of CIQ use. Results The study included 20 adolescents with T1D (HbA1c: 10.0% ± 1.7). Time in range (TIR) increased from 27.1% ± 13.7 at baseline to 68.6% ± 14.2 at 2 weeks, 66.6% ± 10.7 at 1 month, and 60.4% ± 13.3 at 6 months of CIQ use. Time above range (TAR) >250 mg/dL decreased from 46.1% ± 23.8 to 9.9% ± 9.5 at 2 weeks, 10.8% ± 6.1 at 1 month, and 15.5% ± 10.5 at 6 months of AHCL use. Mean glucose levels improved from 251 mg/dL ± 68.9 to 175mg/dL ± 25.5 after 6 months of CIQ use. The Glucose Risk Index (GRI) also significantly reduced from 102 to 48 at 6 months of CIQ. HbA1c also improved from 10.0% ± 1.7 at baseline to 7.0% ± 0.7 after 6 months. Two patients experienced a single episode of mild diabetic ketoacidosis (DKA). Conclusions AHCL systems provide a significant, rapid, and safe improvement in glucose control. This marks a pivotal advancement in technology that primarily benefited those who were already compliant.
Collapse
Affiliation(s)
- Valeria Castorani
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giulio Frontino
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisa Morotti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Federica Sandullo
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Scialabba
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Arrigoni
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Benedetta Dionisi
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Foglino
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Camilla Morosini
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Gabriele Olivieri
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetes Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
14
|
Ginsburg GS, Picard RW, Friend SH. Key Issues as Wearable Digital Health Technologies Enter Clinical Care. N Engl J Med 2024; 390:1118-1127. [PMID: 38507754 DOI: 10.1056/nejmra2307160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Geoffrey S Ginsburg
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Rosalind W Picard
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Stephen H Friend
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| |
Collapse
|
15
|
Mittal R, Koutras N, Maya J, Lemos JRN, Hirani K. Blood glucose monitoring devices for type 1 diabetes: a journey from the food and drug administration approval to market availability. Front Endocrinol (Lausanne) 2024; 15:1352302. [PMID: 38559693 PMCID: PMC10978642 DOI: 10.3389/fendo.2024.1352302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Blood glucose monitoring constitutes a pivotal element in the clinical management of Type 1 diabetes (T1D), a globally escalating metabolic disorder. Continuous glucose monitoring (CGM) devices have demonstrated efficacy in optimizing glycemic control, mitigating adverse health outcomes, and augmenting the overall quality of life for individuals afflicted with T1D. Recent progress in the field encompasses the refinement of electrochemical sensors, which enhances the effectiveness of blood glucose monitoring. This progress empowers patients to assume greater control over their health, alleviating the burdens associated with their condition, and contributing to the overall alleviation of the healthcare system. The introduction of novel medical devices, whether derived from existing prototypes or originating as innovative creations, necessitates adherence to a rigorous approval process regulated by the Food and Drug Administration (FDA). Diverse device classifications, stratified by their associated risks, dictate distinct approval pathways, each characterized by varying timelines. This review underscores recent advancements in blood glucose monitoring devices primarily based on electrochemical sensors and elucidates their regulatory journey towards FDA approval. The advent of innovative, non-invasive blood glucose monitoring devices holds promise for maintaining stringent glycemic control, thereby preventing T1D-associated comorbidities, and extending the life expectancy of affected individuals.
Collapse
Affiliation(s)
- Rahul Mittal
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicole Koutras
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Jonathan Maya
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Joana R. N. Lemos
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Khemraj Hirani
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
16
|
Reddy M, Oliver N. The role of real-time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management. Diabetes Obes Metab 2024; 26 Suppl 1:46-56. [PMID: 38441367 DOI: 10.1111/dom.15504] [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: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
Diabetes is a complex metabolic condition that demands tailored, individualized approaches for effective management. Real-time continuous glucose monitoring (rtCGM) systems have improved in terms of design, usability and accuracy over the years and play a pivotal role in the delivery of integrated personalized diabetes management (iPDM). iPDM is a comprehensive multidisciplinary approach that combines individualized care strategies utilizing technologies and interventions and encourages the active involvement of the person with diabetes in the care provided. The use of stand-alone rtCGM and its integration with other diabetes technologies, such as hybrid automated insulin delivery, have enabled improved glycaemic and quality of life outcomes for people with diabetes. As the uptake of rtCGM and associated technologies is increasing and becoming the standard of care for people with diabetes, it is important that efforts are focused on associated goals such as reducing health inequalities in terms of access, aligning structured education with rtCGM usage, choosing the right technology based on needs and preferences, and minimizing burden while aiming for optimal glucose outcomes. Utilizing rtCGM in other settings than outpatients and in diabetes cohorts beyond type 1 and type 2 diabetes needs further exploration. This review aims to provide an overview of the role of rtCGM and how best to link rtCGM to iPDM, highlighting its role in enhancing personalized treatment strategies.
Collapse
Affiliation(s)
- Monika Reddy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| |
Collapse
|
17
|
Considine EG, Sherr JL. Real-World Evidence of Automated Insulin Delivery System Use. Diabetes Technol Ther 2024; 26:53-65. [PMID: 38377315 PMCID: PMC10890954 DOI: 10.1089/dia.2023.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: Pivotal trials of automated insulin delivery (AID) closed-loop systems have demonstrated a consistent picture of glycemic benefit, supporting approval of multiple systems by the Food and Drug Administration or Conformité Européenne mark receipt. To assess how pivotal trial findings translate to commercial AID use, a systematic review of retrospective real-world studies was conducted. Methods: PubMed and EMBASE were searched for articles published after 2018 with more than five nonpregnant individuals with type 1 diabetes (T1D). Data were screened/extracted in duplicate for sample size, AID system, glycemic outcomes, and time in automation. Results: Of 80 studies identified, 20 met inclusion criteria representing 171,209 individuals. Time in target range 70-180 mg/dL (3.9-10.0 mmol/L) was the primary outcome in 65% of studies, with the majority of reports (71%) demonstrating a >10% change with AID use. Change in hemoglobin A1c (HbA1c) was reported in nine studies (range 0.1%-0.9%), whereas four reported changes in glucose management indicator (GMI) with a 0.1%-0.4% reduction noted. A decrease in HbA1c or GMI of >0.2% was achieved in two-thirds of the studies describing change in HbA1c and 80% of articles where GMI was described. Time below range <70 mg/dL (<3.9 mmol/L) was reported in 16 studies, with all but 1 study showing stable or reduced levels. Most systems had >90% time in automation. Conclusion: With larger and more diverse populations, and follow-up periods of longer duration (∼9 months vs. 3-6 months for pivotal trials), real-world retrospective analyses confirm pivotal trial findings. Given the glycemic benefits demonstrated, AID is rapidly becoming the standard of care for all people living with T1D. Individuals should be informed of these systems and differences between them, have access to and coverage for these technologies, and receive support as they integrate this mode of insulin delivery into their lives.
