Materiały źródłowe

• #1

  https://link.springer.com/article/10.1007/s41745-022-00348-3

  Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGMs), insulin-delivery devices, and hybrid closed loop systems. […] We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care. […] The role of continuous glucose sensors in diabetes care. […] Continuous home monitoring of glucose: improved glycemic control with real-life use of continuous glucose sensors in adult subjects with type 1 diabetes. […] The future of continuous glucose monitoring. […] Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. […] Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes.

• #2 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2022.0271

  Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. […] The combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. […] AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. […] These advances in technology could reduce the burden associated with insulin treatment for diabetes. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%.

• #3 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. […] Continuous glucose monitoring systems (CGMS) are now minimally invasive and more accurate. […] These closed-loop systems also referred to as the artificial pancreas have been likened to the holy grail of diabetes management as they have the potential to improve glycemic outcomes and reduce disease burden. […] Hybrid closed-loop systems aim to minimize hypoglycemia and hyperglycemia and maintain glucose levels within a target range through the use of a computerized algorithm to adjust the basal rate of insulin and administer corrective bolus doses. […] Development of the first hybrid closed-loop systems began in parallel with LGS technology. […] A pivotal trial by Weinzimer et al. in 2008 was the first to show that a hybrid closed-loop system significantly improved overnight time spent in the normoglycemic range compared to conventional open-loop insulin delivery.

• #4 Continuous glucose monitoring for inpatient diabetes management: an update on current evidence and practice in: Endocrine Connections Volume 12 Issue 10 (2023)

  https://ec.bioscientifica.com/view/journals/ec/12/10/EC-23-0180.xml

  Over the last few years, several exciting changes in continuous glucose monitoring (CGM) technology have expanded its use and made CGM the standard of care for patients with type 1 and type 2 diabetes using insulin therapy. […] Several studies have also suggested that CGM has the potential to become the standard of care for some hospitalized patients, overcoming the limitations of current capillary glucose testing. […] Newer factory-calibrated continuous glucose monitoring (CGM) systems have revolutionized the care of patients with diabetes, making it simpler, less burdensome, less painful, and providing a comprehensive overview of glycemic excursions. […] Despite its benefits in the outpatient setting, CGM use in the hospital for glycemic monitoring or optimization is not yet approved by regulatory entities, despite being widely used during and after the coronavirus disease 2019 (COVID-19) pandemic.

• #5 Diabetes technology: A primer for clinicians | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/353

  Diabetes technology is evolving rapidly and is changing the way both patients and clinicians approach the management of diabetes. […] We provide a summary of the commonly available devices in the market today that clinicians will likely encounter. This includes continuous glucose monitors (CGMs); connected insulin pens, caps, and buttons; and insulin pumps. Clinicians awareness of and familiarity with this technology will enhance its accessibility for patients with diabetes. […] CGMs measure interstitial glucose and transmit data wirelessly to a receiver. Evidence supports their use in patients on insulin therapy or who are at a high risk of hypoglycemia. […] Technology in diabetes management has come a long way. Devices measure glucose levels continuously (continuous glucose monitors, or CGMs), make it easier for patients to calculate insulin doses (smart pens, caps, buttons), and deliver insulin based on an algorithm (hybrid closed-loop insulin pumps). These devices help patients manage their diabetes in a manner consistent with their goals and lifestyle.

• #6 Hybrid closed loop technology (artificial pancreas) | Breakthrough T1D UK

  https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/

  Using a hybrid closed loop system eases the burden of type 1 but doesnt mean that type 1 treatment is completely automated. […] You will still need to keep an eye on your glucose levels and take action if the system isnt keeping your glucose in target range, which might suggest that your insulin infusion site isnt working well. […] Nearly 20 years of Breakthrough T1D UK research has pushed forward the development of hybrid closed loop technology, changing the lives of people living with type 1. […] Continuous glucose monitoring can help you manage your glucose levels in real-time and relieve the burden of having to do multiple finger prick tests throughout the day.

• #7 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  The CGM device measures interstitial glucose every 15 minutes and transmits data by Bluetooth to the insulin management algorithm on either the pump or the smartphone. The algorithm autoregulates pulsed insulin delivery from the insulin pump, constantly adjusting in response to CGM data. […] There is high-quality evidence that HCL technology results in better glycaemic control than insulin pump or sensor-augmented pump therapy, achieving more time in target glycaemic range, less time in hyper- and hypoglycaemia, less severe hypoglycaemia and improved HbA1c. […] Most importantly, HCL is associated with improved quality of life; generally positive user experience, including reassurance and reduced anxiety; improved sleep and confidence; and a reduction in the demands of living with type 1 diabetes.

• #8 Insulin Pumps, Continous Glucose Monitoring and Associated Products

  https://www.supplychain.nhs.uk/product-information/contract-launch-brief/insulin-pumps-and-associated-products/

  NICE guidelines for Hybrid Closed Loop (HCL) systems for managing blood glucose in type 1 diabetes […] A continuous glucose monitor is a small device that is worn just under the skin. It measures glucose (sugar) levels continuously throughout the day and night, letting the wearer see trends in their levels, and alerts them to highs and lows. […] Products that connect with blood glucose sensors and insulin pumps automatically increase, decrease, or stop the delivery of insulin in response to the glucose levels of people with diabetes. […] Diabetes Management Systems that allow for the uploading of information from insulin pumps, CGMs, glucose meters, and mobile applications.

• #9 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. […] The combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. […] AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. […] These advances in technology could reduce the burden associated with insulin treatment for diabetes. […] Achieving target glycosylated hemoglobin (HbA1c) while minimizing hypoglycemia has always been a challenge for diabetes treated with insulin.

• #10 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  However, technological advances including continuous glucose monitoring (CGM), connected insulin pens (CIPs), insulin pumps, and automated insulin delivery (AID) algorithms combined with education have made it possible to achieve the optimal control of diabetes using insulin. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%. […] Today, structured education specifically for CGM has been recognized as an essential part of diabetes therapy. […] The CIP is a new technology with a function that displays the last dose of insulin and timing and has reminder alerts that integrate with a smart app. […] Currently, a few clinical trials are collecting data on the effectiveness of these CIPs. […] Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS.

• #11 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2022.0271

  Continuous glucose monitoring (CGM) technology has evolved over the past decade with the integration of various devices including insulin pumps, connected insulin pens (CIPs), automated insulin delivery (AID) systems, and virtual platforms. CGM has shown consistent benefits in glycemic outcomes in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) treated with insulin. […] The combined effect of CGM and education have been shown to improve glycemic outcomes more than CGM alone. […] AID systems and virtual platforms made it possible to achieve target glycosylated hemoglobin in diabetes while minimizing hypoglycemia, which has always been challenging in T1DM. […] These advances in technology could reduce the burden associated with insulin treatment for diabetes. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%.

• #12 NHS England » Hybrid closed loop technology

  https://www.england.nhs.uk/diabetes/digital-innovations-to-support-diabetes-outcomes/hybrid-closed-loop-technology/

  Hybrid closed loop (HCL) systems link continuous glucose monitoring (CGM) with insulin pump technology to monitor blood glucose and automatically adjust the amount of insulin given through a pump to people living with type 1 diabetes. […] HCL can eliminate finger-prick tests and prevent life-threatening hypoglycaemic and hyperglycaemia attacks, which can lead to seizures, coma or even death for people living with type 1 diabetes. […] Following a successful pilot by NHS England, in December 2023 the National Institute for Health and Care Excellence recommended that HCL technology should be rolled-out in a phased implementation, over the next 5 years, to thousands of patients including: […] The first phase of the roll-out to NHS integrated care systems will begin from April 2024. All patients who are eligible should continue to attend appointments as normal and discuss options with their diabetes team.

• #13 Diabetes Technology: A Primer for Clinicians

  https://consultqd.clevelandclinic.org/diabetes-technology-a-primer-for-clinicians

  The distinct advantage CGMs have over traditional fingerstick glucose checks is fewer severe hypoglycemic and hyperglycemic episodes. […] Now, with increased availability of CGM devices and their ability to support meaningful lifestyle changes, patients with diabetes can benefit from continuous glucose monitoring regardless of medication regimens, glucose patterns, or risks of hypoglycemia. […] Continuous subcutaneous insulin infusion demands more patient involvement than multiple injected doses. […] Automated insulin delivery systems are now the standard of care for patients living with Type 1 diabetes. […] Hybrid closed-loop systems use readings from a CGM and deliver basal insulin using a proprietary algorithm, with or without the need to input basal insulin rates into the pump.

• #14 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. […] Continuous glucose monitoring systems (CGMS) are now minimally invasive and more accurate. […] These closed-loop systems also referred to as the artificial pancreas have been likened to the holy grail of diabetes management as they have the potential to improve glycemic outcomes and reduce disease burden. […] Hybrid closed-loop systems aim to minimize hypoglycemia and hyperglycemia and maintain glucose levels within a target range through the use of a computerized algorithm to adjust the basal rate of insulin and administer corrective bolus doses. […] Development of the first hybrid closed-loop systems began in parallel with LGS technology. […] A pivotal trial by Weinzimer et al. in 2008 was the first to show that a hybrid closed-loop system significantly improved overnight time spent in the normoglycemic range compared to conventional open-loop insulin delivery.

• #15 Diabetes technology: A primer for clinicians | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/353

  CGMs were developed for patients who were using insulin pumps or needed multiple daily insulin injections. […] Now, with increased availability of CGM devices and their ability to support meaningful lifestyle changes, patients with diabetes can benefit from continuous glucose monitoring regardless of medication regimens, glucose patterns, or risks of hypoglycemia. […] Hybrid closed-loop systems use readings from a CGM and deliver basal insulin using a proprietary algorithm, with or without the need to input basal insulin rates into the pump. […] Examples of hybrid closed-loop pumps include MiniMed 670G, 770G, and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] Automated insulin delivery systems are now the standard of care for patients living with type 1 diabetes.

