Materiały źródłowe

• #1 Diabetes – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451

  The best current treatment for type one diabetes is an automated insulin delivery system. This system includes a continuous glucose monitor, insulin pump, and a computer algorithm that continually adjusts insulin responding to the continuous glucose monitoring signal. […] Testing using a glucose meter is not enough because glucose measurements in people with type one diabetes, vary from normal to low and normal to high very rapidly in the course of a day, a continuous glucose monitor is needed to assess whether treatment is effective and also to determine how to improve treatment. […] Current guidelines recommend use of a continuous glucose monitor. The percentage of time that is spent daily with glucose between 70 and 180 milligram per deciliter is the main measurement of appropriate treatment.

• #2 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  People with type 1 diabetes require continuous insulin treatment and must regularly measure their glucose levels. […] A study with the involvement of the German Center for Diabetes Research showed that hybrid closed-loop systems offer improved long-term blood sugar values (HbA1c levels) and a lower risk of hypoglycemic coma, but lead to a higher rate of diabetic ketoacidosis. […] Until now, the effect of insulin delivery in hybrid closed-loop systems on the risk of acute diabetes complications in people with type 1 diabetes has been unclear. […] The primary objectives of the study were to determine the rates of severe hypoglycemia and ketoacidosis. […] The results: People using hybrid closed-loop therapy had a significantly lower rate of rate of hypoglycemic coma (0.62 per 100 patient-years) than those using open-loop therapy (0.91 per 100 patient-years).

• #3 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  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. […] Data on CGM use in pregnant women with type 2 diabetes (T2D) are limited. […] A large randomized controlled trial (RCT) on CGM use in people with T2D in pregnancy is ongoing. […] Small studies on CGM use in women with gestational diabetes (GDM) have suggested improved glycaemic control and better qualification when insulin is needed. […] However, none of these studies was powered to evaluate pregnancy outcomes. […] Several large RCTs are ongoing in women with GDM. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D.

• #4 Closed-Loop Insulin Systems | Type 1 | London Diabetes Centre

  https://londondiabetes.com/type-1/insulin-pumps/closed-loop-insulin-systems-for-type-1-diabetes/

  Continuous glucose monitoring or CGM automatically measures your blood sugar levels every few minutes, day and night. Finger-prick tests give a snap-shot of your blood glucose. CGM provides a fuller picture, even when you’re asleep. […] CamAPX FX is compatible with the Dexcom G6, continuously measuring your glucose levels and sends data wirelessly to your smartphone through a transmitter. CGM can provide real-time, around-the-clock information about your glucose levels so that the closed-loop system can adjust the insulin your pump releases. […] The system has been comprehensively tested and is approved for use in the UK and across the European Union. Clinical trials have demonstrated that closed-loop insulin delivery provides better control, a reduced HbA1c, fewer low and high glucose spikes, and improved wellbeing for people whose diabetes control is sub-optimal.

• #5 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/

  A hybrid closed loop system takes readings from a continuous glucose monitor and uses an algorithm to tell an insulin pump how much insulin to deliver. It does this 24 hours a day. […] The CGM tells the algorithm what your glucose levels are and the algorithm tells the pump how much insulin to deliver. It will pause the flow of insulin if your levels are low or increase the flow if your levels are high. […] Automated insulin delivery is another term for HCL which is being used more often. […] 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.

• #6 Hybrid Closed Loop systems, the Dexcom way | Dexcom Healthcare Professionals

  https://uk.provider.dexcom.com/connectivity/hybrid-closed-loop

  One of the longest real-world outcome studies showed that people using rtCGM benefitted from significantly greater reductions in HbA1c compared to people using SMBG (self-monitoring of blood glucose), regardless of insulin delivery method. […] Benefits in time in range that may lead to reductions in HbA1c and a reduced risk of diabetes complications. […] HCL systems do not appear to be associated with increased rates of severe hypoglycaemia. […] Reduced mental burden that may contribute to improved psychosocial outcomes such as treatment satisfaction.

• #7 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

  Technologies and, in particular, CGM, have revolutionised diabetes management, as they have allowed a greater understanding of the disease and an improvement in treatment and outcomes. […] The use of the CGM allows increasing the TIR and reducing the CV (-3.09%) compared to the self-monitoring of glucose (SMBG) in adults and children with type 1 and 2 diabetes, as reported by a meta-analysis published in 2020. […] Gender medicine develops in parallel with technological evolution, the former being defined by WHO as the study of the influence of biological (defined by gender) and socio-economic and cultural (defined by gender) differences on the state of health and disease of each person. […] In type 1 diabetes, gender differences can be easily identified: the incidence varies according to sex, age, race and socio-economic conditions, and it is the only autoimmune disease not characterised by an absolute female predominance.

• #8 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

  Technologies and, in particular, CGM, have revolutionised diabetes management, as they have allowed a greater understanding of the disease and an improvement in treatment and outcomes. […] The use of the CGM allows increasing the TIR and reducing the CV (-3.09%) compared to the self-monitoring of glucose (SMBG) in adults and children with type 1 and 2 diabetes, as reported by a meta-analysis published in 2020. […] Gender medicine develops in parallel with technological evolution, the former being defined by WHO as the study of the influence of biological (defined by gender) and socio-economic and cultural (defined by gender) differences on the state of health and disease of each person. […] In type 1 diabetes, gender differences can be easily identified: the incidence varies according to sex, age, race and socio-economic conditions, and it is the only autoimmune disease not characterised by an absolute female predominance.

• #9 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: […] adults living with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or higher, or have disabling hypoglycaemia despite best possible management with at least one of the following:

• #10 Hybrid Closed Loop systems, the Dexcom way | Dexcom Healthcare Professionals

  https://uk.provider.dexcom.com/connectivity/hybrid-closed-loop

  Hybrid Closed Loop (HCL) systems, also referred to as Automated Insulin Delivery (AID), are designed to mimic the activity of the pancreas. […] Combining knowledge of the bodys prevailing glucose level and where it’s heading (supplied by a real-time continuous glucose monitoring, or rtCGM, system), with a digitally-controlled insulin pump, HCL systems automatically adjust insulin delivery to meet the changing needs of the user. […] NICE recommends HCL technology for all people with diabetes meeting any of the following criteria: Age 18 or under with type 1 diabetes, Over 18 with HbA1c 7.5%, Suffer from disabling hypoglycaemia, Women who are pregnant or trying to conceive a baby. […] Given that Dexcom is the worlds most connected rtCGM family, its no surprise that Dexcom has more HCL studies with more AID systems than any other CGM brand.