Collapse
Affiliation(s)
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
18
|
Nimri R, Phillip M, Clements MA, Kovatchev B. Closed-Loop Control, Artificial Intelligence-Based Decision-Support Systems, and Data Science. Diabetes Technol Ther 2024; 26:S68-S89. [PMID: 38441444 DOI: 10.1089/dia.2024.2505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Revital Nimri
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Clements
- Division of Pediatric Endocrinology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Boris Kovatchev
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
19
|
Lingen K, Maahs D, Bellini N, Isaacs D. Removing Barriers, Bridging the Gap, and the Changing Role of the Health Care Professional with Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:45-52. [PMID: 38377318 DOI: 10.1089/dia.2023.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
As all people with type 1 diabetes (T1D) and some with type 2 diabetes (T2D) require insulin, there is a need to develop management methods that not only achieve glycemic targets but also reduce the burden of living with diabetes. After insulin pumps and continuous glucose monitors, the next step in the evolution of diabetes technology is automated insulin delivery (AID) systems, which have transformed intensive insulin management over the past decade, as these systems address the shortcomings of previous management options. However, AID use remains fairly limited, and access represents a major barrier to use for many people with diabetes, despite these systems being standard of care. Therefore, the future of AID will necessitate addressing barriers related to social determinants of health, finances, and an expansion of the number and type of health care professionals (HCPs) prescribing AID systems. These crucial steps will be essential to ensure that everyone with intensively managed diabetes can use AID systems. The impact of implementing these changes will create a shift in the future of diabetes care that will result in achievement of more targeted glycemia and psychosocial outcomes for all people with diabetes and an expansion of the role of all HCPs in AID-related diabetes care. Even more importantly, by addressing social determinants of health and clinical inertia related to AID, the field can address disparities in outcomes across countries, race, gender, socioeconomic status, and insurance status. Furthermore, the increased use of AID system will provide more time during appointments for a shift in the discussion away from fine tuning insulin dosing and toward a focus on more topics related to behavior and conversations about general health. This will include psychosocial outcomes, and quality of life. In addition, these changes can hopefully allow for time to discuss more general issues, such as cardiovascular health, obesity prevention, diabetes-related complications, and other health-related concerns.
Collapse
Affiliation(s)
| | - David Maahs
- Division of Pediatric Endocrinology, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
| | - Natalie Bellini
- Department of Endocrinology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Diana Isaacs
- Endocrinology and Metabolism Institute, Cleveland Clinic, Ohio, USA
| |
Collapse
|
20
|
Wilkinson T, Tomic D, Boyle E, Burren D, Elghattis Y, Jenkins A, Keesing C, Middleton S, Nanayakkara N, Williman J, de Bock M, Cohen ND. Study protocol for a randomised open-label clinical trial examining the safety and efficacy of the Android Artificial Pancreas System (AAPS) with advanced bolus-free features in adults with type 1 diabetes: the 'CLOSE IT' (Closed Loop Open SourcE In Type 1 diabetes) trial. BMJ Open 2024; 14:e078171. [PMID: 38382954 PMCID: PMC10882371 DOI: 10.1136/bmjopen-2023-078171] [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: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Multiple automated insulin delivery (AID) systems have become commercially available following randomised controlled trials demonstrating benefits in people with type 1 diabetes (T1D). However, their real-world utility may be undermined by user-associated burdens, including the need to carbohydrate count and deliver manual insulin boluses. There is an important need for a 'fully automated closed loop' (FCL) AID system, without manual mealtime boluses. The (Closed Loop Open SourcE In Type 1 diabetes) trial is a randomised trial comparing an FCL AID system to the same system used as a hybrid closed loop (HCL) in people with T1D, in an outpatient setting over an extended time frame. METHODS AND ANALYSIS Randomised, open-label, parallel, non-inferiority trial comparing the Android Artificial Pancreas System (AAPS) AID algorithm used as FCL to the same algorithm used as HCL. Seventy-five participants aged 18-70 will be randomised (1:1) to one of two treatment arms for 12 weeks: (a) FCL-participants will be advised not to bolus for meals and (b) HCL-participants will use the AAPS AID algorithm as HCL with announced meals. The primary outcome is the percentage of time in target sensor glucose range (3.9-10.0 mmol/L). Secondary outcomes include other glycaemic metrics, safety, psychosocial factors, platform performance and user dietary factors. Twenty FCL arm participants will participate in a 4-week extension phase comparing glycaemic and dietary outcomes using NovoRapid (insulin aspart) to Fiasp (insulin aspart and niacinamide). ETHICS AND DISSEMINATION Approvals are by the Alfred Health Ethics Committee (615/22) (Australia) and Health and Disability Ethics Committees (2022 FULL 13832) (New Zealand). Each participant will provide written informed consent. Data protection and confidentiality will be ensured. Study results will be disseminated by publications, conferences and patient advocacy groups. TRIAL REGISTRATION NUMBERS ACTRN12622001400752 and ACTRN12622001401741.