• #16 What are Automated Insulin Delivery Systems? | Medtronic

  https://www.medtronicdiabetes.com/treatments/automated-insulin-delivery

  Automated insulin delivery (AID) systems combine an insulin pump and continuous glucose monitor (CGM) to help people living with type 1 diabetes manage their blood sugar levels. […] AID systems, also known as hybrid closed loop systems, can detect changes in a persons sugar levels in real time and automatically adjust insulin doses in response. […] The CGM tracks your sugar levels every few minutes through a small sensor inserted under the skin. […] The algorithm uses current and past sugar level trends to anticipate, adjust, and correct insulin delivery. […] Its no surprise why the American Diabetes Association calls automated insulin delivery systems the standard of care for people with type 1 diabetes. […] The MiniMed 780G system is intended for continuous delivery of basal insulin at selectable rates, and the administration of insulin boluses at selectable amounts for the management of type 1 diabetes mellitus in persons seven years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin.

• #17 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Further trials in adult and pediatric populations have demonstrated increased time in target and reduced hypoglycemia, mean glucose levels, and HbA1c in hybrid closed-loop systems. […] The MiniMed 670G (Medtronic), the first commercially available hybrid closed-loop system, was released in 2016. […] These systems use three main types of algorithms: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic. […] The pivotal trial establishing the efficacy of the MiniMed 670G system was published by Garg et al. in 2017. […] A recent retrospective analysis of data uploaded over a 15-month period by 14,899 European users of the MiniMed 670G found that users spent a mean 81.4% of the time in Auto Mode and could expect to spend 72% of the time in range with Auto Mode enabled, an increase of 10% compared with pre-Auto Mode initiation.

• #18 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  This automatic insulin dosing is the predictive algorithm and insulin pump working in unison with CGM to help minimize the frequent decisions needed to manage type 1 diabetes. […] The fact that the user still interacts with the pump and CGM, and at times needs to instruct the pump to give extra insulin or change settings, is why these systems are called hybrid. […] Using an advanced hybrid closed-loop system offers a number of benefits over other diabetes management methods. […] In my mind, the biggest benefit of using hybrid closed-loop technology has been improved sleep, said Dr. Pinsker. […] Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care. […] Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.

• #19 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. […] Continuous glucose monitoring systems (CGMS) are now minimally invasive and more accurate. […] These closed-loop systems also referred to as the artificial pancreas have been likened to the holy grail of diabetes management as they have the potential to improve glycemic outcomes and reduce disease burden. […] Hybrid closed-loop systems aim to minimize hypoglycemia and hyperglycemia and maintain glucose levels within a target range through the use of a computerized algorithm to adjust the basal rate of insulin and administer corrective bolus doses. […] Development of the first hybrid closed-loop systems began in parallel with LGS technology. […] A pivotal trial by Weinzimer et al. in 2008 was the first to show that a hybrid closed-loop system significantly improved overnight time spent in the normoglycemic range compared to conventional open-loop insulin delivery.

• #20 CG-DME-50 Automated Insulin Delivery Systems

  https://provider.healthybluenc.com/dam/medpolicies/healthybluenc/active/guidelines/gl_PW_E002723.html

  Continued use of an open-loop, hybrid closed-loop, or fully closed-loop automated insulin delivery system is considered medically necessary when there is documentation that the device has resulted in clinical benefit (for example, improved or stabilized HbA1c control or fewer episodes of symptomatic hypoglycemia or hyperglycemia). […] Automated insulin delivery systems combine an insulin pump and CGM, either as separate devices or as a device that incorporates both functions. These devices may be called open-loop, hybrid closed-loop, or closed-loop. These terms refer to how the devices interact with each other, as well as how the individual interacts with them. […] Hybrid closed-loop devices eliminate the requirement of routine manual adjustment of pump administration rates, with the insulin pump and CGM devices working together to predict and calculate insulin dose requirements. However, these types of devices still require manual calculation and administration of pre-meal insulin bolus doses, hence the hybrid moniker.

• #21 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  This automatic insulin dosing is the predictive algorithm and insulin pump working in unison with CGM to help minimize the frequent decisions needed to manage type 1 diabetes. […] The fact that the user still interacts with the pump and CGM, and at times needs to instruct the pump to give extra insulin or change settings, is why these systems are called hybrid. […] Using an advanced hybrid closed-loop system offers a number of benefits over other diabetes management methods. […] In my mind, the biggest benefit of using hybrid closed-loop technology has been improved sleep, said Dr. Pinsker. […] Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care. […] Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.

• #22 Hybrid closed loop technology (artificial pancreas) | Breakthrough T1D UK

  https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/

  Using a hybrid closed loop system eases the burden of type 1 but doesnt mean that type 1 treatment is completely automated. […] You will still need to keep an eye on your glucose levels and take action if the system isnt keeping your glucose in target range, which might suggest that your insulin infusion site isnt working well. […] Nearly 20 years of Breakthrough T1D UK research has pushed forward the development of hybrid closed loop technology, changing the lives of people living with type 1. […] Continuous glucose monitoring can help you manage your glucose levels in real-time and relieve the burden of having to do multiple finger prick tests throughout the day.

• #23 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Further trials in adult and pediatric populations have demonstrated increased time in target and reduced hypoglycemia, mean glucose levels, and HbA1c in hybrid closed-loop systems. […] The MiniMed 670G (Medtronic), the first commercially available hybrid closed-loop system, was released in 2016. […] These systems use three main types of algorithms: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic. […] The pivotal trial establishing the efficacy of the MiniMed 670G system was published by Garg et al. in 2017. […] A recent retrospective analysis of data uploaded over a 15-month period by 14,899 European users of the MiniMed 670G found that users spent a mean 81.4% of the time in Auto Mode and could expect to spend 72% of the time in range with Auto Mode enabled, an increase of 10% compared with pre-Auto Mode initiation.

• #24 Diabetes technology: A primer for clinicians | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/353

  CGMs were developed for patients who were using insulin pumps or needed multiple daily insulin injections. […] Now, with increased availability of CGM devices and their ability to support meaningful lifestyle changes, patients with diabetes can benefit from continuous glucose monitoring regardless of medication regimens, glucose patterns, or risks of hypoglycemia. […] Hybrid closed-loop systems use readings from a CGM and deliver basal insulin using a proprietary algorithm, with or without the need to input basal insulin rates into the pump. […] Examples of hybrid closed-loop pumps include MiniMed 670G, 770G, and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] Automated insulin delivery systems are now the standard of care for patients living with type 1 diabetes.

• #25 Diabetes Technology: A Primer for Clinicians

  https://consultqd.clevelandclinic.org/diabetes-technology-a-primer-for-clinicians

  Examples of hybrid closed-loop pumps include MiniMed 670G, 770G and 780G, t:slim X2, Mobi with Control-IQ, and Omnipod 5. […] The American Diabetes Association recommends that automated insulin delivery systems be offered to patients with Type 1 and other forms of insulin-deficient diabetes, with the choice based on the patients circumstances, preferences and needs. […] Increased comfort level with this technology among clinicians will benefit patients.

• #26 Advanced Hybrid Closed Loop | Medtronic HCP

  https://hcp.medtronic-diabetes.com.au/advanced-hybrid-closed-loop

  Hybrid closed loop systems use control algorithms to automate basal insulin delivery, based on glucose sensor values. Studies have demonstrated that hybrid closed loop systems improve HbA1c and time in range in people with T1D, while reducing hypoglycaemia and lowering HbA1c, compared to gold-standard insulin therapy. […] Advanced hybrid closed loop systems, such as the MiniMed 780G, with SmartGuard technology, automatically adjusts basal insulin delivery every five minutes, based on CGM readings. This cutting-edge technology helps users spend more time in range (3.9 mmol/L 10 mmol/L) and reduces the burden of managing diabetes compared with MDI. […] CGM improves time in range and glycaemic control. Several randomised controlled trials showed that CGM can lead to a 98% improvement in HbA1c when compared to MDI. […] SmartGuard Auto Mode is designed to determine an individuals insulin needs and to take action to reduce high and low glucose levels, to spend more time in range.

• #27 Advanced Technology (Continuous Glucose Monitoring and Advanced Hybrid Closed-Loop Systems) in Diabetes from the Perspective of Gender Differences

  https://www.mdpi.com/2673-4540/4/4/45

  An ever-growing body of evidence suggests that sex and gender influence the pathophysiology, incidence, prevalence, clinical manifestations, course, and response to therapy of diabetes. […] The turning point came in 2000 with the introduction of continuous glucose monitoring (CGM) and the first miniaturised insulin pumps (CSII) equipped with advanced functions; from the integration of the two devices, it was possible to create the SAP (Sensor Augmented Pump) system; from this moment on, the development of technologies has undergone an acceleration, up to the creation and appearance on the market of the first artificial pancreas system (Automatic Insulin Delivery—AID), closed-loop, and hybrid systems (HCL—Hybrid Closed Loop) a century after the discovery of insulin. […] HCL, by regulating the delivery of basal insulin for 24 h, in addition to preventing hypoglycaemia, also allows the better management of hyperglycaemia; this aspect is perfected with advanced hybrid closed-loop systems (AHCL), which are able to automatically deliver the correction boluses as well, and, therefore, allow reducing the time spent in hypoglycemia (TBR) and hyperglycaemia (TAR), with an improvement of the time in range (TIR).

• #28 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  The learning takes place on three levels: Overall learning: This learning is based on the body’s overall insulin need; the insulin needed on average and during the day. […] The use of CamAPS FX in young children aged 1 to 7 years documented clinically and statistically significant reduction of HbA1c by 0.4%, and an increase in time in target glucose range by 9% without increasing time in hypoglycaemia below 3.9 mmol/L (70 mg/dL). […] The use of the CamAPS FX control algorithm in people aged 6 years and older including adults resulted in reduction of HbA1c by 0.4%, increased time in target glucose range by 11%, and reduced time in hypoglycaemia below 3.9 mmol/L (70 mg/dL) by 0.8%. […] Control and monitoring of glucose, especially overnight, is a relief and leads to a better night’s sleep.

• #29 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  The past five to ten years have seen an explosion in research and published literature about closed-loop systems. […] Future directions in closed-loop research are principally aimed at the advanced generations of closed-loop systems as outlined by the JDRF: fully automated and multi-hormone systems. […] The main challenge in fully closed-loop systems therefore is postprandial hyperglycemia, as there is no manually provided information about the timing and carbohydrate content of meals. […] Fully closed-loop systems can use the same types of algorithms as hybrid systems MPC, PID, or fuzzy logic although all fully closed-loop systems included in a 2017 meta-analysis used MPC-based algorithms. […] The primary rationale for dual-hormone systems, which are capable of administering boluses of glucagon in addition to continuous insulin infusion, is that prevention of hypoglycemia is more effective with administration of glucagon than with suspension of insulin delivery.