• #11 Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-center, randomized crossover trial | Nature Medicine

  https://www.nature.com/articles/s41591-022-02144-z

  In adults with type 2 diabetes, the benefits of fully closed-loop insulin delivery, which does not require meal bolusing, are unclear. […] Fully closed-loop insulin delivery improved glucose control without increasing hypoglycemia compared with standard insulin therapy and may represent a safe and efficacious method to improve outcomes in adults with type 2 diabetes. […] Closed-loop insulin delivery offers a new, glucose-responsive method of glucose control and comprises a continuous glucose monitor, an insulin pump and a control algorithm that automatically modulates subcutaneous insulin delivery. […] Fully closed-loop systems, which are more convenient and have no requirement for user input at meal times, have previously been shown to improve glucose control in people with type 2 diabetes in the inpatient setting.

• #12 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/

  A hybrid closed loop system takes readings from a continuous glucose monitor and uses an algorithm to tell an insulin pump how much insulin to deliver. It does this 24 hours a day. […] The CGM tells the algorithm what your glucose levels are and the algorithm tells the pump how much insulin to deliver. It will pause the flow of insulin if your levels are low or increase the flow if your levels are high. […] Automated insulin delivery is another term for HCL which is being used more often. […] 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.

• #13 Continuous glucose monitoring and hybrid closed loop for diabetes – NHS

  https://www.nhs.uk/conditions/cgm-and-hcl-for-diabetes/

  Continuous glucose monitors and hybrid closed loop systems are technology that can help people with diabetes manage their blood glucose (sugar) levels. […] A hybrid closed loop system (sometimes called an „artificial pancreas”) is technology that allows a CGM to work together with an insulin pump to help you manage your blood glucose. […] A hybrid closed loop system can improve your blood glucose levels, reduce the risk of hypos and make it easier to manage diabetes. […] Hybrid closed loop systems are being made available on the NHS to some people with type 1 diabetes. They’ll be introduced gradually over 5 years from April 2024, starting with people who need them most. […] Insulin pumps and hybrid closed loop systems are not currently available on the NHS for people with type 2 diabetes.

• #14 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/

  Hybrid closed-loop systems are a new class of technology to manage type 1 diabetes mellitus. The system includes a combination of real-time continuous glucose monitoring from a continuous glucose monitoring device and a control algorithm to direct insulin delivery through an insulin pump. Evidence suggests that such technologies have the potential to improve the lives of people with type 1 diabetes mellitus and their families. […] The clinical evidence identified 12 randomised controlled trials that compared hybrid closed loop with continuous subcutaneous insulin infusion + continuous glucose monitoring. Hybrid closed-loop arm of randomised controlled trials achieved improvement in glycated haemoglobin per cent [hybrid closed loop decreased glycated haemoglobin per cent by 0.28 (95% confidence interval -0.34 to -0.21), increased per cent of time in range (between 3.9 and 10.0 mmol/l) with a MD of 8.6 (95% confidence interval 7.03 to 10.22), and significantly decreased time in range (per cent above 10.0 mmol/l) with a MD of -7.2 (95% confidence interval -8.89 to -5.51), but did not significantly affect per cent of time below range ( 3.9 mmol/l)].

• #15 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

  Similarly, results regarding the percentage of time that the glucose level was above 250 mg per deciliter, the mean glucose level, and the glycated hemoglobin level all favored the closed-loop system. […] We infer that the finding that patients with higher baseline glycated hemoglobin levels had the greatest improvement in the percentage of time that the glucose level was in the target range may be of public health importance for the prevention of long-term complications of type 1 diabetes, the authors said.

• #16 Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI) | BMC Endocrine Disorders | F

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00996-7

  One of the latest HCL systems is the MiniMed 780G system (Medtronic, Northridge, CA, USA), which was commercialized in October 2020 in selected countries. This system automatically delivers basal insulin with a customizable glucose target in addition delivering an automated bolus correction, as required. […] The pivotal trial data demonstrated that the system was safe and significantly improved HbA1c and sensor glucose (SG) levels in adolescents and adults with T1D and provided rapid glycemic improvements in people with T1D with pre-existing good glycemic control. […] The objective of this study was to evaluate the glycemic outcome using a structured initiation protocol for AHCL Minimed 780G system in children and adolescents with T1D on MDI therapy. […] The primary outcome was the TIR change and HbA1c from baseline (MDI+CGM, 1 week) to study phase (AHCL,12 weeks).

• #17 Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI) | BMC Endocrine Disorders | F

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00996-7

  One of the latest HCL systems is the MiniMed 780G system (Medtronic, Northridge, CA, USA), which was commercialized in October 2020 in selected countries. This system automatically delivers basal insulin with a customizable glucose target in addition delivering an automated bolus correction, as required. […] The pivotal trial data demonstrated that the system was safe and significantly improved HbA1c and sensor glucose (SG) levels in adolescents and adults with T1D and provided rapid glycemic improvements in people with T1D with pre-existing good glycemic control. […] The objective of this study was to evaluate the glycemic outcome using a structured initiation protocol for AHCL Minimed 780G system in children and adolescents with T1D on MDI therapy. […] The primary outcome was the TIR change and HbA1c from baseline (MDI+CGM, 1 week) to study phase (AHCL,12 weeks).

• #18 Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI) | BMC Endocrine Disorders | F

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00996-7

  HbA1c decreased from 8.61.7% (7018.6 mmol/mol) at baseline, to 6.50.7% (487.7 mmol/mol) at the end of the study and TIR (70-180 mg/dL) increased from 42.118.7% at baseline to 78.86.1% in study phase. […] The significant TIR improvement reaching more than 70% after only 7 days of AHCL use which indicates the rapid adaptation on the algorithm to the specific needs of the individual, as well the effectiveness of our structured initiation protocol. […] The reduction in HbA1c, by a mean of 2.1% (23 mmol/mol), observed in our study are more than 1.6% reduction with a previous HCL (MiniMed 670G) system, greater than 0.6% in sub-optimally controlled patients with T1D and 0.6% in children with T1D, both using different AHCL algorithms. […] ICR modifications, automated bolus correction in addition to automated basal insulin delivery, as well as optimizing glucose target and active insulin time, effectively distributed the insulin delivery according to patients individual requirements, resulting in better glycemic outcome with minimal increase in total insulin dose. […] The improved clinical outcomes observed in our study were achieved in a safe manner, with no DKA events, or severe hypoglycemia and with no hospital admission.