Collapse
Affiliation(s)
- Tom Wilkinson
- University of Otago Christchurch, Christchurch, New Zealand
| | - Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erin Boyle
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Burren
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yasser Elghattis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alicia Jenkins
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Sonia Middleton
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | | | - Martin de Bock
- University of Otago Christchurch, Christchurch, New Zealand
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| |
Collapse
|
21
|
Schütz A, Rami-Merhar B, Schütz-Fuhrmann I, Blauensteiner N, Baumann P, Pöttler T, Mader JK. Retrospective Comparison of Commercially Available Automated Insulin Delivery With Open-Source Automated Insulin Delivery Systems in Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241230106. [PMID: 38366626 DOI: 10.1177/19322968241230106] [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: 02/18/2024]
Abstract
BACKGROUND Automated insulin delivery (AID) systems have shown to improve glycemic control in a range of populations and settings. At the start of this study, only one commercial AID system had entered the Austrian market (MiniMed 670G, Medtronic). However, there is an ever-growing community of people living with type 1 diabetes (PWT1D) using open-source (OS) AID systems. MATERIALS AND METHODS A total of 144 PWT1D who used either the MiniMed 670G (670G) or OS-AID systems routinely for a period of at least three to a maximum of six months, between February 18, 2020 and January 15, 2023, were retrospectively analyzed (116 670G aged from 2.6 to 71.8 years and 28 OS-AID aged from 3.4 to 53.5 years). The goal is to evaluate and compare the quality of glycemic control of commercially available AID and OS-AID systems and to present all data by an in-depth descriptive analysis of the population. No statistical tests were performed. RESULTS The PWT1D using OS-AID systems spent more time in range (TIR)70-180 mg/dL (81.7% vs 73.9%), less time above range (TAR)181-250 mg/dL (11.1% vs 19.6%), less TAR>250 mg/dL (2.5% vs 4.3%), and more time below range (TBR)54-69 mg/dL (2.2% vs 1.7%) than PWT1D using the 670G system. The TBR<54 mg/dL was comparable in both groups (0.3% vs 0.4%). In the OS-AID group, median glucose level and glycated hemoglobin (HbA1c) were lower than in the 670G system group (130 vs 150 mg/dL; 6.2% vs 7.0%). CONCLUSION In conclusion, both groups were able to achieve satisfactory glycemic outcomes independent of age, gender, and diabetes duration. However, the PWT1D using OS-AID systems attained an even better glycemic control with no clinical safety concerns.
Collapse
Affiliation(s)
- Anna Schütz
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Schütz-Fuhrmann
- Karl Landsteiner Institute, Endocrinology and Nephrology, Vienna, Austria
- Department of Endocrinology and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Nicole Blauensteiner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
22
|
Samuel P, Khan N, Klein G, Skobkarev S, Mammon B, Fournier M, Hawke K, Weissinger A, Elliott T. Open-source Artificial Pancreas Systems Are Safe and Effective When Supported In-clinic: Outcomes in 248 Consecutive Type 1 Diabetes Clients. Can J Diabetes 2024; 48:59-65.e1. [PMID: 37802366 DOI: 10.1016/j.jcjd.2023.09.003] [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: 06/26/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Our aim in this study was to determine the safety, glycemia, and quality of life (QoL) associated with in-clinic installation and management of supported open-source artificial pancreas systems (SOSAPS) in type 1 diabetes (T1D). METHODS This investigation is a retrospective cohort study of consecutive SOSAPS users at a Canadian diabetes centre. SOSAPS were offered to all moderately tech-savvy T1D clients on sensor-augmented multiple daily injection or pump, able to pay for hardware, and willing to sign a consent and waiver document. SOSAPS were installed and maintained by clinic staff at no cost to clients. iPhone users were assigned to either Loop (n=108) or iPhone artificial pancreas systems (iAPS; n=114) and Android users to Android-type APS (n=24). Outcomes included severe hypoglycemia and diabetic ketoacidosis (DKA), time in range (TIR) 4.0 to 10.0 mmol/L, time below range (TBR) <4 mmol/L, glucose management indicator (GMI), mean sensor glucose (MSG), change in glycated hemoglobin (A1C), and QoL. RESULTS Two hundred forty-eight subjects (131 males, 117 females), with a mean age of 36 years and diabetes duration of 21 years, experienced 3 episodes of severe hypoglycemia and no DKA over a follow-up of 17 months. TIR rose by 16%, from 64% to 80% (p<0.0001); TBR fell by 1.0%, from 3.5% to 2.5% (p=0.001); MSG fell from 9.0 to 8.1 mmol/L (p<0.001); GMI fell from 7.3% to 6.7% (p<0.001); and A1C fell from 7.2% to 6.7% (p<0.0001). QoL scores were healthy before and improved after SOSAPS. CONCLUSIONS Clients with T1D using SOSAPS and supported with no-cost care to the client (software, technology, and physician/physician assistant) safely achieved improved TIR, GMI, A1C, and QoL.
Collapse
Affiliation(s)
| | - Nabeel Khan
- BCDiabetes, Vancouver, British Columbia, Canada
| | - Gerri Klein
- BCDiabetes, Vancouver, British Columbia, Canada
| | | | | | | | - Kate Hawke
- BCDiabetes, Vancouver, British Columbia, Canada; Logan Endocrinology and Diabetes Service (LEADS), Logan Hospital, Meadowbrook, Queensland, Australia
| | | | - Tom Elliott
- BCDiabetes, Vancouver, British Columbia, Canada; Division of Endocrinology, University of British Columbia, Gordon and Leslie Diamond Centre, Vancouver, British Columbia, Canada.
| |
Collapse
|
23
|
Guerlich K, Patro-Golab B, Dworakowski P, Fraser AG, Kammermeier M, Melvin T, Koletzko B. Evidence from clinical trials on high-risk medical devices in children: a scoping review. Pediatr Res 2024; 95:615-624. [PMID: 37758865 PMCID: PMC10899114 DOI: 10.1038/s41390-023-02819-4] [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: 07/21/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Meeting increased regulatory requirements for clinical evaluation of medical devices marketed in Europe in accordance with the Medical Device Regulation (EU 2017/745) is challenging, particularly for high-risk devices used in children. METHODS Within the CORE-MD project, we performed a scoping review on evidence from clinical trials investigating high-risk paediatric medical devices used in paediatric cardiology, diabetology, orthopaedics and surgery, in patients aged 0-21 years. We searched Medline and Embase from 1st January 2017 to 9th November 2022. RESULTS From 1692 records screened, 99 trials were included. Most were multicentre studies performed in North America and Europe that mainly had evaluated medical devices from the specialty of diabetology. Most had enrolled adolescents and 39% of trials included both children and adults. Randomized controlled trials accounted for 38% of the sample. Other frequently used designs were before-after studies (21%) and crossover trials (20%). Included trials were mainly small, with a sample size <100 participants in 64% of the studies. Most frequently assessed outcomes were efficacy and effectiveness as well as safety. CONCLUSION Within the assessed sample, clinical trials on high-risk medical devices in children were of various designs, often lacked a concurrent control group, and recruited few infants and young children. IMPACT In the assessed sample, clinical trials on high-risk medical devices in children were mainly small, with variable study designs (often without concurrent control), and they mostly enrolled adolescents. We provide a systematic summary of methodologies applied in clinical trials of medical devices in the paediatric population, reflecting obstacles in this research area that make it challenging to conduct adequately powered randomized controlled trials. In view of changing European regulations and related concerns about shortages of high-risk medical devices for children, our findings may assist competent authorities in setting realistic requirements for the evidence level to support device conformity certification.