• #30 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  The past five to ten years have seen an explosion in research and published literature about closed-loop systems. […] Future directions in closed-loop research are principally aimed at the advanced generations of closed-loop systems as outlined by the JDRF: fully automated and multi-hormone systems. […] The main challenge in fully closed-loop systems therefore is postprandial hyperglycemia, as there is no manually provided information about the timing and carbohydrate content of meals. […] Fully closed-loop systems can use the same types of algorithms as hybrid systems MPC, PID, or fuzzy logic although all fully closed-loop systems included in a 2017 meta-analysis used MPC-based algorithms. […] The primary rationale for dual-hormone systems, which are capable of administering boluses of glucagon in addition to continuous insulin infusion, is that prevention of hypoglycemia is more effective with administration of glucagon than with suspension of insulin delivery.

• #31 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  The past five to ten years have seen an explosion in research and published literature about closed-loop systems. […] Future directions in closed-loop research are principally aimed at the advanced generations of closed-loop systems as outlined by the JDRF: fully automated and multi-hormone systems. […] The main challenge in fully closed-loop systems therefore is postprandial hyperglycemia, as there is no manually provided information about the timing and carbohydrate content of meals. […] Fully closed-loop systems can use the same types of algorithms as hybrid systems MPC, PID, or fuzzy logic although all fully closed-loop systems included in a 2017 meta-analysis used MPC-based algorithms. […] The primary rationale for dual-hormone systems, which are capable of administering boluses of glucagon in addition to continuous insulin infusion, is that prevention of hypoglycemia is more effective with administration of glucagon than with suspension of insulin delivery.

• #32 Diabetes Management Technology Update

  https://www.umassmed.edu/dcoe/news/diabetes-technology-update/

  The pump integrates with the Dexcom G6 CGM. It’s compatible with certain Samsung smartphones to automatically adjust insulin based upon a predicted glucose level in 60 minutes and helps to protect against highs and lows. […] This new insulin-delivery system fully automates 100% of insulin doses. It offers a choice of three insulins, Novolog; Humalog; and Fiasp Pumpcart. The iLet is paired with a Dexcom G6 or G7 and manages glucose levels with only a meal announcement.

• #33 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  The past five to ten years have seen an explosion in research and published literature about closed-loop systems. […] Future directions in closed-loop research are principally aimed at the advanced generations of closed-loop systems as outlined by the JDRF: fully automated and multi-hormone systems. […] The main challenge in fully closed-loop systems therefore is postprandial hyperglycemia, as there is no manually provided information about the timing and carbohydrate content of meals. […] Fully closed-loop systems can use the same types of algorithms as hybrid systems MPC, PID, or fuzzy logic although all fully closed-loop systems included in a 2017 meta-analysis used MPC-based algorithms. […] The primary rationale for dual-hormone systems, which are capable of administering boluses of glucagon in addition to continuous insulin infusion, is that prevention of hypoglycemia is more effective with administration of glucagon than with suspension of insulin delivery.

• #34 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Compared with conventional insulin pump therapy, dual-hormone closed-loop systems have been shown to reduce hypoglycemia, improve mean glucose levels, and increase time spent in the target glycemic range. […] Most commercially available hybrid closed-loop systems are licensed for use in children, albeit with varying minimum ages for use. […] A recent randomized trial of hybrid closed-loop therapy in children aged 1 to 7 demonstrated significant improvements in time in range, HbA1c, and mean glucose level compared to sensor-augmented pump therapy, without a significant difference in total daily insulin dose.

• #35 Hybrid Closed-Loop System Favorable for Type 1 Diabetes

  https://www.pharmacytimes.com/view/hybrid-closedloop-system-favorable-for-type-1-diabetes

  These systems also assist patients during the day in decreasing the magnitude of both high- and low-glucose fluctuations. […] The investigators discovered that automated dosing of glucagon plus insulin during and after exercise dropped hypoglycemia from 6.3% to 3% compared with insulin monotherapy. […] Our findings show that fully automated insulin and glucagon delivery, combined with wearable physical activity sensors that detect exercise, effectively controlled glucose levels, reduced exercise-induced hypoglycemia and can safely be used in a home environment, said investigator Peter G. Jacobs, PhD. […] These findings suggest that the dual-hormone closed-loop system should be used for patients with type 1 diabetes who are at risk of exercise-induced hypoglycemia.

• #36 Hybrid Closed-Loop System Favorable for Type 1 Diabetes

  https://www.pharmacytimes.com/view/hybrid-closedloop-system-favorable-for-type-1-diabetes

  These systems also assist patients during the day in decreasing the magnitude of both high- and low-glucose fluctuations. […] The investigators discovered that automated dosing of glucagon plus insulin during and after exercise dropped hypoglycemia from 6.3% to 3% compared with insulin monotherapy. […] Our findings show that fully automated insulin and glucagon delivery, combined with wearable physical activity sensors that detect exercise, effectively controlled glucose levels, reduced exercise-induced hypoglycemia and can safely be used in a home environment, said investigator Peter G. Jacobs, PhD. […] These findings suggest that the dual-hormone closed-loop system should be used for patients with type 1 diabetes who are at risk of exercise-induced hypoglycemia.

• #37 In Brief: Hybrid Closed-Loop Systems for Type 1 Diabetes | CDA-AMC

  https://www.cda-amc.ca/brief-hybrid-closed-loop-systems-type-1-diabetes

  Hybrid closed-loop systems generally increase the amount of time a person is in their target blood glucose ranges compared with other insulin delivery methods. […] For people with type 1 diabetes, and their caregivers, hybrid closed-loop systems can decrease the amount of time and energy spent on diabetes management. […] HCL systems generally increased the amount of time a person spends in their target blood glucose ranges compared with other insulin delivery methods. […] HCL systems improved other diabetes management measures (e.g., hemoglobin A1C, average blood glucose, and glycemic variability) compared with other therapies. […] For people with type 1 diabetes and their caregivers, HCL systems may decrease the amount of time and energy spent on diabetes management and enable users to be more immersed in other aspects of their lives. […] The ethics analysis in the health technology assessment review highlighted the non-clinical and short-term clinical benefits of these systems but noted the uncertainty of whether the overall health of people with type 1 diabetes might improve over the long term.

• #38 In Brief: Hybrid Closed-Loop Systems for Type 1 Diabetes | CDA-AMC

  https://www.cda-amc.ca/brief-hybrid-closed-loop-systems-type-1-diabetes

  Hybrid closed-loop systems generally increase the amount of time a person is in their target blood glucose ranges compared with other insulin delivery methods. […] For people with type 1 diabetes, and their caregivers, hybrid closed-loop systems can decrease the amount of time and energy spent on diabetes management. […] HCL systems generally increased the amount of time a person spends in their target blood glucose ranges compared with other insulin delivery methods. […] HCL systems improved other diabetes management measures (e.g., hemoglobin A1C, average blood glucose, and glycemic variability) compared with other therapies. […] For people with type 1 diabetes and their caregivers, HCL systems may decrease the amount of time and energy spent on diabetes management and enable users to be more immersed in other aspects of their lives. […] The ethics analysis in the health technology assessment review highlighted the non-clinical and short-term clinical benefits of these systems but noted the uncertainty of whether the overall health of people with type 1 diabetes might improve over the long term.

• #39 Hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes: a systematic review and economic modelling – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39673446/

  Randomised controlled trials of hybrid closed-loop interventions in comparison with continuous subcutaneous insulin infusion + continuous glucose monitoring achieved a statistically significant improvement in glycated haemoglobin per cent in time in range between 3.9 and 10 mmol/l, and in hyperglycaemic levels. […] Studies that looked at hybrid closed loop in people with type 1 diabetes mellitus seem to suggest that it is better for diabetes management in terms of glucose levels, better time in range between 3.9 and 10 mmol/l, and less hyperglycaemic levels.

• #40 Hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes: a systematic review and economic modelling – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39673446/

  Randomised controlled trials of hybrid closed-loop interventions in comparison with continuous subcutaneous insulin infusion + continuous glucose monitoring achieved a statistically significant improvement in glycated haemoglobin per cent in time in range between 3.9 and 10 mmol/l, and in hyperglycaemic levels. […] Studies that looked at hybrid closed loop in people with type 1 diabetes mellitus seem to suggest that it is better for diabetes management in terms of glucose levels, better time in range between 3.9 and 10 mmol/l, and less hyperglycaemic levels.

• #41 Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes, time-in-range, and quality of life in children and young people with type 1 diabetes | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03396-x

  Hybrid closed-loop (HCL) systems seamlessly interface continuous glucose monitoring (CGM) with insulin pumps, employing specialised algorithms and user-initiated automated insulin delivery. This study aimed to assess the efficacy of HCLs at 12 months post-initiation on glycated haemoglobin (HbA1c), time-in-range (TIR), hypoglycaemia frequency, and quality of life measures among children and young people (CYP) with type 1 diabetes mellitus (T1DM) and their caregivers in a real-world setting. […] Results demonstrated significant improvements in HbA1c (average reduction at 12 months 7 mmol/mol; P0.001), time-in-range (TIR) (average increase 13.4%; P0.001), hypoglycaemia frequency (50% reduction), hypoglycaemia fear, and quality of sleep (P0.001) among CYP over a 12-month period of HCL usage. Additionally, parents and carers experienced improvements in hypoglycaemia fear and quality of sleep after 6 and 12 months of use.

• #42 NHS England » Hybrid closed loop technology

  https://www.england.nhs.uk/diabetes/digital-innovations-to-support-diabetes-outcomes/hybrid-closed-loop-technology/

  Hybrid closed loop (HCL) systems link continuous glucose monitoring (CGM) with insulin pump technology to monitor blood glucose and automatically adjust the amount of insulin given through a pump to people living with type 1 diabetes. […] HCL can eliminate finger-prick tests and prevent life-threatening hypoglycaemic and hyperglycaemia attacks, which can lead to seizures, coma or even death for people living with type 1 diabetes. […] Following a successful pilot by NHS England, in December 2023 the National Institute for Health and Care Excellence recommended that HCL technology should be rolled-out in a phased implementation, over the next 5 years, to thousands of patients including: […] The first phase of the roll-out to NHS integrated care systems will begin from April 2024. All patients who are eligible should continue to attend appointments as normal and discuss options with their diabetes team.