• #19 Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI) | BMC Endocrine Disorders | F

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00996-7

  HbA1c decreased from 8.61.7% (7018.6 mmol/mol) at baseline, to 6.50.7% (487.7 mmol/mol) at the end of the study and TIR (70-180 mg/dL) increased from 42.118.7% at baseline to 78.86.1% in study phase. […] The significant TIR improvement reaching more than 70% after only 7 days of AHCL use which indicates the rapid adaptation on the algorithm to the specific needs of the individual, as well the effectiveness of our structured initiation protocol. […] The reduction in HbA1c, by a mean of 2.1% (23 mmol/mol), observed in our study are more than 1.6% reduction with a previous HCL (MiniMed 670G) system, greater than 0.6% in sub-optimally controlled patients with T1D and 0.6% in children with T1D, both using different AHCL algorithms. […] ICR modifications, automated bolus correction in addition to automated basal insulin delivery, as well as optimizing glucose target and active insulin time, effectively distributed the insulin delivery according to patients individual requirements, resulting in better glycemic outcome with minimal increase in total insulin dose. […] The improved clinical outcomes observed in our study were achieved in a safe manner, with no DKA events, or severe hypoglycemia and with no hospital admission.

• #20 Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI) | BMC Endocrine Disorders | F

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00996-7

  HbA1c decreased from 8.61.7% (7018.6 mmol/mol) at baseline, to 6.50.7% (487.7 mmol/mol) at the end of the study and TIR (70-180 mg/dL) increased from 42.118.7% at baseline to 78.86.1% in study phase. […] The significant TIR improvement reaching more than 70% after only 7 days of AHCL use which indicates the rapid adaptation on the algorithm to the specific needs of the individual, as well the effectiveness of our structured initiation protocol. […] The reduction in HbA1c, by a mean of 2.1% (23 mmol/mol), observed in our study are more than 1.6% reduction with a previous HCL (MiniMed 670G) system, greater than 0.6% in sub-optimally controlled patients with T1D and 0.6% in children with T1D, both using different AHCL algorithms. […] ICR modifications, automated bolus correction in addition to automated basal insulin delivery, as well as optimizing glucose target and active insulin time, effectively distributed the insulin delivery according to patients individual requirements, resulting in better glycemic outcome with minimal increase in total insulin dose. […] The improved clinical outcomes observed in our study were achieved in a safe manner, with no DKA events, or severe hypoglycemia and with no hospital admission.

• #21 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  People with type 1 diabetes require continuous insulin treatment and must regularly measure their glucose levels. […] A study with the involvement of the German Center for Diabetes Research showed that hybrid closed-loop systems offer improved long-term blood sugar values (HbA1c levels) and a lower risk of hypoglycemic coma, but lead to a higher rate of diabetic ketoacidosis. […] Until now, the effect of insulin delivery in hybrid closed-loop systems on the risk of acute diabetes complications in people with type 1 diabetes has been unclear. […] The primary objectives of the study were to determine the rates of severe hypoglycemia and ketoacidosis. […] The results: People using hybrid closed-loop therapy had a significantly lower rate of rate of hypoglycemic coma (0.62 per 100 patient-years) than those using open-loop therapy (0.91 per 100 patient-years).

• #22 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  However, individuals using a hybrid closed-loop system had a higher rate of ketoacidosis (1.74 events per 100 patient-years) than those using open-loop therapy (0.96 per 100 patient-years). […] Due to the higher risk of ketoacidosis, it is important to provide patients with targeted information and, in case of potential metabolic decompensation, to closely monitor ketone bodies in the blood or urine in order to prevent such adverse events, emphasize the authors of the study. […] Hybrid closed-loop systems (HCL) are technologies used to treat type 1 diabetes. They combine an insulin pump, continuous glucose monitoring, and an algorithm for automated insulin delivery. […] Open-loop systems combine an insulin pump and continuous glucose monitoring (CGM).

• #23 Type 1 Diabetes: Hybrid Closed-Loop and Open-Loop…

  https://www.dzd-ev.de/en/press/press-releases/press-releases-2025/type-1-diabetes-hybrid-closed-loop-and-open-loop-systems/index.html

  However, individuals using a hybrid closed-loop system had a higher rate of ketoacidosis (1.74 events per 100 patient-years) than those using open-loop therapy (0.96 per 100 patient-years). […] Due to the higher risk of ketoacidosis, it is important to provide patients with targeted information and, in case of potential metabolic decompensation, to closely monitor ketone bodies in the blood or urine in order to prevent such adverse events, emphasize the authors of the study. […] Hybrid closed-loop systems (HCL) are technologies used to treat type 1 diabetes. They combine an insulin pump, continuous glucose monitoring, and an algorithm for automated insulin delivery. […] Open-loop systems combine an insulin pump and continuous glucose monitoring (CGM).

• #24 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] 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.

• #25 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] 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.

• #26 Insulin edema after initiation of hybrid closed-loop insulin pump therapy with continuous glucose monitoring: a case report | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-022-00143-0

  Insulin edema is a rare complication which can present after initiation or intensification of insulin therapy in people with diabetes. […] Initiation of closed-loop hybrid insulin pump therapy can result in rapid improvement in glycemic control for people with diabetes. […] To our knowledge, this is the first case of insulin edema reported in a person with type 1 diabetes using CGM and a hybrid closed-loop insulin pump system. […] Use of hybrid closed-loop systems can help achieve rapid improvement in glycemic control in people with diabetes. […] This case suggests that consideration should be given to adjusting initial blood glucose targets when starting these remarkable new technologies in people with baseline poor glycemic control. […] Insulin edema rarely occurs with initiation or intensification of insulin treatment in people with diabetes.