Collapse
Affiliation(s)
- Kathrin Guerlich
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
- Child Health Foundation - Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, Munich, Germany
| | - Bernadeta Patro-Golab
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | | | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Michael Kammermeier
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | - Tom Melvin
- Department of Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Berthold Koletzko
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany.
- Child Health Foundation - Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, Munich, Germany.
- European Academy of Paediatrics, Brussels, Belgium.
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S158-S178. [PMID: 38078590 PMCID: PMC10725810 DOI: 10.2337/dc24-s009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
26
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [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] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
27
|
Braune K, Hussain S, Lal R, Leibrand S, Lewis DM, O'Donnell S. Breaking a feedback loop: A reassessment of an investigator initiated OS-AID study. Diabetes Obes Metab 2024; 26:400-402. [PMID: 37795622 DOI: 10.1111/dom.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Katarina Braune
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King's College London, London, UK
| | - Rayhan Lal
- Department of Medicine & Pediatrics, Divisions of Endocrinology, Stanford University, Stanford, California, USA
| | | | | | | |
Collapse
|
28
|
Kubo H, Sugimoto K. Two Cases With Type 1 Diabetes Treated With Insulin Pump Therapy Using a Telemedicine Approach During the COVID-19 Pandemic. Cureus 2024; 16:e51607. [PMID: 38313889 PMCID: PMC10837046 DOI: 10.7759/cureus.51607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Type 1 diabetes mellitus (T1D) is an autoimmune-related disease resulting in insulin dependency, treated with insulin injection via pen devices or continuous subcutaneous insulin infusion (CSII). Face-to-face instruction for managing insulin injection and dosing and machine-to-device troubleshooting are required early to initiate CSII from insulin injections. Thus, T1D individuals may encounter significant barriers to pen devices or CSII introduction if they live in remote rural areas. In this regard, intermittently scanned continuous glucose monitoring (isCGM) can share visualized glucose profiles via a cloud-platform-based system, offering the potential as an effective tool in telemedicine. Herewith, we report two cases of subjects with T1D living in remote rural areas whose CSII was safely introduced in outpatient settings with the aid of cloud-platform-based isCGM and a video-meeting tool. They showed improved glucose profiles after CSII initiation. Even under the coronavirus disease 2019 (COVID-19) pandemic, the telemedicine system enabled healthcare providers to monitor glucose profiles and confirm device procedures of CSII. We emphasize the usefulness of online instruction with cloud-platform-based isCGM for introducing CSII in cases with barriers to healthcare access, particularly during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Haremaru Kubo
- Diabetes Center, Ohta Nishinouchi Hospital, Koriyama, JPN
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, JPN
| | | |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Schipp J, Hendrieckx C, Braune K, Knoll C, O'Donnell S, Ballhausen H, Cleal B, Wäldchen M, Lewis DM, Gajewska KA, Skinner TC, Speight J. Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes. J Med Internet Res 2023; 25:e44002. [PMID: 38096018 PMCID: PMC10755653 DOI: 10.2196/44002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/10/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emerging research suggests that open-source automated insulin delivery (AID) may reduce diabetes burden and improve sleep quality and quality of life (QoL). However, the evidence is mostly qualitative or uses unvalidated, study-specific, single items. Validated person-reported outcome measures (PROMs) have demonstrated the benefits of other diabetes technologies. The relative lack of research investigating open-source AID using PROMs has been considered a missed opportunity. OBJECTIVE This study aimed to examine the psychosocial outcomes of adults with type 1 diabetes using and not using open-source AID systems using a comprehensive set of validated PROMs in a real-world, multinational, cross-sectional study. METHODS Adults with type 1 diabetes completed 8 validated measures of general emotional well-being (5-item World Health Organization Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), diabetes-specific QoL (modified DAWN Impact of Diabetes Profile), diabetes-specific positive well-being (4-item subscale of the 28-item Well-Being Questionnaire), diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire), diabetes distress (20-item Problem Areas in Diabetes scale), fear of hypoglycemia (short form of the Hypoglycemia Fear Survey II), and a measure of the impact of COVID-19 on QoL. Independent groups 2-tailed t tests and Mann-Whitney U tests compared PROM scores between adults with type 1 diabetes using and not using open-source AID. An analysis of covariance was used to adjust for potentially confounding variables, including all sociodemographic and clinical characteristics that differed by use of open-source AID. RESULTS In total, 592 participants were eligible (attempting at least 1 questionnaire), including 451 using open-source AID (mean age 43, SD 13 years; n=189, 41.9% women) and 141 nonusers (mean age 40, SD 13 years; n=90, 63.8% women). Adults using open-source AID reported significantly better general emotional well-being and subjective sleep quality, as well as better diabetes-specific QoL, positive well-being, and treatment satisfaction. They also reported significantly less diabetes distress, fear of hypoglycemia, and perceived less impact of the COVID-19 pandemic on their QoL. All were medium-to-large effects (Cohen d=0.5-1.5). The differences between groups remained significant after adjusting for sociodemographic and clinical characteristics. CONCLUSIONS Adults with type 1 diabetes using open-source AID report significantly better psychosocial outcomes than those not using these systems, after adjusting for sociodemographic and clinical characteristics. Using validated, quantitative measures, this real-world study corroborates the beneficial psychosocial outcomes described previously in qualitative studies or using unvalidated study-specific items.