• #43 Closed loop systems | Diabetes tech | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems

  Then, in April 2024, NHS England announced that it will start identifying tens of thousands of eligible children and adults living with type 1 diabetes who health chiefs believe could benefit from the hybrid closed loop system. […] People with type 1 diabetes using a hybrid closed loop system can have a better quality of life, research shows, because of the benefits it brings. And it can also make life easier for people caring for them. Blood sugar levels may be more stable and there are no insulin injections to do and fewer finger prick tests. […] As the amount of insulin given is calculated more precisely and given more often, this can help keep blood sugar levels more stable. As a result, this can increase the amount of time you spend in your target blood sugar range. This can reduce hypos and lower your HbA1c and risk of diabetes complications.

• #44 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  Advice regarding the management of hypoglycaemia needs to be tailored for HCL users. The automated feedback loop between CGM and pump insulin delivery means that, in the event of falling glucose levels or impending hypoglycaemia, insulin delivery is slowed or suspended, helping to avoid hypoglycaemia or limit its severity. […] The NICE TA943 recommendations have the potential to substantially change the management and improve the outcomes of people living with type 1 diabetes across England. […] In particular, supporting people with diabetes to have ongoing access to the equipment they need to safely manage and troubleshoot when using HCL will be important.

• #45 In Brief: Hybrid Closed-Loop Systems for Type 1 Diabetes | CDA-AMC

  https://www.cda-amc.ca/brief-hybrid-closed-loop-systems-type-1-diabetes

  Hybrid closed-loop systems generally increase the amount of time a person is in their target blood glucose ranges compared with other insulin delivery methods. […] For people with type 1 diabetes, and their caregivers, hybrid closed-loop systems can decrease the amount of time and energy spent on diabetes management. […] HCL systems generally increased the amount of time a person spends in their target blood glucose ranges compared with other insulin delivery methods. […] HCL systems improved other diabetes management measures (e.g., hemoglobin A1C, average blood glucose, and glycemic variability) compared with other therapies. […] For people with type 1 diabetes and their caregivers, HCL systems may decrease the amount of time and energy spent on diabetes management and enable users to be more immersed in other aspects of their lives. […] The ethics analysis in the health technology assessment review highlighted the non-clinical and short-term clinical benefits of these systems but noted the uncertainty of whether the overall health of people with type 1 diabetes might improve over the long term.

• #46 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  NICE made evidence-based recommendations for the HCL technology for NHS patients in December 2023. […] NICE concluded that HCL systems would reduce some of this burden, and improve quality of life for people, their families and carers. […] The HCL can also be used by a much wider range of people than is appropriate for separate CGM and insulin pump technology, because it lessens the number of manual calculations made with the separate technologies, therefore it could be rolled out to those who would not manage a single digital device for example adults with special educational needs. […] The mental burden of living with type 1 diabetes is said to be significant. HCL systems are designed to reduce the mental burden and improve quality of life. User opinion within the NHS pilot found that almost all participants (94%) rated HCL therapy as having a positive impact on their quality of life.

• #47 Hybrid closed loop systems recommended for people living with type 1 diabetes (1) – Diabetes Research & Wellness Foundation

  https://www.drwf.org.uk/news-and-events/news/hybrid-closed-loop-systems-recommended-for-people-living-with-type-1-diabetes-1/

  Hybrid closed loop management system is expected to be available via the NHS following a recommendation from NICE. […] The hybrid closed loop system, also referred to as an artificial pancreas, can help people living with type 1 diabetes to improve management of their blood glucose levels. […] Hybrid closed loop (HCL) systems work by linking an insulin pump and continuous glucose monitor (CGM) with a computer algorithm that can calculate the amount of insulin someone needs based on their blood glucose readings, helping people manage diabetes with minimal user interaction. […] According to HCL users participating in the study there were numerous benefits to HCL, including improvements in quality of life (52%), time in range (46%), productivity at work (44%), sleep (42%) and reduced stress related to diabetes (40%).

• #48 Hybrid closed loop systems recommended for people living with type 1 diabetes – Diabetes Research & Wellness Foundation

  https://www.drwf.org.uk/news-and-events/news/hybrid-closed-loop-systems-recommended-for-people-living-with-type-1-diabetes/

  Hybrid closed loop management system is expected to be available via the NHS following a recommendation from NICE. […] The hybrid closed loop system, also referred to as an artificial pancreas, can help people living with type 1 diabetes to improve management of their blood glucose levels. […] Hybrid closed loop (HCL) systems work by linking an insulin pump and continuous glucose monitor (CGM) with a computer algorithm that can calculate the amount of insulin someone needs based on their blood glucose readings, helping people manage diabetes with minimal user interaction. […] According to HCL users participating in the study there were numerous benefits to HCL, including improvements in quality of life (52%), time in range (46%), productivity at work (44%), sleep (42%) and reduced stress related to diabetes (40%).

• #49 Hybrid closed loop systems recommended for people living with type 1 diabetes (1) – Diabetes Research & Wellness Foundation

  https://www.drwf.org.uk/news-and-events/news/hybrid-closed-loop-systems-recommended-for-people-living-with-type-1-diabetes-1/

  Healthcare providers were also in agreement at the potential of HCL to change lives for people living with type 1 diabetes for the better (99%), while 98% said they would want all people with the condition to have access to HCL. […] Partha Kar, National Specialty Advisor, Diabetes with NHS England, said: It’s a cause for celebration that hybrid closed loop systems are now a possibility for around 150,000 people with type 1 diabetes. […] Every single person (100%) surveyed with type 1 diabetes said that being on an HCL system has reduced the burden of managing their diabetes and 98% of healthcare practitioners say they would want all people with type 1 diabetes to have access to HCL. […] Jeremy Irvine, actor and HCL user, said: I can honestly say using the Dexcom G6 continuous glucose monitoring device to power my HCL system has changed my life.

• #50 Hybrid closed loop systems recommended for people living with type 1 diabetes – Diabetes Research & Wellness Foundation

  https://www.drwf.org.uk/news-and-events/news/hybrid-closed-loop-systems-recommended-for-people-living-with-type-1-diabetes/

  Healthcare providers were also in agreement at the potential of HCL to change lives for people living with type 1 diabetes for the better (99%), while 98% said they would want all people with the condition to have access to HCL. […] Every single person (100%) surveyed with type 1 diabetes said that being on an HCL system has reduced the burden of managing their diabetes and 98% of healthcare practitioners say they would want all people with type 1 diabetes to have access to HCL. […] I can honestly say using the Dexcom G6 continuous glucose monitoring device to power my HCL system has changed my life.

• #51 Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes, time-in-range, and quality of life in children and young people with type 1 diabetes | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03396-x

  Hybrid closed-loop systems have demonstrated efficacy in maintaining stable overnight glucose concentrations, providing parents with greater peace of mind and ensuring that children can enjoy uninterrupted sleep. […] The integration of HCL systems has the potential to transform the lives of CYP with T1DM, providing them with greater freedom, improved health outcomes, and a brighter future.

• #52 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  The learning takes place on three levels: Overall learning: This learning is based on the body’s overall insulin need; the insulin needed on average and during the day. […] The use of CamAPS FX in young children aged 1 to 7 years documented clinically and statistically significant reduction of HbA1c by 0.4%, and an increase in time in target glucose range by 9% without increasing time in hypoglycaemia below 3.9 mmol/L (70 mg/dL). […] The use of the CamAPS FX control algorithm in people aged 6 years and older including adults resulted in reduction of HbA1c by 0.4%, increased time in target glucose range by 11%, and reduced time in hypoglycaemia below 3.9 mmol/L (70 mg/dL) by 0.8%. […] Control and monitoring of glucose, especially overnight, is a relief and leads to a better night’s sleep.

• #53 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Compared with conventional insulin pump therapy, dual-hormone closed-loop systems have been shown to reduce hypoglycemia, improve mean glucose levels, and increase time spent in the target glycemic range. […] Most commercially available hybrid closed-loop systems are licensed for use in children, albeit with varying minimum ages for use. […] A recent randomized trial of hybrid closed-loop therapy in children aged 1 to 7 demonstrated significant improvements in time in range, HbA1c, and mean glucose level compared to sensor-augmented pump therapy, without a significant difference in total daily insulin dose.

• #54 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Compared with conventional insulin pump therapy, dual-hormone closed-loop systems have been shown to reduce hypoglycemia, improve mean glucose levels, and increase time spent in the target glycemic range. […] Most commercially available hybrid closed-loop systems are licensed for use in children, albeit with varying minimum ages for use. […] A recent randomized trial of hybrid closed-loop therapy in children aged 1 to 7 demonstrated significant improvements in time in range, HbA1c, and mean glucose level compared to sensor-augmented pump therapy, without a significant difference in total daily insulin dose.

• #55 Closed-Loop Insulin System Keeps Glucose Levels in Range Longer Than Standard Care in Children With Type 1 Diabetes

  https://www.ajmc.com/view/closed-loop-insulin-system-keeps-glucose-levels-in-range-longer-than-standard-care-in-children-with-type-1-diabetes

  Young children using the t:slim X2 insulin pump with Control-IQ Technology system maintained target glucose levels for 3 hours longer than children using an insulin pump or daily injections with a continuous glucose monitor. […] A hybrid closed-loop system was shown to improve and maintain glucose levels in children aged between 2 and 6 years with type 1 diabetes (T1D) better than standard care. […] The t:slim X2 insulin pump with Control-IQ Technology system is a hybrid closed-loop system that automatically monitors and regulates blood glucose through advanced control algorithms. […] After 13 weeks of follow-up, among the patients who used the closed-loop system, their glucose level was in the target range for a significantly longer time by about 3 hours per day, on average. […] The percentage of time that the glucose level was within the target range consistently favored the closed-loop system across a broad range of baseline characteristics, including age, sex, body mass index, household income, parental education level, use of an insulin pump or receipt of multiple daily injections of insulin before the trial, and glycated hemoglobin level, the authors noted.