• #27 Insulin edema after initiation of hybrid closed-loop insulin pump therapy with continuous glucose monitoring: a case report | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-022-00143-0

  Insulin edema is a rare complication which can present after initiation or intensification of insulin therapy in people with diabetes. […] Initiation of closed-loop hybrid insulin pump therapy can result in rapid improvement in glycemic control for people with diabetes. […] To our knowledge, this is the first case of insulin edema reported in a person with type 1 diabetes using CGM and a hybrid closed-loop insulin pump system. […] Use of hybrid closed-loop systems can help achieve rapid improvement in glycemic control in people with diabetes. […] This case suggests that consideration should be given to adjusting initial blood glucose targets when starting these remarkable new technologies in people with baseline poor glycemic control. […] Insulin edema rarely occurs with initiation or intensification of insulin treatment in people with diabetes.

• #28 Insulin edema after initiation of hybrid closed-loop insulin pump therapy with continuous glucose monitoring: a case report | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-022-00143-0

  We believe this is the first report of insulin edema in an individual with type 1 diabetes occurring after transitioning to a hybrid closed-loop system. […] Several clinical features have been described as risk factors for developing insulin edema including poor glycemic control, new-onset diabetes, type 1 diabetes, low body weight, poor nutritional status, and higher doses of insulin therapy. […] In our case, the use of concentrated insulin U-200 lispro in the insulin pump is off-label. […] This case also points to a potential concern about initiation of these systems in patients with poor glycemic control at baseline. […] Consideration might be given to adjusting blood glucose targets when initiating hybrid closed-loop insulin pump therapy in people with baseline poor glycemic control. […] Given the increasing use of automated insulin delivery systems in type 1 diabetes, future studies examining the best approaches for initiating this therapy in people with high insulin requirements should be considered.

• #29 Insulin edema after initiation of hybrid closed-loop insulin pump therapy with continuous glucose monitoring: a case report | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-022-00143-0

  We believe this is the first report of insulin edema in an individual with type 1 diabetes occurring after transitioning to a hybrid closed-loop system. […] Several clinical features have been described as risk factors for developing insulin edema including poor glycemic control, new-onset diabetes, type 1 diabetes, low body weight, poor nutritional status, and higher doses of insulin therapy. […] In our case, the use of concentrated insulin U-200 lispro in the insulin pump is off-label. […] This case also points to a potential concern about initiation of these systems in patients with poor glycemic control at baseline. […] Consideration might be given to adjusting blood glucose targets when initiating hybrid closed-loop insulin pump therapy in people with baseline poor glycemic control. […] Given the increasing use of automated insulin delivery systems in type 1 diabetes, future studies examining the best approaches for initiating this therapy in people with high insulin requirements should be considered.

• #30 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

  Technologies and, in particular, CGM, have revolutionised diabetes management, as they have allowed a greater understanding of the disease and an improvement in treatment and outcomes. […] The use of the CGM allows increasing the TIR and reducing the CV (-3.09%) compared to the self-monitoring of glucose (SMBG) in adults and children with type 1 and 2 diabetes, as reported by a meta-analysis published in 2020. […] Gender medicine develops in parallel with technological evolution, the former being defined by WHO as the study of the influence of biological (defined by gender) and socio-economic and cultural (defined by gender) differences on the state of health and disease of each person. […] In type 1 diabetes, gender differences can be easily identified: the incidence varies according to sex, age, race and socio-economic conditions, and it is the only autoimmune disease not characterised by an absolute female predominance.

• #31 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

  Technologies and, in particular, CGM, have revolutionised diabetes management, as they have allowed a greater understanding of the disease and an improvement in treatment and outcomes. […] The use of the CGM allows increasing the TIR and reducing the CV (-3.09%) compared to the self-monitoring of glucose (SMBG) in adults and children with type 1 and 2 diabetes, as reported by a meta-analysis published in 2020. […] Gender medicine develops in parallel with technological evolution, the former being defined by WHO as the study of the influence of biological (defined by gender) and socio-economic and cultural (defined by gender) differences on the state of health and disease of each person. […] In type 1 diabetes, gender differences can be easily identified: the incidence varies according to sex, age, race and socio-economic conditions, and it is the only autoimmune disease not characterised by an absolute female predominance.

• #32 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

  The results of the German study contradict the Italian data from AMD Annals 2021, according to which in the adult population of women are 30% less likely to have an HbA1c ≤ 7% than men, and are more frequently treated with CSII (15.5% vs. 11.1%), even if the percentage of use in both sexes is much lower than in Germany. […] In people with type 1 diabetes, technologies facilitate the performance of physical activity and, above all, the management of hypoglycaemia. […] Various technologies have made it possible to improve the management of type 1 diabetes in pregnancy. […] Although sex and gender differences have emerged regarding the prevalence of use and adherence to therapy with advanced technologies, the perceived benefits for both sexes were better glycaemic control, the prevention of long-term complications, better quality of life, and reduced mental burden related to diabetes.

• #33 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

  The results of the German study contradict the Italian data from AMD Annals 2021, according to which in the adult population of women are 30% less likely to have an HbA1c ≤ 7% than men, and are more frequently treated with CSII (15.5% vs. 11.1%), even if the percentage of use in both sexes is much lower than in Germany. […] In people with type 1 diabetes, technologies facilitate the performance of physical activity and, above all, the management of hypoglycaemia. […] Various technologies have made it possible to improve the management of type 1 diabetes in pregnancy. […] Although sex and gender differences have emerged regarding the prevalence of use and adherence to therapy with advanced technologies, the perceived benefits for both sexes were better glycaemic control, the prevention of long-term complications, better quality of life, and reduced mental burden related to diabetes.

• #34

  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 newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. […] An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. […] Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. […] The FDA approved Libre 3 which provides real-time glucose values every minute.

• #35

  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 newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. […] An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. […] Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. […] The FDA approved Libre 3 which provides real-time glucose values every minute.

• #36

  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 newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. […] An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. […] Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. […] The FDA approved Libre 3 which provides real-time glucose values every minute.

• #37

  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 newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. […] An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. […] Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. […] The FDA approved Libre 3 which provides real-time glucose values every minute.

• #38

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

  Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. […] It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. […] 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. […] Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. […] Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. […] A clinical guide to advanced diabetes devices and closed-loop systems using the CARES paradigm.

• #39

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

  Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. […] It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. […] 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. […] Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. […] Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. […] A clinical guide to advanced diabetes devices and closed-loop systems using the CARES paradigm.