Collapse
Affiliation(s)
- Jasmine Schipp
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- Section for Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
| | - Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Christine Knoll
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Shane O'Donnell
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | - Hanne Ballhausen
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mandy Wäldchen
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
| |
Collapse
|
31
|
Weiss R. Closed loop insulin delivery-Opportunities and limitations. J Diabetes 2023; 15:1103-1106. [PMID: 37855262 PMCID: PMC10755602 DOI: 10.1111/1753-0407.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Ram Weiss
- Department of PediatricsRuth Children's Hospital, Rambam Medical Center and the Bruce Rappaport School of Medicine at the TechnionHaifaIsrael
| |
Collapse
|
32
|
Wu Z, Talbo M, Lebbar M, Messier V, Courchesne A, Brazeau AS, Rabasa-Lhoret R. Characteristics associated with having a hemoglobin A1c ≤ 7 % (≤53 mmol/mol) among adults with type 1 diabetes using an automated insulin delivery system. Diabetes Res Clin Pract 2023; 206:111006. [PMID: 37952601 DOI: 10.1016/j.diabres.2023.111006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND We aim to investigate which characteristics are associated with having an HbA1c ≤ 7 % (≤53 mmol/mol) among adult automated insulin delivery (AID) users living with type 1 diabetes (T1D). METHODS Cross-sectional study using data from the T1D BETTER registry. INCLUSION CRITERIA aged ≥ 18 years old, using a commercial AID system, and with a reported HbA1c range value. Participants were divided into two groups (HbA1c ≤ 7 % group, N = 57; and HbA1c > 7 % group, N = 74). RESULTS A total of 131 participants were included: 61.8 % females, median age (Q1-Q3) was 43.0 (30.0, 55.0) years, and median duration of T1D was 24.0 (16.0, 36.0) years. Logistic regression analysis suggested that participants with a bachelor's degree or above were more likely (OR 3.04, 95 %CI 1.22, 7.58; P = 0.017) and with a longer duration of pump use were less likely (OR 0.90, 95 %CI 0.84, 0.98; P = 0.009) to report an HbA1c ≤ 7 % when using an AID, after adjusting for age, sex, body mass index, and annual household income. CONCLUSIONS Our study indicates that among AID users, in order to maximize benefits, additional support is needed for those who do not have a bachelor's degree and/or who have been using an insulin pump for a long time.
Collapse
Affiliation(s)
- Zekai Wu
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, H3A 0G4, Canada; Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada.
| | - Meryem Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Virginie Messier
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Alec Courchesne
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Remi Rabasa-Lhoret
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, H3A 0G4, Canada; Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada; Division of Endocrinology and Metabolism, Centre hospitalier de l'Université de montréal, 1051 Rue Sanguinet, Montréal, Quebec, H2X 3E4, Canada
| |
Collapse
|
33
|
Mesa A, Beneyto A, Martín-SanJosé JF, Viaplana J, Bondia J, Vehí J, Conget I, Giménez M. Safety and performance of a hybrid closed-loop insulin delivery system with carbohydrate suggestion in adults with type 1 diabetes prone to hypoglycemia. Diabetes Res Clin Pract 2023; 205:110956. [PMID: 37844798 DOI: 10.1016/j.diabres.2023.110956] [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: 05/30/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
AIMS To evaluate the safety and performance of a hybrid closed-loop (HCL) system with automatic carbohydrate suggestion in adults with type 1 diabetes (T1D) prone to hypoglycemia. METHODS A 32-hour in-hospital pilot study, including a night period, 4 meals and 2 vigorous unannounced 45-minute aerobic sessions, was conducted in 11 adults with T1D prone to hypoglycemia. The primary outcome was the percentage of time in range 70-180 mg/dL (TIR). Main secondary outcomes were time below range < 70 mg/dL (TBR < 70) and < 54 (TBR < 54). Data are presented as median (10th-90th percentile ranges). RESULTS The participants, 6 (54.5%) men, were 24 (22-48) years old, and had 22 (9-32) years of T1D duration. All of them regularly used an insulin pump and a continuous glucose monitoring system. The median TIR was 78.7% (75.6-91.2): 92.7% (68.2-100.0) during exercise and recovery period, 79.3% (34.9-100.0) during postprandial period, and 95.4% (66.4-100.0) during overnight period. The TBR < 70 and TBR < 54 were 0.0% (0.0-6.6) and 0.0% (0.0-1.2), respectively. A total of 4 (3-9) 15-g carbohydrate suggestions were administered per person. No severe acute complications occurred during the study. CONCLUSIONS The HCL system with automatic carbohydrate suggestion performed well and was safe in this population during challenging conditions in a hospital setting.
Collapse
Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aleix Beneyto
- Institute of Informatics and Applications, University of Girona, Girona, Spain
| | - Juan-Fernando Martín-SanJosé
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Judith Viaplana
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain
| | - Josep Vehí
- Institute of Informatics and Applications, University of Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain.
| |
Collapse
|
34
|
Biester T, Eckert A, Becker M, Boettcher C, Golembowski S, Heidtmann B, Klinkert C, Müther S, Rami-Merhar B, Holl RW. Expected Basal Insulin Requirement During Continuous Subcutaneous Insulin Infusion Therapy by Age Group, Sex, and Body Mass Index, Based on 25,718 Young People with Type 1 Diabetes in the DPV Registry. Diabetes Technol Ther 2023; 25:774-781. [PMID: 37668604 DOI: 10.1089/dia.2023.0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background: Since the introduction of insulin pumps into the therapy of pediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods: We included all recent basal profiles from type 1 diabetes (T1D) patients between 1 and 25 years from the DPV 2021 data pool. We excluded night-time-only pump users, human regular insulin users, and daily basal rates <0.05 and >1.0 U/(kgBW·d). Results: In the analysis of profiles from 25,718 young persons with T1D, differences in the daily pattern of basal rates were found between age groups. In addition, we saw significant (P < 0.001) differences in total daily basal dose between genders in all age groups except adults. In addition, the shape of the expected basal-rate pattern differed by body mass index, HbA1c, and use of continuous glucose monitoring. Discussion: This analysis demonstrates multiple factors influencing basal patterns and insulin requirement, including age group, gender, overweight, HbA1c, bolus frequency, and sensor use. As circadian basal rates are still mandatory for initiating insulin pump therapy with or without automation, a multimodal approach is necessary to estimate optimal basal rates.