• #56 Closed-Loop Insulin System Keeps Glucose Levels in Range Longer Than Standard Care in Children With Type 1 Diabetes

  https://www.ajmc.com/view/closed-loop-insulin-system-keeps-glucose-levels-in-range-longer-than-standard-care-in-children-with-type-1-diabetes

  Young children using the t:slim X2 insulin pump with Control-IQ Technology system maintained target glucose levels for 3 hours longer than children using an insulin pump or daily injections with a continuous glucose monitor. […] A hybrid closed-loop system was shown to improve and maintain glucose levels in children aged between 2 and 6 years with type 1 diabetes (T1D) better than standard care. […] The t:slim X2 insulin pump with Control-IQ Technology system is a hybrid closed-loop system that automatically monitors and regulates blood glucose through advanced control algorithms. […] After 13 weeks of follow-up, among the patients who used the closed-loop system, their glucose level was in the target range for a significantly longer time by about 3 hours per day, on average. […] The percentage of time that the glucose level was within the target range consistently favored the closed-loop system across a broad range of baseline characteristics, including age, sex, body mass index, household income, parental education level, use of an insulin pump or receipt of multiple daily injections of insulin before the trial, and glycated hemoglobin level, the authors noted.

• #57 Closed-Loop Insulin System Keeps Glucose Levels in Range Longer Than Standard Care in Children With Type 1 Diabetes

  https://www.ajmc.com/view/closed-loop-insulin-system-keeps-glucose-levels-in-range-longer-than-standard-care-in-children-with-type-1-diabetes

  Young children using the t:slim X2 insulin pump with Control-IQ Technology system maintained target glucose levels for 3 hours longer than children using an insulin pump or daily injections with a continuous glucose monitor. […] A hybrid closed-loop system was shown to improve and maintain glucose levels in children aged between 2 and 6 years with type 1 diabetes (T1D) better than standard care. […] The t:slim X2 insulin pump with Control-IQ Technology system is a hybrid closed-loop system that automatically monitors and regulates blood glucose through advanced control algorithms. […] After 13 weeks of follow-up, among the patients who used the closed-loop system, their glucose level was in the target range for a significantly longer time by about 3 hours per day, on average. […] The percentage of time that the glucose level was within the target range consistently favored the closed-loop system across a broad range of baseline characteristics, including age, sex, body mass index, household income, parental education level, use of an insulin pump or receipt of multiple daily injections of insulin before the trial, and glycated hemoglobin level, the authors noted.

• #58 Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes, time-in-range, and quality of life in children and young people with type 1 diabetes | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03396-x

  The NHS England Closed Loop Study in Children and Young People represents a ground-breaking initiative, marking the first nationwide pilot effort to extend universal health coverage for HCL systems. This study stands out as the largest real-world investigation of HCL in the UK, revealing a sustained enhancement in glycaemic management, time-in-range, and quality of life measures. […] The NHSE Closed Loop Study demonstrated notable and sustained improvements in various diabetes-related parameters over a 12-month period. These enhancements included better glycaemic management, increased TIR, reduced frequency of hypoglycaemia, diminished hypoglycaemia fear, and improved quality of sleep for CYP. […] One of the primary advantages of HCL systems is their ability to maintain blood glucose concentrations within a target range more consistently. This is particularly crucial in children, as their glucose concentrations tend to fluctuate more rapidly due to factors such as growth, physical activity, and varying meal sizes.

• #59 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://health.learning.wiley.com/courses/dom-15999/

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #60 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy

  https://health.learning.wiley.com/courses/dom-15999/

  Continuous glucose monitoring (CGM) has led to a paradigm shift in the management of pregnant women with type 1 diabetes (T1D), with improved glycaemic control, less hypoglycaemia and fewer pregnancy complications. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D. AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] More evidence is needed on the impact of AHCL therapy on maternal and neonatal outcomes and on which glycaemic targets with CGM should be used in pregnant women with T2D and GDM. We review the current evidence on the use of CGM and AHCL therapy in pregnancy.

• #61 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Women strive to achieve tight glycaemic management during pregnancy to reduce the risks of obstetric and neonatal complications. […] Thanks to its unique technology and highly adaptive capabilities, CamAPS FX demonstrated in the AiDAPT (Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes) study that it can support women achieving their treatment goals during pregnancy, providing 10.5 % additional time in the pregnancy specific range, over the entire pregnancy period, without increasing hypoglycaemias. […] The mylife CamAPS FX app constantly learns and quickly adapts to ever changing insulin needs. […] This enables safe and efficient use in all life circumstances.

• #62 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Women strive to achieve tight glycaemic management during pregnancy to reduce the risks of obstetric and neonatal complications. […] Thanks to its unique technology and highly adaptive capabilities, CamAPS FX demonstrated in the AiDAPT (Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes) study that it can support women achieving their treatment goals during pregnancy, providing 10.5 % additional time in the pregnancy specific range, over the entire pregnancy period, without increasing hypoglycaemias. […] The mylife CamAPS FX app constantly learns and quickly adapts to ever changing insulin needs. […] This enables safe and efficient use in all life circumstances.

• #63 Closed-loop insulin system effective for pregnant women with type 1 diabetes

  https://evidence.nihr.ac.uk/alert/closed-loop-insulin-systems-are-effective-for-pregnant-women-with-type-1-diabetes/

  This study included pregnant women with type 1 diabetes, who were all using continuous glucose monitoring. A closed-loop system that automatically adjusts insulin delivery in real-time, was compared with standard therapy (a standard pump releasing low levels of insulin, topped up with injections). […] The National Institute of Health and Care Excellence (NICE) now recommends closed-loop as an option for all women with type 1 diabetes who are pregnant or planning pregnancy. […] Closed-loop systems have been shown to improve blood sugar control in adults and children; however, before this study it was unclear whether they are effective in pregnancy. This trial compared closed-loop systems with standard insulin therapy in pregnant women with type 1 diabetes. […] In this study, closed-loop effectively controlled blood sugar levels in pregnant women with type 1 diabetes.

• #64 Closed-loop insulin system effective for pregnant women with type 1 diabetes

  https://evidence.nihr.ac.uk/alert/closed-loop-insulin-systems-are-effective-for-pregnant-women-with-type-1-diabetes/

  This study included pregnant women with type 1 diabetes, who were all using continuous glucose monitoring. A closed-loop system that automatically adjusts insulin delivery in real-time, was compared with standard therapy (a standard pump releasing low levels of insulin, topped up with injections). […] The National Institute of Health and Care Excellence (NICE) now recommends closed-loop as an option for all women with type 1 diabetes who are pregnant or planning pregnancy. […] Closed-loop systems have been shown to improve blood sugar control in adults and children; however, before this study it was unclear whether they are effective in pregnancy. This trial compared closed-loop systems with standard insulin therapy in pregnant women with type 1 diabetes. […] In this study, closed-loop effectively controlled blood sugar levels in pregnant women with type 1 diabetes.

• #65 Closed-loop insulin system effective for pregnant women with type 1 diabetes

  https://evidence.nihr.ac.uk/alert/closed-loop-insulin-systems-are-effective-for-pregnant-women-with-type-1-diabetes/

  This study provides convincing evidence that the best way to achieve this control is by offering all pregnant women with type 1 diabetes a hybrid closed-loop insulin delivery system, which is capable of targeting blood glucose levels of 5.5 mmol/L or lower. […] Closed-loop insulin delivery will become the gold standard treatment for pregnant women with type 1 diabetes and recently published NICE guidance, has advised that this will be the recommended standard of care.

• #66 ADVANCED HYBRID CLOSED LOOP STUDY IN AN ADULT POPULATION WITH TYPE 1 DIABETES (ADAPT): A RANDOMIZED CONTROLLED STUDY

  https://www.repository.cam.ac.uk/items/6aa47ac9-1e62-412a-91e5-cb2f61ccd402

  Background The aim was to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with multiple daily injections (MDI) and intermittently-scanned continuous glucose monitoring (isCGM) therapy in adults with type 1 diabetes (T1D) with suboptimal glucose control. […] Interpretation In people with T1D using MDI+isCGM and with HbA1c 80% the use of AHCL confers benefits in terms of glycemic control and treatment satisfaction beyond those that can be achieved with MDI+isCGM therapy. These data support wider access to AHCL in people with T1D not at target glucose levels.

• #67 ADVANCED HYBRID CLOSED LOOP STUDY IN AN ADULT POPULATION WITH TYPE 1 DIABETES (ADAPT): A RANDOMIZED CONTROLLED STUDY

  https://www.repository.cam.ac.uk/items/6aa47ac9-1e62-412a-91e5-cb2f61ccd402

  Background The aim was to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with multiple daily injections (MDI) and intermittently-scanned continuous glucose monitoring (isCGM) therapy in adults with type 1 diabetes (T1D) with suboptimal glucose control. […] Interpretation In people with T1D using MDI+isCGM and with HbA1c 80% the use of AHCL confers benefits in terms of glycemic control and treatment satisfaction beyond those that can be achieved with MDI+isCGM therapy. These data support wider access to AHCL in people with T1D not at target glucose levels.

• #68 ADVANCED HYBRID CLOSED LOOP STUDY IN AN ADULT POPULATION WITH TYPE 1 DIABETES (ADAPT): A RANDOMIZED CONTROLLED STUDY

  https://www.repository.cam.ac.uk/items/6aa47ac9-1e62-412a-91e5-cb2f61ccd402

  Background The aim was to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with multiple daily injections (MDI) and intermittently-scanned continuous glucose monitoring (isCGM) therapy in adults with type 1 diabetes (T1D) with suboptimal glucose control. […] Interpretation In people with T1D using MDI+isCGM and with HbA1c 80% the use of AHCL confers benefits in terms of glycemic control and treatment satisfaction beyond those that can be achieved with MDI+isCGM therapy. These data support wider access to AHCL in people with T1D not at target glucose levels.

• #69 Randomised controlled trial of Advanced Hybrid Closed Loop in an Adult Population with Type 1 Diabetes (ADAPT): study protocol and rationale | BMJ Open

  https://bmjopen.bmj.com/content/12/2/e050635

  The inclusion criteria limit trial enrolment to subjects with a baseline HbA1c of 8.0% (64 mmol/mol), that is, subjects failing to achieve good glycaemic control as stipulated by HbA1c targets recommended in major guidelines. […] The ADAPT study will address the issue of whether the AHCL system can provide incremental benefits over a period of 6 months in terms of glycaemic control relative to MDI plus IS-CGM in adults with T1D.