• #40 Hybrid Closed Loop systems, the Dexcom way | Dexcom Healthcare Professionals

  https://uk.provider.dexcom.com/connectivity/hybrid-closed-loop

  Hybrid Closed Loop (HCL) systems, also referred to as Automated Insulin Delivery (AID), are designed to mimic the activity of the pancreas. […] Combining knowledge of the bodys prevailing glucose level and where it’s heading (supplied by a real-time continuous glucose monitoring, or rtCGM, system), with a digitally-controlled insulin pump, HCL systems automatically adjust insulin delivery to meet the changing needs of the user. […] NICE recommends HCL technology for all people with diabetes meeting any of the following criteria: Age 18 or under with type 1 diabetes, Over 18 with HbA1c 7.5%, Suffer from disabling hypoglycaemia, Women who are pregnant or trying to conceive a baby. […] Given that Dexcom is the worlds most connected rtCGM family, its no surprise that Dexcom has more HCL studies with more AID systems than any other CGM brand.

• #41 Hybrid Closed Loop Systems for Adults

  https://www.hweclinicalguidance.nhs.uk/clinical-policies/hybrid-closed-loop-systems-for-adults/

  A hybrid closed loop system, sometimes referred to as an „artificial pancreas, links an insulin pump and continuous glucose monitor (CGM) with a mathematical control algorithm that can calculate and automatically deliver the amount of insulin someone needs based on blood sugar readings. This allows the system to do some of the work to help manage blood sugar levels. Manual input is still needed to alert the system when eating or doing exercise. […] A NICE Technology Appraisal (TA954) on hybrid closed loops in type 1 diabetes was published on 19th December 2023. This states that hybrid closed loop systems are recommended as an option for: all children and young people, all people who are pregnant or planning a pregnancy, and adults with a HbA1c of 58mmol/mol or more or who have disabling hypoglycaemia, despite best management with a pump or CGM.

• #42 Hybrid Closed Loop systems, the Dexcom way | Dexcom Healthcare Professionals

  https://uk.provider.dexcom.com/connectivity/hybrid-closed-loop

  Hybrid Closed Loop (HCL) systems, also referred to as Automated Insulin Delivery (AID), are designed to mimic the activity of the pancreas. […] Combining knowledge of the bodys prevailing glucose level and where it’s heading (supplied by a real-time continuous glucose monitoring, or rtCGM, system), with a digitally-controlled insulin pump, HCL systems automatically adjust insulin delivery to meet the changing needs of the user. […] NICE recommends HCL technology for all people with diabetes meeting any of the following criteria: Age 18 or under with type 1 diabetes, Over 18 with HbA1c 7.5%, Suffer from disabling hypoglycaemia, Women who are pregnant or trying to conceive a baby. […] Given that Dexcom is the worlds most connected rtCGM family, its no surprise that Dexcom has more HCL studies with more AID systems than any other CGM brand.

• #43 Continuous glucose monitoring and hybrid closed loop for diabetes – NHS

  https://www.nhs.uk/conditions/cgm-and-hcl-for-diabetes/

  Continuous glucose monitors and hybrid closed loop systems are technology that can help people with diabetes manage their blood glucose (sugar) levels. […] A hybrid closed loop system (sometimes called an „artificial pancreas”) is technology that allows a CGM to work together with an insulin pump to help you manage your blood glucose. […] A hybrid closed loop system can improve your blood glucose levels, reduce the risk of hypos and make it easier to manage diabetes. […] Hybrid closed loop systems are being made available on the NHS to some people with type 1 diabetes. They’ll be introduced gradually over 5 years from April 2024, starting with people who need them most. […] Insulin pumps and hybrid closed loop systems are not currently available on the NHS for people with type 2 diabetes.

• #44 Continuous glucose monitoring and hybrid closed loop for diabetes – NHS

  https://www.nhs.uk/conditions/cgm-and-hcl-for-diabetes/

  Continuous glucose monitors and hybrid closed loop systems are technology that can help people with diabetes manage their blood glucose (sugar) levels. […] A hybrid closed loop system (sometimes called an „artificial pancreas”) is technology that allows a CGM to work together with an insulin pump to help you manage your blood glucose. […] A hybrid closed loop system can improve your blood glucose levels, reduce the risk of hypos and make it easier to manage diabetes. […] Hybrid closed loop systems are being made available on the NHS to some people with type 1 diabetes. They’ll be introduced gradually over 5 years from April 2024, starting with people who need them most. […] Insulin pumps and hybrid closed loop systems are not currently available on the NHS for people with type 2 diabetes.

• #45 Hybrid Closed Loop Systems for Adults

  https://www.hweclinicalguidance.nhs.uk/clinical-policies/hybrid-closed-loop-systems-for-adults/

  Only use HCL systems in secondary care with the support of a trained multidisciplinary team experienced in CSII and continuous glucose monitoring in type 1 diabetes. […] A Hybrid Closed Loop system should only be continued if it results in a sustained improvement in glycaemic control, evidenced by a fall in HbA1c levels, or a sustained decrease in the rate of hypoglycaemic episodes. Appropriate targets for such improvements should be set by the responsible physician, in discussion with the person receiving the treatment or their carer.

• #46 Hybrid Closed Loop Systems for Adults

  https://www.hweclinicalguidance.nhs.uk/clinical-policies/hybrid-closed-loop-systems-for-adults/

  Only use HCL systems in secondary care with the support of a trained multidisciplinary team experienced in CSII and continuous glucose monitoring in type 1 diabetes. […] A Hybrid Closed Loop system should only be continued if it results in a sustained improvement in glycaemic control, evidenced by a fall in HbA1c levels, or a sustained decrease in the rate of hypoglycaemic episodes. Appropriate targets for such improvements should be set by the responsible physician, in discussion with the person receiving the treatment or their carer.

• #47 Closed loop system to treat type 1 diabetes: everything there is to know! – Carenity

  https://www.carenity.us/condition-information/magazine/news/closed-loop-system-to-treat-type-1-diabetes-everything-there-is-to-know-1797

  The closed loop is a system for managing type 1 diabetes through automated delivery of insulin. Its aim is to keep normal blood glucose levels as stable as possible. […] The closed loop system is a hybrid medical system designed to mimic the natural functioning of the pancreas, the organ responsible for producing insulin. Insulin is essential for regulating blood sugar levels. […] Research has demonstrated that such hybrid systems improve diabetes management, reduce hypoglycemia and improve quality of life for patients with type 1 diabetes. […] The closed loop system offers a number of advantages, including maintaining glycemic control over time, reducing the risk of hypoglycemia or hyperglycemia. This improvement helps prevent diabetes-related complications (cardiovascular disease, blindness, kidney failure, neuropathy and amputations).