Collapse
Affiliation(s)
- Torben Biester
- AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Alexander Eckert
- University of Ulm, Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research e.V., Munich-Neuherberg, Germany
| | - Marianne Becker
- Centre Hospitalier de Luxembourg, DECCP, Luxembourg, Luxembourg
| | - Claudia Boettcher
- Department of Paediatrics, Division of Paediatric Endocrinology, Diabetology & Metabolism, University of Bern, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sven Golembowski
- Sana Klinikum Lichtenberg, Diabetes Center for Children and Adolescents, Berlin, Germany
| | | | | | - Silvia Müther
- DRK Kliniken Berlin Westend, Diabetes Center for Children and Adolescents, Berlin, Germany
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Reinhard W Holl
- University of Ulm, Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research e.V., Munich-Neuherberg, Germany
| |
Collapse
|
35
|
Benhamou PY, Adenis A, Lablanche S, Franc S, Amadou C, Penfornis A, Kariyawasam D, Beltrand J, Charpentier G. First Generation of a Modular Interoperable Closed-Loop System for Automated Insulin Delivery in Patients With Type 1 Diabetes: Lessons From Trials and Real-Life Data. J Diabetes Sci Technol 2023; 17:1433-1439. [PMID: 37449762 PMCID: PMC10658690 DOI: 10.1177/19322968231186976] [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: 07/18/2023]
Abstract
BACKGROUND DBLG1 (Diabeloop Generation 1) stands as one of the five commercially available closed-loop solution worldwide for patients with type 1 diabetes as of 2023. Our aim was to provide an overview of all data obtained with this system regarding outcomes and populations, with an emphasis on interoperability. METHODS This report includes all available sources of data (three randomized control trials and five surveys on real-life data). Collection ran from March 3, 2017 to April 30, 2022. RESULTS We gathered data from 6859 adult patients treated with closed-loop from three to 12 months. Overall, all sources of data showed that time in range (TIR) 70 to 180 mg/dL, starting from 47.4% to 56.6%, improved from 12.2 to 17.3 percentage points. Time in hypoglycemia was reduced by 48% in average (range: 26%-70%) and reached a level of 1.3% in the largest and most recent cohort. In patients with excessive time in hypoglycemia at baseline (≥5%), closed-loop allowed a reduction in time below range (TBR) by 59%. The comparison of days with declared physical activity versus days without physical activity did not show differences in TBR. The improvement in TIR observed with three different pump systems (Vicentra Kaleido, n = 117; Sooil Dana-I, n = 84; and Roche Insight, n = 6684) ranged from 15.4 to 17.3 percentage points. DISCUSSION These data obtained in different European countries were consistent throughout all reports, showing that this closed-loop system is efficient (high improvement in TIR), safe (remarkably low level of TBR), and interoperable (three pump settings so far).
Collapse
Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble
University Hospital, Grenoble Alpes University, INSERM U1055, Laboratory of
Fundamental and Applied Bioenergetics, Grenoble, France
- Endocrinology, Centre Hospitalier
Universitaire Grenoble Alpes, Grenoble Alpes University, Grenoble, France
| | | | - Sandrine Lablanche
- Department of Endocrinology, Grenoble
University Hospital, Grenoble Alpes University, INSERM U1055, Laboratory of
Fundamental and Applied Bioenergetics, Grenoble, France
| | - Sylvia Franc
- Center for Study and Research for
Improvement of the Treatment of Diabetes, Bioparc-Genopole Evry-Corbeil, Evry,
France
- Department of Diabetes and
Endocrinology, Sud-Francilien Hospital, Corbeil-Essonnes, France
- Department of Endocrinology,
Diabetology & Metabolic Diseases, Sud-Francilien Hospital, Paris-Saclay
University, Corbeil-Essonnes, France
| | - Coralie Amadou
- Department of Endocrinology,
Diabetology & Metabolic Diseases, Sud-Francilien Hospital, Paris-Saclay
University, Corbeil-Essonnes, France
| | - Alfred Penfornis
- Department of Endocrinology,
Diabetology & Metabolic Diseases, Sud-Francilien Hospital, Paris-Saclay
University, Corbeil-Essonnes, France
| | - Dulanjalee Kariyawasam
- Paediatric Endocrinology, Diabetology,
Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance
Publique des Hôpitaux de Paris-Centre, Paris, France
- Paris Cite University, Paris,
France
| | - Jacques Beltrand
- Paediatric Endocrinology, Diabetology,
Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance
Publique des Hôpitaux de Paris-Centre, Paris, France
- Paris Cite University, Paris,
France
| | - Guillaume Charpentier
- Center for Study and Research for
Improvement of the Treatment of Diabetes, Bioparc-Genopole Evry-Corbeil, Evry,
France
- Department of Diabetes and
Endocrinology, Sud-Francilien Hospital, Corbeil-Essonnes, France
| |
Collapse
|
36
|
Jacobsen LM, Sherr JL, Considine E, Chen A, Peeling SM, Hulsmans M, Charleer S, Urazbayeva M, Tosur M, Alamarie S, Redondo MJ, Hood KK, Gottlieb PA, Gillard P, Wong JJ, Hirsch IB, Pratley RE, Laffel LM, Mathieu C. Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:132. [PMID: 37794113 PMCID: PMC10550996 DOI: 10.1038/s43856-023-00358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care. METHODS Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years). RESULTS We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact. CONCLUSIONS Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Selma Alamarie
- Stanford University School of Medicine, Stanford, CA, USA
| | - Maria J Redondo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Peter A Gottlieb
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jessie J Wong
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Cooper D, Reinhold B, Shahid A, Lewis DM. Glucose Variability Analysis in Two Large-Scale and Real-World Data Sets of Open-Source Automated Insulin Delivery Systems. J Diabetes Sci Technol 2023:19322968231198871. [PMID: 37750308 DOI: 10.1177/19322968231198871] [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: 09/27/2023]
Abstract
BACKGROUND Open-source automated insulin delivery (OS-AID) systems combine commercially available insulin pumps and continuous glucose monitors with open-source algorithms to automate insulin dosing for people with insulin-requiring diabetes. Two data sets (OPEN and the OpenAPS Data Commons) contain anonymized OS-AID user data. METHODS We assessed glycemic variability (GV) outcomes in the OPEN data set and characterized it alongside a comparison to the n = 122 version of the OpenAPS Data Commons. Glucose data are analyzed using an unsupervised machine learning algorithm for clustering, and GV metrics are quantified using statistical tests for distribution comparison. Demographic data are also analyzed quantitatively. RESULTS The n = 75 OPEN data set contains 36 827 days worth of data. Mean TIR is 82.08% (TOR < 70: 3.66%; TOR > 180: 14.3%). LBGI (P < .05) differs by gender whereas HBGI distributions are similar (P > .05). GV metrics (except TOR < 70, LBGI) show a statistically significant difference (P < .05) between data sets. CONCLUSIONS Both the OPEN and OpenAPS Data Commons data sets show TOR < 70, TIR, and TOR > 180 within recommended goals, adding additional evidence of real-world efficacy of OS-AID. Future research should evaluate in more detail potential data set differences and relationships between individual patterns of user behaviors and GV outcomes.