• #70 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  However, technological advances including continuous glucose monitoring (CGM), connected insulin pens (CIPs), insulin pumps, and automated insulin delivery (AID) algorithms combined with education have made it possible to achieve the optimal control of diabetes using insulin. […] The use of rtCGM reduces HbA1c by about 0.3% to 0.6%. […] Today, structured education specifically for CGM has been recognized as an essential part of diabetes therapy. […] The CIP is a new technology with a function that displays the last dose of insulin and timing and has reminder alerts that integrate with a smart app. […] Currently, a few clinical trials are collecting data on the effectiveness of these CIPs. […] Increasing evidence demonstrates the effectiveness of insulin pumps when used in combination with a CGM and closed-loop algorithm controller to automate basal insulin delivery, these are known as HCLS.

• #71

  https://www.bjd-abcd.com/bjdvd/index.php/bjd/article/view/1191

  HCL studies have similarly shown improved HbA1c and other sensor-based glucose outcomes. […] Recent recommendations from the National Institute of Health and Care Excellence (NICE) regarding HCL further underscore the growing significance of these advances in diabetes care. […] To get the best from novel diabetes technology, appropriate training and education are required, specifically in identifying and dealing with critical system failures such as cannula failure and the risk of ketoacidosis. […] Some disadvantages of technology include alarm burden, connectivity problems and premature device failure.

• #72 NHS England » Hybrid closed loop technologies: 5-year implementation strategy

  https://www.england.nhs.uk/long-read/hybrid-closed-loop-technologies-5-year-implementation-strategy/

  HCL is the next step in the evolution of diabetes technology as it links CGM with insulin pump technology. […] Hybrid closed loop (HCL) technologies are the next phase of technical advancement linking continuous glucose monitoring (CGM) and insulin pump technology to provide people living with type 1 diabetes with support 24 hours a day. […] The strategy focuses on improving population health outcomes, ensuring equitable access to HCL and reducing health inequalities. […] Education and training is a vital component in supporting wider access to HCL technologies and will be at the heart of the rollout. […] NHS England encourages proactive conversations between local ICB leaders and providers of children, young people and adult diabetes services to agree a delivery plan for their local population.

• #73 NHS England » Hybrid closed loop technologies: 5-year implementation strategy

  https://www.england.nhs.uk/long-read/hybrid-closed-loop-technologies-5-year-implementation-strategy/

  NHS England will also work with professional representative bodies like the Diabetes Technology Network, and structured education and self-management support providers to ensure HCL training modules are tailored and readily available to clinicians and people living with type 1 diabetes. […] The phased implementation of HCL will be transparent and supported by data. A robust process for monitoring and reporting uptake will be formalised through the National Diabetes Audit and National Paediatric Diabetes Audit.

• #74 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] It also says that eligible people and their carers should be able to use them safely and either be offered an approved structured education programme or know how to manage insulin dosing and adjustments. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #75 NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes

  https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1

  The guidance goes on to say that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes. […] It also says that eligible people and their carers should be able to use them safely and either be offered an approved structured education programme or know how to manage insulin dosing and adjustments. […] Theres lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. […] Hybrid closed-loop technology has the potential to transform the lives of many people with type 1 diabetes, improving both health and quality of life. […] This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples lives, not to mention outcomes it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication. […] In order for most adults to be considered for hybrid closed-loop, they will need to already be using a CGM or insulin pump.

• #76 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  The initial discussion will include clarification on whether they qualify under the NICE and NHS England criteria, as listed above. […] The group start session is followed by telephone support and reviews of the technology are built into the regular clinics. […] NHS England has provided interactive resources for clinicians in emergency departments to allow them to understand the pathways for patients presenting with diabetes related adverse events. […] The technology may also rely on the digital maturity of the surrounding environment, and this may need to be a factor in the choice of the HCL system. […] The NICE recommendations are presented with the expectation that the guidelines will be implemented.

• #77 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  The initial discussion will include clarification on whether they qualify under the NICE and NHS England criteria, as listed above. […] The group start session is followed by telephone support and reviews of the technology are built into the regular clinics. […] NHS England has provided interactive resources for clinicians in emergency departments to allow them to understand the pathways for patients presenting with diabetes related adverse events. […] The technology may also rely on the digital maturity of the surrounding environment, and this may need to be a factor in the choice of the HCL system. […] The NICE recommendations are presented with the expectation that the guidelines will be implemented.

• #78 Insulin Pumps and Continuous Glucose Monitors: Understanding Their Use in the Hospital Setting – Advances in Diabetes and Endocrinology | NewYork-Presbyterian

  https://www.nyp.org/advances/article/diabetes-endocrinology/insulin-pumps-and-continuous-glucose-monitors

  Drs. Mendelsohn, Yeh, and Yeung advise that in any circumstance that may affect the use of continuous glucose insulin infusion and CGM devices while a patient is in the hospital, consultation with an endocrinologist or diabetes specialist is warranted to ensure that the healthcare team can proceed safely with regard to glycemic management. […] Managing these devices in the setting of radiology studies is another unique aspect that we dont encounter as frequently in the outpatient world. […] The expert panel that developed the 2020 Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline recommends that devices should be discontinued in the hospital for patients with diabetic ketoacidosis, rapidly changing glucose levels and fluid/electrolyte shifts, skin infections or edema near the sensor site, and patients treated with vasoactive agents for poor tissue perfusion.

• #79 Insulin Pumps and Continuous Glucose Monitors: Understanding Their Use in the Hospital Setting – Advances in Diabetes and Endocrinology | NewYork-Presbyterian

  https://www.nyp.org/advances/article/diabetes-endocrinology/insulin-pumps-and-continuous-glucose-monitors

  Drs. Mendelsohn, Yeh, and Yeung advise that in any circumstance that may affect the use of continuous glucose insulin infusion and CGM devices while a patient is in the hospital, consultation with an endocrinologist or diabetes specialist is warranted to ensure that the healthcare team can proceed safely with regard to glycemic management. […] Managing these devices in the setting of radiology studies is another unique aspect that we dont encounter as frequently in the outpatient world. […] The expert panel that developed the 2020 Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline recommends that devices should be discontinued in the hospital for patients with diabetic ketoacidosis, rapidly changing glucose levels and fluid/electrolyte shifts, skin infections or edema near the sensor site, and patients treated with vasoactive agents for poor tissue perfusion.

• #80 Satisfaction with Home Healthcare Provider Service in Adults with Type 1 Diabetes Using a Hybrid Closed Loop System: The SATURN Study – European Medical Journal

  https://www.emjreviews.com/diabetes/article/satisfaction-with-home-healthcare-provider-service-in-adults-with-type-1-diabetes-using-a-hybrid-closed-loop-system-the-saturn-study-j040123/

  Hybrid closed loop (HCL) systems have the potential to improve glycaemic control in people with Type 1 diabetes (T1D). In France, patient technical education and assistance for HCL users is provided by trained nurses from home healthcare providers (HHP). The objective of this study was to evaluate satisfaction of people with T1D with HHP services. […] HHP services for early phase HCL implementation were met with high client satisfaction levels. Study results emphasise the need for a personalised HHP approach. […] HHPs may be of particular value during the first few months to reduce the risk of early discontinuation. The need for HHP support may gradually decrease as patients get more proficient in the use of their HCL system. […] The goal of the HHP service is to ensure that patients acquire the knowledge and proficiency required to use the HCL system, and to develop trust in the system and its algorithm. Trust and knowledge are paramount in order for patients to let go and hand over control to the system.

• #81 Satisfaction with Home Healthcare Provider Service in Adults with Type 1 Diabetes Using a Hybrid Closed Loop System: The SATURN Study – European Medical Journal

  https://www.emjreviews.com/diabetes/article/satisfaction-with-home-healthcare-provider-service-in-adults-with-type-1-diabetes-using-a-hybrid-closed-loop-system-the-saturn-study-j040123/

  Hybrid closed loop (HCL) systems have the potential to improve glycaemic control in people with Type 1 diabetes (T1D). In France, patient technical education and assistance for HCL users is provided by trained nurses from home healthcare providers (HHP). The objective of this study was to evaluate satisfaction of people with T1D with HHP services. […] HHP services for early phase HCL implementation were met with high client satisfaction levels. Study results emphasise the need for a personalised HHP approach. […] HHPs may be of particular value during the first few months to reduce the risk of early discontinuation. The need for HHP support may gradually decrease as patients get more proficient in the use of their HCL system. […] The goal of the HHP service is to ensure that patients acquire the knowledge and proficiency required to use the HCL system, and to develop trust in the system and its algorithm. Trust and knowledge are paramount in order for patients to let go and hand over control to the system.

• #82 Satisfaction with Home Healthcare Provider Service in Adults with Type 1 Diabetes Using a Hybrid Closed Loop System: The SATURN Study – European Medical Journal

  https://www.emjreviews.com/diabetes/article/satisfaction-with-home-healthcare-provider-service-in-adults-with-type-1-diabetes-using-a-hybrid-closed-loop-system-the-saturn-study-j040123/

  Hybrid closed loop (HCL) systems have the potential to improve glycaemic control in people with Type 1 diabetes (T1D). In France, patient technical education and assistance for HCL users is provided by trained nurses from home healthcare providers (HHP). The objective of this study was to evaluate satisfaction of people with T1D with HHP services. […] HHP services for early phase HCL implementation were met with high client satisfaction levels. Study results emphasise the need for a personalised HHP approach. […] HHPs may be of particular value during the first few months to reduce the risk of early discontinuation. The need for HHP support may gradually decrease as patients get more proficient in the use of their HCL system. […] The goal of the HHP service is to ensure that patients acquire the knowledge and proficiency required to use the HCL system, and to develop trust in the system and its algorithm. Trust and knowledge are paramount in order for patients to let go and hand over control to the system.

• #83 Satisfaction with Home Healthcare Provider Service in Adults with Type 1 Diabetes Using a Hybrid Closed Loop System: The SATURN Study – European Medical Journal

  https://www.emjreviews.com/diabetes/article/satisfaction-with-home-healthcare-provider-service-in-adults-with-type-1-diabetes-using-a-hybrid-closed-loop-system-the-saturn-study-j040123/

  Hybrid closed loop (HCL) systems have the potential to improve glycaemic control in people with Type 1 diabetes (T1D). In France, patient technical education and assistance for HCL users is provided by trained nurses from home healthcare providers (HHP). The objective of this study was to evaluate satisfaction of people with T1D with HHP services. […] HHP services for early phase HCL implementation were met with high client satisfaction levels. Study results emphasise the need for a personalised HHP approach. […] HHPs may be of particular value during the first few months to reduce the risk of early discontinuation. The need for HHP support may gradually decrease as patients get more proficient in the use of their HCL system. […] The goal of the HHP service is to ensure that patients acquire the knowledge and proficiency required to use the HCL system, and to develop trust in the system and its algorithm. Trust and knowledge are paramount in order for patients to let go and hand over control to the system.