• #48 NHS Tayside

  https://www.nhstayside.scot.nhs.uk/OurServicesA-Z/DiabetesOutThereDOTTayside/PROD_364253/index.htm

  A closed loop system involves using an insulin pump that communicates with a continuous glucose monitor (CGM) to adjust insulin levels automatically in response to rising or falling glucose levels. […] The main advantages of using hybrid closed loop are: Eases the burden of diabetes – research studies have demonstrated that people with diabetes and their families report improved sleep and feeling less worried about the possibility of having low or high blood sugar. […] Improves glucose control – research studies have also shown that glucose control improves in those who start using hybrid closed loop systems, with more time spent in range and less time below or above the target range.

• #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/

  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%).

• #50 NHS Tayside

  https://www.nhstayside.scot.nhs.uk/OurServicesA-Z/DiabetesOutThereDOTTayside/PROD_364253/index.htm

  A closed loop system involves using an insulin pump that communicates with a continuous glucose monitor (CGM) to adjust insulin levels automatically in response to rising or falling glucose levels. […] The main advantages of using hybrid closed loop are: Eases the burden of diabetes – research studies have demonstrated that people with diabetes and their families report improved sleep and feeling less worried about the possibility of having low or high blood sugar. […] Improves glucose control – research studies have also shown that glucose control improves in those who start using hybrid closed loop systems, with more time spent in range and less time below or above the target range.

• #51 Challenge of managing type 1 diabetes in young children eased by hybrid closed loop technology | Breakthrough T1D UK

  https://breakthrought1d.org.uk/news/challenge-of-managing-type-1-diabetes-in-young-children-eased-by-hybrid-closed-loop-technology/

  Hybrid closed loop technology can help children as young as one year old manage their type 1 diabetes lifting some of the burden on parents and carers, and reducing the childrens risk of later complications. […] Sometimes known as an artificial pancreas, hybrid closed loop systems combine a continuous glucose monitor (CGM) and an insulin pump to deliver insulin automatically. […] The new study compared data from children using a hybrid closed loop system, to data from children using a CGM and insulin pump independently of one another. […] The data showed that the children on hybrid closed loop therapy did better, spending an extra two hours a day in their target glucose range and having lower HbA1c levels after 16 weeks. […] Keeping blood glucose levels within their recommended range is one way to reduce the risk of developing complications from type 1 diabetes.

• #52 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.

• #53 Managing Diabetes

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

  A closed-loop system combines a continuous glucose monitoring (CGM) sensor with an insulin pump to automate the delivery of insulin. […] Automated insulin dosing technology has completely changed diabetes care, said Dr. Jordan Pinsker, Vice President and Medical Director at Tandem Diabetes Care. […] The advancement of predictive algorithms and closed-loop systems have been game-changers for diabetes management. […] An advanced hybrid closed-loop system such as Control-IQ technology on the t:slim X2 insulin pump has removed the minute-to-minute, decision-making burden of diabetes management, said Ms. McElwee Malloy. […] Automatic insulin dosing systems excel at bringing down blood sugar overnight and keeping it in a steady range, allowing for a great start to the morning.

• #54 Challenge of managing type 1 diabetes in young children eased by hybrid closed loop technology | Breakthrough T1D UK

  https://breakthrought1d.org.uk/news/challenge-of-managing-type-1-diabetes-in-young-children-eased-by-hybrid-closed-loop-technology/

  JDRF research was also the first to show that continuous glucose monitoring technology helps prevent dangerous blood glucose highs and lows, and later showed that CGM significantly benefits both mother and child during pregnancy. […] CamAPS FX led to improvements in several measures, including hyperglycaemia and average blood sugar levels, without increasing the risk of hypos. This is likely to have important benefits for those children who use it. […] Dr Julia Ware, the studys first author, said: Very young children are extremely vulnerable to changes in their blood sugar levels. High levels in particular can have potentially lasting consequences to their brain development. On top of that, diabetes is very challenging to manage in this age group, creating a huge burden for families.

• #55 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/

  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.

• #56 Hybrid closed loops to be offered to people living with type 1 diabetes – Diabetes Research & Wellness Foundation

  https://www.drwf.org.uk/news-and-events/news/hybrid-closed-loops-to-be-offered-to-people-living-with-type-1-diabetes/

  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. […] The guidance adds 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. […] 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%). […] 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.

• #57 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. […] Although technologies may find use in type 2 diabetes, particularly Flash Glucose Monitoring (FGM), the use of CGM and HCL is targeted almost exclusively at type 1 diabetes.

• #58 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  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. […] Data on CGM use in pregnant women with type 2 diabetes (T2D) are limited. […] A large randomized controlled trial (RCT) on CGM use in people with T2D in pregnancy is ongoing. […] Small studies on CGM use in women with gestational diabetes (GDM) have suggested improved glycaemic control and better qualification when insulin is needed. […] However, none of these studies was powered to evaluate pregnancy outcomes. […] Several large RCTs are ongoing in women with GDM. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D.

• #59 Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-center, randomized crossover trial | Nature Medicine

  https://www.nature.com/articles/s41591-022-02144-z

  In adults with type 2 diabetes, the benefits of fully closed-loop insulin delivery, which does not require meal bolusing, are unclear. […] Fully closed-loop insulin delivery improved glucose control without increasing hypoglycemia compared with standard insulin therapy and may represent a safe and efficacious method to improve outcomes in adults with type 2 diabetes. […] Closed-loop insulin delivery offers a new, glucose-responsive method of glucose control and comprises a continuous glucose monitor, an insulin pump and a control algorithm that automatically modulates subcutaneous insulin delivery. […] Fully closed-loop systems, which are more convenient and have no requirement for user input at meal times, have previously been shown to improve glucose control in people with type 2 diabetes in the inpatient setting.