Collapse
Affiliation(s)
- Drew Cooper
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Arsalan Shahid
- CeADAR, Ireland's Centre for Applied AI, University College Dublin, Dublin, Ireland
| | | |
Collapse
|
39
|
Braune K, Hussain S, Lal R. The First Regulatory Clearance of an Open-Source Automated Insulin Delivery Algorithm. J Diabetes Sci Technol 2023; 17:1139-1141. [PMID: 37051947 PMCID: PMC10563523 DOI: 10.1177/19322968231164166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Open-source Automated Insulin Dosing (OS-AID) algorithms are made publicly accessible so that every facet of their operation can be understood. Currently, commercial AID algorithms are kept proprietary trade secrets, despite the role they take in making life and death decisions for people living with type 1 diabetes. Loop was the second OS-AID algorithm, developed initially by Nate Racklyeft and Pete Schwamb. In 2018, the nonprofit organization Tidepool (Palo Alto, CA) announced the launch of the "Tidepool Loop" initiative with the aim to generate real-world evidence and obtain regulatory clearance. By the end of 2020, the U.S. Food and Drug Administration received Tidepool's application for an interoperable automated glycemic controller based on Loop. After 2 years, the FDA approved the Tidepool Loop on January 23, 2023.
Collapse
Affiliation(s)
- Katarina Braune
- Institute of Medical Informatics, Berlin Institute of Health at Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, UK
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Rayhan Lal
- Department of Medicine, Divisions of Endocrinology, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Divisions of Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| |
Collapse
|
40
|
Lewis DM. Harnessing wearables and mobile phones to improve glycemic outcomes with automated insulin delivery. Lancet Digit Health 2023; 5:e548-e549. [PMID: 37543513 DOI: 10.1016/s2589-7500(23)00127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 08/07/2023]
|
41
|
Winterdijk P, Aanstoot HJ, Nefs G. The impact of real-time sensor technology on quality of life for adults with type 1 diabetes: A Dutch national survey. Diabetes Res Clin Pract 2023; 203:110886. [PMID: 37604282 DOI: 10.1016/j.diabres.2023.110886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIMS To examine the impact of real-time continuous glucose monitoring (RT-CGM) on quality of life in Dutch adults with type 1 diabetes, inside/outside automated insulin delivery (AID) systems. METHODS In this cross-sectional retrospective observational study, RT-CGM users completed an online survey including (adapted) validated questionnaires, study-specific items and open-ended questions. RESULTS Of 893 participating adults, 69% used the RT-CGM as part of AID. The overall sample reported improvements in quality of life related to RT-CGM use (irrespective of initial indication), particularly with respect to physical health, emotional wellbeing and energy. Merits for sleep, intimacy and cognitive diabetes load lagged somewhat behind, mostly when RT-CGM was not integrated in AID. Users of AID had significantly larger improvements in overall quality of life, fatigue and diabetes-specific distress than users of sensor-augmented pump or Open Loop treatment. In regression analyses, user evaluations were associated with perceptions of benefit and burden. In qualitative content analysis, benefits (e.g. life 'normalization', increased perceptions of control) outweighed burdens (e.g. technology frustrations, confrontation with diabetes). CONCLUSIONS RT-CGM positively impacted the quality of life of adults with type 1 diabetes. This justifies a (re-)consideration of broader access. Increased support to maximize device benefits and minimize burdens is also warranted.
Collapse
Affiliation(s)
- Per Winterdijk
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Henk-Jan Aanstoot
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Giesje Nefs
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands; Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
| |
Collapse
|
42
|
Dovc K, Bergford S, Fröhlich-Reiterer E, Zaharieva DP, Potocnik N, Müller A, Lenarcic Z, Calhoun P, Fritsch M, Sourij H, Bratina N, Kollman C, Battelino T. A Comparison of Faster Insulin Aspart with Standard Insulin Aspart Using Hybrid Automated Insulin Delivery System in Active Children and Adolescents with Type 1 Diabetes: A Randomized Double-Blind Crossover Trial. Diabetes Technol Ther 2023; 25:612-621. [PMID: 37404205 PMCID: PMC10460686 DOI: 10.1089/dia.2023.0178] [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: 07/06/2023]
Abstract
Objective: To evaluate the use of faster acting (FIA) and standard insulin aspart (SIA) with hybrid automated insulin delivery (AID) in active youth with type 1 diabetes. Research Design and Methods: In this double-blind multinational randomized crossover trial, 30 children and adolescents with type 1 diabetes (16 females; aged 15.0 ± 1.7 years; baseline HbA1c 7.5% ± 0.9% [58 ± 9.8 mmol/mol]) underwent two unrestricted 4-week periods using hybrid AID with either FIA or SIA in random order. During both interventions, participants were using the hybrid AID (investigational version of MiniMed™ 780G; Medtronic). Participants were encouraged to exercise as frequently as possible, capturing physical activity with an activity monitor. The primary outcome was the percentage of sensor glucose time above range (180 mg/dL [10.0 mmol/L]) measured by continuous glucose monitoring. Results: In an intention-to-treat analysis, mean time above range was 31% ± 15% at baseline, 19% ± 6% during FIA use, and 20% ± 6% during SIA use with no difference between treatments: mean difference = -0.9%; 95% CI: -2.4% to 0.6%; P = 0.23. Similarly, there was no difference in mean time in range (TIR) (78% and 77%) or median time below range (2.5% and 2.8%). Glycemic outcomes during exercise or postprandial periods were comparable for the two treatment arms. No severe hypoglycemia or diabetic ketoacidosis events occurred. Conclusions: FIA was not superior to SIA with hybrid AID system use in physically active children and adolescents with type 1 diabetes. Nonetheless, both insulin formulations enabled high overall TIR and low time above and below ranges, even during and after documented exercise. Trial Registration Clinicaltrials.gov: NCT04853030.