• #84 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Further trials in adult and pediatric populations have demonstrated increased time in target and reduced hypoglycemia, mean glucose levels, and HbA1c in hybrid closed-loop systems. […] The MiniMed 670G (Medtronic), the first commercially available hybrid closed-loop system, was released in 2016. […] These systems use three main types of algorithms: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic. […] The pivotal trial establishing the efficacy of the MiniMed 670G system was published by Garg et al. in 2017. […] A recent retrospective analysis of data uploaded over a 15-month period by 14,899 European users of the MiniMed 670G found that users spent a mean 81.4% of the time in Auto Mode and could expect to spend 72% of the time in range with Auto Mode enabled, an increase of 10% compared with pre-Auto Mode initiation.

• #85 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Further trials in adult and pediatric populations have demonstrated increased time in target and reduced hypoglycemia, mean glucose levels, and HbA1c in hybrid closed-loop systems. […] The MiniMed 670G (Medtronic), the first commercially available hybrid closed-loop system, was released in 2016. […] These systems use three main types of algorithms: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic. […] The pivotal trial establishing the efficacy of the MiniMed 670G system was published by Garg et al. in 2017. […] A recent retrospective analysis of data uploaded over a 15-month period by 14,899 European users of the MiniMed 670G found that users spent a mean 81.4% of the time in Auto Mode and could expect to spend 72% of the time in range with Auto Mode enabled, an increase of 10% compared with pre-Auto Mode initiation.

• #86 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  Further trials in adult and pediatric populations have demonstrated increased time in target and reduced hypoglycemia, mean glucose levels, and HbA1c in hybrid closed-loop systems. […] The MiniMed 670G (Medtronic), the first commercially available hybrid closed-loop system, was released in 2016. […] These systems use three main types of algorithms: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic. […] The pivotal trial establishing the efficacy of the MiniMed 670G system was published by Garg et al. in 2017. […] A recent retrospective analysis of data uploaded over a 15-month period by 14,899 European users of the MiniMed 670G found that users spent a mean 81.4% of the time in Auto Mode and could expect to spend 72% of the time in range with Auto Mode enabled, an increase of 10% compared with pre-Auto Mode initiation.

• #87 What are Automated Insulin Delivery Systems? | Medtronic

  https://www.medtronicdiabetes.com/treatments/automated-insulin-delivery

  Automated insulin delivery (AID) systems combine an insulin pump and continuous glucose monitor (CGM) to help people living with type 1 diabetes manage their blood sugar levels. […] AID systems, also known as hybrid closed loop systems, can detect changes in a persons sugar levels in real time and automatically adjust insulin doses in response. […] The CGM tracks your sugar levels every few minutes through a small sensor inserted under the skin. […] The algorithm uses current and past sugar level trends to anticipate, adjust, and correct insulin delivery. […] Its no surprise why the American Diabetes Association calls automated insulin delivery systems the standard of care for people with type 1 diabetes. […] The MiniMed 780G system is intended for continuous delivery of basal insulin at selectable rates, and the administration of insulin boluses at selectable amounts for the management of type 1 diabetes mellitus in persons seven years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin.

• #88 What are Automated Insulin Delivery Systems? | Medtronic

  https://www.medtronicdiabetes.com/treatments/automated-insulin-delivery

  The MiniMed 780G system includes SmartGuard technology, which can be programmed to automatically adjust insulin delivery based on the continuous glucose monitoring (CGM) sensor glucose values and can suspend delivery of insulin when the sensor glucose (SG) value falls below or is predicted to fall below predefined threshold values.

• #89 Diabetes Management Technology Update

  https://www.umassmed.edu/dcoe/news/diabetes-technology-update/

  Continuous glucose monitors are constantly improving. The latest technology offers various options and benefits including alarms for highs and lows. Many of our patients, with both type 1 and type 2 diabetes, have experienced drastic improvements to their blood glucose control by starting to use a CGM. […] Some insulin pumps automatically adjust background (basal) insulin based on sensor glucose readings to prevent both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). […] The Control-IQ closed loop feature predicts glucose levels 30 minutes in advance (using the Dexcom G6) and automatically adjusts basal rates to prevent both hyper and hypoglycemia. […] This device is approved for people with type 1 diabetes seven years and older. The system delivers basal insulin every five minutes and constantly self-adjusts to help avoid highs and lows.

• #90 Diabetes Management Technology Update

  https://www.umassmed.edu/dcoe/news/diabetes-technology-update/

  Continuous glucose monitors are constantly improving. The latest technology offers various options and benefits including alarms for highs and lows. Many of our patients, with both type 1 and type 2 diabetes, have experienced drastic improvements to their blood glucose control by starting to use a CGM. […] Some insulin pumps automatically adjust background (basal) insulin based on sensor glucose readings to prevent both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). […] The Control-IQ closed loop feature predicts glucose levels 30 minutes in advance (using the Dexcom G6) and automatically adjusts basal rates to prevent both hyper and hypoglycemia. […] This device is approved for people with type 1 diabetes seven years and older. The system delivers basal insulin every five minutes and constantly self-adjusts to help avoid highs and lows.

• #91 Diabetes Management Technology Update

  https://www.umassmed.edu/dcoe/news/diabetes-technology-update/

  The pump integrates with the Dexcom G6 CGM. It’s compatible with certain Samsung smartphones to automatically adjust insulin based upon a predicted glucose level in 60 minutes and helps to protect against highs and lows. […] This new insulin-delivery system fully automates 100% of insulin doses. It offers a choice of three insulins, Novolog; Humalog; and Fiasp Pumpcart. The iLet is paired with a Dexcom G6 or G7 and manages glucose levels with only a meal announcement.

• #92 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  This automatic insulin dosing is the predictive algorithm and insulin pump working in unison with CGM to help minimize the frequent decisions needed to manage type 1 diabetes. […] The fact that the user still interacts with the pump and CGM, and at times needs to instruct the pump to give extra insulin or change settings, is why these systems are called hybrid. […] Using an advanced hybrid closed-loop system offers a number of benefits over other diabetes management methods. […] In my mind, the biggest benefit of using hybrid closed-loop technology has been improved sleep, said Dr. Pinsker. […] Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care. […] Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.

• #93 Managing Diabetes

  https://www.tandemdiabetes.com/support/diabetes-education/managing-diabetes/closed-loop-insulin-pump

  This automatic insulin dosing is the predictive algorithm and insulin pump working in unison with CGM to help minimize the frequent decisions needed to manage type 1 diabetes. […] The fact that the user still interacts with the pump and CGM, and at times needs to instruct the pump to give extra insulin or change settings, is why these systems are called hybrid. […] Using an advanced hybrid closed-loop system offers a number of benefits over other diabetes management methods. […] In my mind, the biggest benefit of using hybrid closed-loop technology has been improved sleep, said Dr. Pinsker. […] Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care. […] Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.

• #94 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Smartphone-based therapy management is the future of diabetes treatment. Combine the mylife YpsoPump insulin pump, the mylife CamAPS FX mobile application and the Dexcom G6, FreeStyle Libre 3 or FreeStyle Libre 3 Plus Continuous Glucose Monitoring (CGM) sensor for an automated insulin delivery system managed directly from your smartphone. […] The Automated Insulin Delivery (AID) system mylife Loop was designed to simplify diabetes management, boosting physical and mental wellbeing as much as lifestyle freedom. […] For automated insulin delivery with the mylife YpsoPump you need the mylife CamAPS FX app installed on an iPhone or Android smartphone and the Dexcom G6 or FreeStyle Libre 3 and Libre 3 Plus CGM sensor. […] The mylife CamAPS FX app is approved for people with type 1 diabetes aged one year and over, including pregnant women. Approved for people with type 1 diabetes aged two years and over when used in combination with Dexcom G6 or FreeStyle Libre 3 Plus sensors or aged four years and over when used in combination with FreeStyle Libre 3 sensor.

• #95 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Smartphone-based therapy management is the future of diabetes treatment. Combine the mylife YpsoPump insulin pump, the mylife CamAPS FX mobile application and the Dexcom G6, FreeStyle Libre 3 or FreeStyle Libre 3 Plus Continuous Glucose Monitoring (CGM) sensor for an automated insulin delivery system managed directly from your smartphone. […] The Automated Insulin Delivery (AID) system mylife Loop was designed to simplify diabetes management, boosting physical and mental wellbeing as much as lifestyle freedom. […] For automated insulin delivery with the mylife YpsoPump you need the mylife CamAPS FX app installed on an iPhone or Android smartphone and the Dexcom G6 or FreeStyle Libre 3 and Libre 3 Plus CGM sensor. […] The mylife CamAPS FX app is approved for people with type 1 diabetes aged one year and over, including pregnant women. Approved for people with type 1 diabetes aged two years and over when used in combination with Dexcom G6 or FreeStyle Libre 3 Plus sensors or aged four years and over when used in combination with FreeStyle Libre 3 sensor.

• #96 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Smartphone-based therapy management is the future of diabetes treatment. Combine the mylife YpsoPump insulin pump, the mylife CamAPS FX mobile application and the Dexcom G6, FreeStyle Libre 3 or FreeStyle Libre 3 Plus Continuous Glucose Monitoring (CGM) sensor for an automated insulin delivery system managed directly from your smartphone. […] The Automated Insulin Delivery (AID) system mylife Loop was designed to simplify diabetes management, boosting physical and mental wellbeing as much as lifestyle freedom. […] For automated insulin delivery with the mylife YpsoPump you need the mylife CamAPS FX app installed on an iPhone or Android smartphone and the Dexcom G6 or FreeStyle Libre 3 and Libre 3 Plus CGM sensor. […] The mylife CamAPS FX app is approved for people with type 1 diabetes aged one year and over, including pregnant women. Approved for people with type 1 diabetes aged two years and over when used in combination with Dexcom G6 or FreeStyle Libre 3 Plus sensors or aged four years and over when used in combination with FreeStyle Libre 3 sensor.