• #60 Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-center, randomized crossover trial | Nature Medicine

  https://www.nature.com/articles/s41591-022-02144-z

  Here we proposed that fully closed-loop insulin delivery in people with type 2 diabetes may improve glycemic control compared with standard insulin therapy, without increasing the risk of hypoglycemia over an 8-week period of unrestricted living. […] The present study shows that fully closed-loop insulin delivery is a safe and effective approach to improve glycemic control in people with type 2 diabetes during 8 weeks of use in the outpatient setting. […] As a considerable proportion of people with type 2 diabetes struggle to achieve the recommended glycemic targets with currently available therapies, including insulin therapy, fully closed-loop systems offer a new approach to improve glycemic outcomes to reduce the risk of long-term complications. […] We have shown that fully closed-loop insulin delivery does not increase the risk of hypoglycemia despite improved glycemic control and there were no episodes of severe hypoglycemia during closed-loop therapy. […] This study suggests that fully closed-loop insulin delivery is a safe and efficacious approach to manage type 2 diabetes in adults.

• #61 Fully automated closed-loop insulin delivery in adults with type 2 diabetes: an open-label, single-center, randomized crossover trial | Nature Medicine

  https://www.nature.com/articles/s41591-022-02144-z

  Here we proposed that fully closed-loop insulin delivery in people with type 2 diabetes may improve glycemic control compared with standard insulin therapy, without increasing the risk of hypoglycemia over an 8-week period of unrestricted living. […] The present study shows that fully closed-loop insulin delivery is a safe and effective approach to improve glycemic control in people with type 2 diabetes during 8 weeks of use in the outpatient setting. […] As a considerable proportion of people with type 2 diabetes struggle to achieve the recommended glycemic targets with currently available therapies, including insulin therapy, fully closed-loop systems offer a new approach to improve glycemic outcomes to reduce the risk of long-term complications. […] We have shown that fully closed-loop insulin delivery does not increase the risk of hypoglycemia despite improved glycemic control and there were no episodes of severe hypoglycemia during closed-loop therapy. […] This study suggests that fully closed-loop insulin delivery is a safe and efficacious approach to manage type 2 diabetes in adults.

• #62 JMIR Diabetes – Clinician Experiences With Hybrid Closed Loop Insulin Delivery Systems in Veterans With Type 1 Diabetes: Qualitative Study

  https://diabetes.jmir.org/2023/1/e45241/

  Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system. […] Clinicians noticed improved glucose control with less variability and fluctuations in patient blood sugars. […] Importantly, clinicians noted the reduction in hypoglycemia, especially nocturnal hypoglycemia and hypoglycemia surrounding physical activity. […] Additionally, clinicians discussed various challenges patients face while initiating use of an HCL insulin pump. […] Clinicians highlighted that much of their confidence was due to these pumps often resulting in less hypoglycemia, a potentially dangerous side effect of poor insulin management, leading to a perception of safer care for patients.

• #63 JMIR Diabetes – Clinician Experiences With Hybrid Closed Loop Insulin Delivery Systems in Veterans With Type 1 Diabetes: Qualitative Study

  https://diabetes.jmir.org/2023/1/e45241/

  Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system. […] Clinicians noticed improved glucose control with less variability and fluctuations in patient blood sugars. […] Importantly, clinicians noted the reduction in hypoglycemia, especially nocturnal hypoglycemia and hypoglycemia surrounding physical activity. […] Additionally, clinicians discussed various challenges patients face while initiating use of an HCL insulin pump. […] Clinicians highlighted that much of their confidence was due to these pumps often resulting in less hypoglycemia, a potentially dangerous side effect of poor insulin management, leading to a perception of safer care for patients.

• #64 JMIR Diabetes – Clinician Experiences With Hybrid Closed Loop Insulin Delivery Systems in Veterans With Type 1 Diabetes: Qualitative Study

  https://diabetes.jmir.org/2023/1/e45241/

  Hybrid closed loop (HCL) insulin pumps adjust insulin delivery based on input from a continuous glucose monitor. […] Several studies have reported many glycemic benefits to the use of HCL systems. […] These studies demonstrate that HCL systems increase time-in-range (TIR) up to 10% overall and 15% overnight compared to older insulin pump technology. […] The improvements in HbA1c and TIR are presumed to translate to a reduction in microvascular complications. […] Findings suggest that clinicians believe HCL systems have significant glycemic benefits but are not appropriate for all patients, especially those with cognitive impairment. […] HCL systems improve clinician confidence in overall diabetes management. […] Overall, the provider assessment and evaluation of patients for HCL candidacy was highly individualized, reflecting their years of clinical experience and different examples of patients they had cared for during various clinic encounters.

• #65 JMIR Diabetes – Clinician Experiences With Hybrid Closed Loop Insulin Delivery Systems in Veterans With Type 1 Diabetes: Qualitative Study

  https://diabetes.jmir.org/2023/1/e45241/

  Hybrid closed loop (HCL) insulin pumps adjust insulin delivery based on input from a continuous glucose monitor. […] Several studies have reported many glycemic benefits to the use of HCL systems. […] These studies demonstrate that HCL systems increase time-in-range (TIR) up to 10% overall and 15% overnight compared to older insulin pump technology. […] The improvements in HbA1c and TIR are presumed to translate to a reduction in microvascular complications. […] Findings suggest that clinicians believe HCL systems have significant glycemic benefits but are not appropriate for all patients, especially those with cognitive impairment. […] HCL systems improve clinician confidence in overall diabetes management. […] Overall, the provider assessment and evaluation of patients for HCL candidacy was highly individualized, reflecting their years of clinical experience and different examples of patients they had cared for during various clinic encounters.

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

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

  In pregnancy, HCL leads to substantial improvements in glucose control, which will translate into improved outcomes for both mother and baby. […] 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. […] However, it is important to recognise that benefits may be counterbalanced by important challenges, such as variable levels of trust in technologies; concerns about the physical size or bulk of devices; technical glitches that require troubleshooting to ensure safety; and the challenges associated with incorporating HCL into everyday life. […] NICE TA943 guidance recommends HCL systems as an option for managing blood glucose levels in children and young people with type 1 diabetes.

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

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

  The guidance also highlights the requirement for a cost-effective pricing structure between the technology companies and NHS England. […] One third of people living with type 1 diabetes do not access specialist services. […] Not attending specialist care is a barrier to accessing various diabetes technologies, including CGM, insulin pumps and HCL, as these have typically been initiated in specialist care. […] 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. […] Consequently, self-management of hypoglycaemia in the context of HCL systems requires different advice.