Collapse
Affiliation(s)
- Klemen Dovc
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simon Bergford
- Jaeb Center for Health Research Foundation, Inc., Tampa, Florida, USA
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Nejka Potocnik
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
| | - Alexander Müller
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Ziva Lenarcic
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Calhoun
- Jaeb Center for Health Research Foundation, Inc., Tampa, Florida, USA
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Natasa Bratina
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Craig Kollman
- Jaeb Center for Health Research Foundation, Inc., Tampa, Florida, USA
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
43
|
Lei M, Lin B, Ling P, Liu Z, Yang D, Deng H, Yang X, Lv J, Xu W, Yan J. Efficacy and safety of Android artificial pancreas system use at home among adults with type 1 diabetes mellitus in China: protocol of a 26-week, free-living, randomised, open-label, two-arm, two-phase, crossover trial. BMJ Open 2023; 13:e073263. [PMID: 37558445 PMCID: PMC10414065 DOI: 10.1136/bmjopen-2023-073263] [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: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Do-it-yourself artificial pancreas system (DIY APS) is built using commercially available insulin pump, continuous glucose monitoring (CGM) and an open-source algorithm. Compared with commercial products, DIY systems are affordable, allow personalised settings and provide updated algorithms, making them a more promising therapy for most patients with type 1 diabetes mellitus (T1DM). Many small and self-reported observational studies have found that their real-world use was associated with potential metabolic and psychological benefits. However, rigorous-designed studies are urgently needed to confirm its efficacy and safety. METHODS AND ANALYSIS In this 26-week randomised, open-label, two-arm, two-phase, crossover trial, participants aged 18-75 years, with T1DM and glycated haemoglobin (HbA1c) 7-11%, will use AndroidAPS during one 12-week period and sensor-augmented pump during another 12-week period. This study will recruit at least 24 randomised participants. AndroidAPS consists of three components: (1) real-time CGM; (2) insulin pump; (3) AndroidAPS algorithm implemented in Android smartphone. The primary endpoint is time in range (3.9-10.0 mmol/L) derived from CGM. The main secondary endpoints include percentage of sensor glucose values below, within and above target range; mean sensor glucose value; measures of glycaemic variability and centralised HbA1c. Safety endpoints mainly include the frequency of hypoglycaemia events, diabetic ketoacidosis and other serious adverse events. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University. There will be verbal and written information regarding the trial given to each participant. The study will be disseminated through peer-reviewed publications and conference presentations. OVERALL STATUS Recruiting. STUDY START 11 February 2023. PRIMARY COMPLETION 31 July 2024. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05726461).
Collapse
Affiliation(s)
- Mengyun Lei
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Beisi Lin
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Ling
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhigu Liu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xubin Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Lv
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
44
|
Drew L. A DIY 'bionic pancreas' is changing diabetes care - what's next? Nature 2023; 620:940-941. [PMID: 37648761 DOI: 10.1038/d41586-023-02648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
45
|
Halperin IJ, Chambers A, Covello L, Farnsworth K, Morrison AE, Schuklenk U, Witteman HO, Senior P, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, Mackay D, Mansell K, Rabi D, Senior P, Sherifali D. Do-It-Yourself Automated Insulin Delivery: A Position Statement. Can J Diabetes 2023; 47:381-388. [PMID: 37532365 DOI: 10.1016/j.jcjd.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
|
46
|
Sobhani NC, Killion M, Patzek S. Use of Open-Source Automated Insulin Delivery Systems in Pregnancies With Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:1126-1128. [PMID: 37062960 PMCID: PMC10347983 DOI: 10.1177/19322968231169777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Nasim C. Sobhani
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Molly Killion
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sophie Patzek
- Division of Endocrinology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Nir J, Rachmiel M, Fraser A, Lebenthal Y, Brener A, Pinhas-Hamiel O, Haim A, Stern E, Levek N, Ben-Ari T, Landau Z. Open-source automated insulin delivery systems (OS-AIDs) in a pediatric population with type 1 diabetes in a real-life setting: the AWeSoMe study group experience. Endocrine 2023:10.1007/s12020-023-03398-4. [PMID: 37222881 DOI: 10.1007/s12020-023-03398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE The use of open-source automated insulin delivery systems (OS-AIDs), for the management of type 1 diabetes (T1D), has increased over recent years in all age groups. Real-life data has demonstrated the safety and efficacy of these systems, however, studies in the pediatric population remain limited. In this study, we aimed to examine the effect of transition to an OS-AIDs on glycemic parameters, and on several aspects related to quality of life. In addition, we aimed to characterize the socioeconomic position of families who chose this treatment modality, assess their motivations to do so, and evaluate treatment satisfaction. METHODS In this multi-center observational real-life study from the AWeSoMe Group, we compared glycemic parameters of 52 individuals with T1D (56% males, mean diabetes duration 4.2 ± 3.9 years), from the last clinic visit prior to OS-AIDs initiation to the most recent clinic visit while using the system. Socioeconomic position (SEP) index was retrieved from the Israel Central Bureau of Statistics. Caregivers completed questionnaires assessing reasons for system initiation and treatment satisfaction. RESULTS Mean age at OS-AIDs initiation was 11.2 ± 4 years, range 3.3-20.7 years with a median usage duration of 11.1 months (range 3-45.7). Mean SEP Index was 1.033 ± 0.956 (value range: -2.797 to 2.590). Time in range (TIR) of 70 to 180 mg/dl increased from 69.0 ± 11.9 to 75.5 ± 11.7%, (P < 0.001), and HbA1c decreased from 6.9 ± 0.7 to 6.4 ± 0.6%, (P < 0.001). Time in tight range (TITR) of 70 to 140 mg/dl increased from 49.7 ± 12.9 to 58.8 ± 10.8% (P < 0.001). No episodes of severe hypoglycemia or DKA were reported. Reduction in diabetes burden and sleep quality improvement were the main reasons for OS-AID initiation. CONCLUSIONS In our cohort of youth with T1D, the transition to an OS-AID resulted in greater TIR and less severe hypoglycemia regardless of age, diabetes duration or SEP, which was found to be above average. The overall improvement in glycemic parameters in our study population with excellent baseline glycemic control, provides additional evidence of beneficence and efficacy of OS-AIDs in the pediatric population.
Collapse
Affiliation(s)
- Judith Nir
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Marianna Rachmiel
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yael Lebenthal
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Avivit Brener
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Juvenile Diabetes Center, Maccabi Healthcare Services, Raanana, Israel
| | - Alon Haim
- Pediatric Endocrinology and Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eve Stern
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Levek
- Juvenile Diabetes Center, Maccabi Healthcare Services, Raanana, Israel
| | - Tal Ben-Ari
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Zohar Landau
- Juvenile Diabetes Center, Maccabi Healthcare Services, Raanana, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
49
|
Simkovich SM, Foeller ME, Tunçalp Ö, Papageorghiou A, Checkley W. Integrating non-communicable disease prevention and control into maternal and child health programmes. BMJ 2023; 381:e071072. [PMID: 37220922 PMCID: PMC10203824 DOI: 10.1136/bmj-2022-071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Suzanne M Simkovich
- Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington USA
| | - Megan E Foeller
- Department of Obstetrics and Gynaecology, St Alphonsus Regional Medical Center, Boise, USA
| | - Özge Tunçalp
- UNDP, UNFPA, Unicef, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Aris Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
50
|
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: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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.
Collapse
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.
| |
Collapse
|