• #97 YpsoPump with mylife Loop – mylife Diabetescare – International

  https://www.mylife-diabetescare.com/en/mylife-loop.html

  Women strive to achieve tight glycaemic management during pregnancy to reduce the risks of obstetric and neonatal complications. […] Thanks to its unique technology and highly adaptive capabilities, CamAPS FX demonstrated in the AiDAPT (Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes) study that it can support women achieving their treatment goals during pregnancy, providing 10.5 % additional time in the pregnancy specific range, over the entire pregnancy period, without increasing hypoglycaemias. […] The mylife CamAPS FX app constantly learns and quickly adapts to ever changing insulin needs. […] This enables safe and efficient use in all life circumstances.

• #98 Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9207329/

  The past five to ten years have seen an explosion in research and published literature about closed-loop systems. […] Future directions in closed-loop research are principally aimed at the advanced generations of closed-loop systems as outlined by the JDRF: fully automated and multi-hormone systems. […] The main challenge in fully closed-loop systems therefore is postprandial hyperglycemia, as there is no manually provided information about the timing and carbohydrate content of meals. […] Fully closed-loop systems can use the same types of algorithms as hybrid systems MPC, PID, or fuzzy logic although all fully closed-loop systems included in a 2017 meta-analysis used MPC-based algorithms. […] The primary rationale for dual-hormone systems, which are capable of administering boluses of glucagon in addition to continuous insulin infusion, is that prevention of hypoglycemia is more effective with administration of glucagon than with suspension of insulin delivery.

• #99 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] There is no doubt that evolving diabetes technology has changed the treatment paradigm for patients with diabetes using insulin treatment and reduced the burden of diabetes self-management such as the adjustment of insulin dosing.

• #100 Advances in Continuous Glucose Monitoring and Integrated Devices for Management of Diabetes with Insulin-Based Therapy: Improvement in Glycemic Control

  https://www.e-dmj.org/journal/view.php?number=2703

  The outcomes are well summarized in the review article by Moon et al. […] Thus, this review only includes updated clinical trials beyond the previous review article. […] The development of diabetes technology made it possible to avoid hyperglycemia without increasing hypoglycemia with a more comfortable fit and less effort, which could not previously be shown in diabetes with insulin therapy. […] In the future, we expect that a fully automatic AID system will emerge, just as Bionic Pancreas has developed no carbohydrate counting pumps, which was previously burdensome for users. […] There is no doubt that evolving diabetes technology has changed the treatment paradigm for patients with diabetes using insulin treatment and reduced the burden of diabetes self-management such as the adjustment of insulin dosing.

• #101

  https://www.bjd-abcd.com/bjdvd/index.php/bjd/article/view/1191

  HCL studies have similarly shown improved HbA1c and other sensor-based glucose outcomes. […] Recent recommendations from the National Institute of Health and Care Excellence (NICE) regarding HCL further underscore the growing significance of these advances in diabetes care. […] To get the best from novel diabetes technology, appropriate training and education are required, specifically in identifying and dealing with critical system failures such as cannula failure and the risk of ketoacidosis. […] Some disadvantages of technology include alarm burden, connectivity problems and premature device failure.

• #102 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  The initial discussion will include clarification on whether they qualify under the NICE and NHS England criteria, as listed above. […] The group start session is followed by telephone support and reviews of the technology are built into the regular clinics. […] NHS England has provided interactive resources for clinicians in emergency departments to allow them to understand the pathways for patients presenting with diabetes related adverse events. […] The technology may also rely on the digital maturity of the surrounding environment, and this may need to be a factor in the choice of the HCL system. […] The NICE recommendations are presented with the expectation that the guidelines will be implemented.

• #103 Is a hybrid closed-loop system safe for my son who has T1D?

  https://www.icliniq.com/qa/continuous-glucose-monitoring-sensor/do-hybrid-closed-loop-systems-benefit-t1d-management

  Unexplained blood sugar spikes could indicate that his pump settings, especially basal and bolus ratios need adjustment. […] Regularly reviewing and adjusting his insulin settings is essential as his body changes. […] Guidelines for teenagers: Regular monitoring: Analyze CGM (continuous glucose monitor) data to optimize insulin settings. […] Adjustments: Modify basal rates and carbohydrate-to-insulin ratios as needed. […] Consulting with his healthcare team can help fine-tune his management plan.

• #104 Is a hybrid closed-loop system safe for my son who has T1D?

  https://www.icliniq.com/qa/continuous-glucose-monitoring-sensor/do-hybrid-closed-loop-systems-benefit-t1d-management

  Unexplained blood sugar spikes could indicate that his pump settings, especially basal and bolus ratios need adjustment. […] Regularly reviewing and adjusting his insulin settings is essential as his body changes. […] Guidelines for teenagers: Regular monitoring: Analyze CGM (continuous glucose monitor) data to optimize insulin settings. […] Adjustments: Modify basal rates and carbohydrate-to-insulin ratios as needed. […] Consulting with his healthcare team can help fine-tune his management plan.

• #105 Is a hybrid closed-loop system safe for my son who has T1D?

  https://www.icliniq.com/qa/continuous-glucose-monitoring-sensor/do-hybrid-closed-loop-systems-benefit-t1d-management

  Unexplained blood sugar spikes could indicate that his pump settings, especially basal and bolus ratios need adjustment. […] Regularly reviewing and adjusting his insulin settings is essential as his body changes. […] Guidelines for teenagers: Regular monitoring: Analyze CGM (continuous glucose monitor) data to optimize insulin settings. […] Adjustments: Modify basal rates and carbohydrate-to-insulin ratios as needed. […] Consulting with his healthcare team can help fine-tune his management plan.

• #106 Randomised controlled trial of Advanced Hybrid Closed Loop in an Adult Population with Type 1 Diabetes (ADAPT): study protocol and rationale | BMJ Open

  https://bmjopen.bmj.com/content/12/2/e050635

  The Advanced Hybrid Closed Loop study in Adult Population with Type 1 Diabetes (ADAPT) study will examine potential improvements associated with the use of the AHCL system in people with T1D with sub-optimal glycaemic control on a non-automated system. […] The ADAPT study will assess patient-reported outcomes, including fear of hypoglycaemia, quality of life and treatment satisfaction, and provide valuable input data for future health economic analyses, allowing better informed decision making among healthcare payers, for whom the acquisition costs of new technologies can represent a barrier to uptake or reimbursement. […] The aim of the ADAPT study will be to determine the change in HbA1c from baseline to 6 months for adults with T1D using the AHCL system relative to those using MDI plus IS-CGM.

• #107 At a glance factsheet: Hybrid closed-loop therapy – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/factsheet-hybrid-closed-loop-therapy/

  In December 2023, NICE published the TA943 guidance, which lays out recommendations for use of hybrid closed-loop (HCL) systems in the management of type 1 diabetes, with a 5-year roll-out plan. […] Although the treatment and care of people using HCL technology sits within specialist multidisciplinary teams, there are elements of care that are useful for primary care clinicians to know. This factsheet explains what HCL systems are and outlines what primary healthcare professionals need to know to support their use. […] An HCL system, also known as an artificial pancreas or Automated Insulin Delivery (AID) system, refers to the use of an insulin pump that is looped with an algorithm that continuously takes data from a continuous glucose monitoring (CGM) device to make and communicate decisions on insulin dosing to maintain glucose levels within the target range.

• #108 Diabetes hybrid closed loop systems | HFMA

  https://www.hfma.org.uk/publications/diabetes-hybrid-closed-loop-systems-0

  The initial discussion will include clarification on whether they qualify under the NICE and NHS England criteria, as listed above. […] The group start session is followed by telephone support and reviews of the technology are built into the regular clinics. […] NHS England has provided interactive resources for clinicians in emergency departments to allow them to understand the pathways for patients presenting with diabetes related adverse events. […] The technology may also rely on the digital maturity of the surrounding environment, and this may need to be a factor in the choice of the HCL system. […] The NICE recommendations are presented with the expectation that the guidelines will be implemented.

• #109 Hybrid Closed Loop System to Manage Blood Glucose Levels | Healthcare Paper Example

  https://nursingbird.com/hybrid-closed-loop-system-to-manage-blood-glucose-levels/

  In addition to helping people with T1D and their carers live better lives, hybrid closed-loop devices are more successful than traditional therapy in maintaining blood glucose levels in a healthy range. […] The evaluation of research within the scope of the use of a hybrid closed-loop system in T1D reveals promising results and potential applications. As such, studies have shown that the use of hybrid closed-loop systems can lead to improved glycemic control and reduced hypoglycemia for people with T1D. […] The current evidence also suggests that hybrid closed-loop systems are beneficial in the financial aspect. For instance, Hicks claims that this technology is more cost effective than traditional treatment methods for people with T1D. […] The findings suggest that hybrid closed-loop systems are more cost-effective than conventional care for people with T1D managing their glucose levels, although improvements are possible. […] In conclusion, using a hybrid closed-loop system to control the blood sugar levels of people with T1D seems to be a promising strategy for enhancing glycemic control, lowering hypoglycemia episodes, and maybe lowering healthcare expenditures.

• #110 Hybrid Closed Loop System to Manage Blood Glucose Levels | Healthcare Paper Example

  https://nursingbird.com/hybrid-closed-loop-system-to-manage-blood-glucose-levels/

  In addition to helping people with T1D and their carers live better lives, hybrid closed-loop devices are more successful than traditional therapy in maintaining blood glucose levels in a healthy range. […] The evaluation of research within the scope of the use of a hybrid closed-loop system in T1D reveals promising results and potential applications. As such, studies have shown that the use of hybrid closed-loop systems can lead to improved glycemic control and reduced hypoglycemia for people with T1D. […] The current evidence also suggests that hybrid closed-loop systems are beneficial in the financial aspect. For instance, Hicks claims that this technology is more cost effective than traditional treatment methods for people with T1D. […] The findings suggest that hybrid closed-loop systems are more cost-effective than conventional care for people with T1D managing their glucose levels, although improvements are possible. […] In conclusion, using a hybrid closed-loop system to control the blood sugar levels of people with T1D seems to be a promising strategy for enhancing glycemic control, lowering hypoglycemia episodes, and maybe lowering healthcare expenditures.

Zobacz więcej