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

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

  The guidance also highlights the requirement for a cost-effective pricing structure between the technology companies and NHS England. […] One third of people living with type 1 diabetes do not access specialist services. […] Not attending specialist care is a barrier to accessing various diabetes technologies, including CGM, insulin pumps and HCL, as these have typically been initiated in specialist care. […] 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. […] Consequently, self-management of hypoglycaemia in the context of HCL systems requires different advice.

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

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

  The guidance also highlights the requirement for a cost-effective pricing structure between the technology companies and NHS England. […] One third of people living with type 1 diabetes do not access specialist services. […] Not attending specialist care is a barrier to accessing various diabetes technologies, including CGM, insulin pumps and HCL, as these have typically been initiated in specialist care. […] 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. […] Consequently, self-management of hypoglycaemia in the context of HCL systems requires different advice.

• #70 Closed loop systems | Know Diabetes

  https://www.knowdiabetes.org.uk/know-more/type-1-diabetes/insulin/closed-loop-systems/

  A closed-loop system is a pump and a continuous glucose monitor that are able to talk to each other. […] Although they can help people manage their diabetes, people on closed-loop systems still have to carbohydrate count accurately and tell the pump when and how much insulin to inject around meals or snacks. […] The sensor communicates all changes in blood glucose to the pump which then automatically adjusts the basal rate of insulin infusion. […] NICE has published the outcome of their appraisal for hybrid closed-loop systems. They recommend that over the next five years, hundreds of thousands of people living with type 1 diabetes should be offered this next-generation technology to help them manage their condition. […] Improved blood sugar control […] Reduced hypoglycaemia […] Improved quality of life.

• #71 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  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. […] Data on CGM use in pregnant women with type 2 diabetes (T2D) are limited. […] A large randomized controlled trial (RCT) on CGM use in people with T2D in pregnancy is ongoing. […] Small studies on CGM use in women with gestational diabetes (GDM) have suggested improved glycaemic control and better qualification when insulin is needed. […] However, none of these studies was powered to evaluate pregnancy outcomes. […] Several large RCTs are ongoing in women with GDM. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D.

• #72 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] 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.

• #73 Challenge of managing type 1 diabetes in young children eased by hybrid closed loop technology | Breakthrough T1D UK

  https://breakthrought1d.org.uk/news/challenge-of-managing-type-1-diabetes-in-young-children-eased-by-hybrid-closed-loop-technology/

  Hybrid closed loop technology can help children as young as one year old manage their type 1 diabetes lifting some of the burden on parents and carers, and reducing the childrens risk of later complications. […] Sometimes known as an artificial pancreas, hybrid closed loop systems combine a continuous glucose monitor (CGM) and an insulin pump to deliver insulin automatically. […] The new study compared data from children using a hybrid closed loop system, to data from children using a CGM and insulin pump independently of one another. […] The data showed that the children on hybrid closed loop therapy did better, spending an extra two hours a day in their target glucose range and having lower HbA1c levels after 16 weeks. […] Keeping blood glucose levels within their recommended range is one way to reduce the risk of developing complications from type 1 diabetes.

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

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

  In pregnancy, HCL leads to substantial improvements in glucose control, which will translate into improved outcomes for both mother and baby. […] 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. […] However, it is important to recognise that benefits may be counterbalanced by important challenges, such as variable levels of trust in technologies; concerns about the physical size or bulk of devices; technical glitches that require troubleshooting to ensure safety; and the challenges associated with incorporating HCL into everyday life. […] NICE TA943 guidance recommends HCL systems as an option for managing blood glucose levels in children and young people with type 1 diabetes.

• #75

  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 newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. […] An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. […] Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. […] The FDA approved Libre 3 which provides real-time glucose values every minute.

• #76 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  AHCL therapy adapts insulin delivery via a predictive algorithm integrated with CGM and an insulin pump. […] A large RCT with the AHCL CamAPS FX demonstrated a 10% increase in time in range compared to standard insulin therapy in a pregnant population with T1D. […] Recently, an RCT of an AHCL system not approved for use in pregnancy (780G MiniMed) has also demonstrated additional benefits of AHCL therapy compared to standard insulin therapy, with improved time in range overnight, less hypoglycaemia and improved treatment satisfaction. […] 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.

• #77 Use of continuous glucose monitoring and hybrid closed-loop therapy in pregnancy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39411880/

  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. […] Data on CGM use in pregnant women with type 2 diabetes (T2D) are limited. […] A large randomized controlled trial (RCT) on CGM use in people with T2D in pregnancy is ongoing. […] Small studies on CGM use in women with gestational diabetes (GDM) have suggested improved glycaemic control and better qualification when insulin is needed. […] However, none of these studies was powered to evaluate pregnancy outcomes. […] Several large RCTs are ongoing in women with GDM. […] In addition to CGM, other technologies, such as advanced hybrid closed-loop (AHCL) systems have further improved glycaemic management in people with T1D.

• #78 Which Insulin Pumps Are Closed-Loop? – Gluroo

  https://gluroo.com/blog/diabetes-101/closed-loop-insulin-pumps/

  A hybrid closed-loop insulin pump uses a combination of a CGM sensor, a program, and an insulin pump. However, the system is not fully closed-loop, as it still requires some manual input from the user for bolus doses during meals. […] These systems are not yet a reality, however. The hybrid systems are as far as weve gotten with closed-loop research so far. […] DIY looping involves using an insulin pump and a CGM in combination with a custom-built algorithm to create a closed-loop system. The CGM continuously measures the users blood glucose levels, and the algorithm analyzes this data to predict future glucose levels and adjust the insulin delivery accordingly.

• #79 Which Insulin Pumps Are Closed-Loop? – Gluroo

  https://gluroo.com/blog/diabetes-101/closed-loop-insulin-pumps/

  A hybrid closed-loop insulin pump uses a combination of a CGM sensor, a program, and an insulin pump. However, the system is not fully closed-loop, as it still requires some manual input from the user for bolus doses during meals. […] These systems are not yet a reality, however. The hybrid systems are as far as weve gotten with closed-loop research so far. […] DIY looping involves using an insulin pump and a CGM in combination with a custom-built algorithm to create a closed-loop system. The CGM continuously measures the users blood glucose levels, and the algorithm analyzes this data to predict future glucose levels and adjust the insulin delivery accordingly.

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

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

  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.

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

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

  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.

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