Materiały źródłowe

• #1 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 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. […] If you think you might be eligible for hybrid closed loop, speak to your diabetes team at your next appointment. They’ll be able to explain your options.

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

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

  Some people with type 1 diabetes use an insulin pump and a continuous glucose monitor that talk to each other. […] This is called a closed loop system. It is sometimes known as an artificial pancreas. […] The doses of insulin your body needs through the day and night to help keep your blood sugar levels stable are released via your pump. […] In November 2023, new hybrid closed-loop recommendations were published by the National Institute for Health and Care Excellence (NICE) which said that over the next five years hundreds of thousands of people living with type 1 diabetes in England and Wales should be offered this technology. […] 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.

• #3 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)].

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

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

  Some people with type 1 diabetes use an insulin pump and a continuous glucose monitor that talk to each other. […] This is called a closed loop system. It is sometimes known as an artificial pancreas. […] The doses of insulin your body needs through the day and night to help keep your blood sugar levels stable are released via your pump. […] In November 2023, new hybrid closed-loop recommendations were published by the National Institute for Health and Care Excellence (NICE) which said that over the next five years hundreds of thousands of people living with type 1 diabetes in England and Wales should be offered this technology. […] 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.

• #5 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. […] 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. […] Closed-loop delivery is particularly helpful if you are struggling to achieve your blood glucose targets, have an unpredictable lifestyle, are pregnant, experience regular hypos, or get high glucose levels in the early mornings, the so-called ‘dawn effect.’ It may also appeal to those who want more freedom from the continual supervision that Type 1 diabetes requires.

• #6 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. […] 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. […] Closed-loop delivery is particularly helpful if you are struggling to achieve your blood glucose targets, have an unpredictable lifestyle, are pregnant, experience regular hypos, or get high glucose levels in the early mornings, the so-called ‘dawn effect.’ It may also appeal to those who want more freedom from the continual supervision that Type 1 diabetes requires.

• #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. […] Furthermore, all this is associated with a satisfaction with the device and a lower burden related to the management of diabetes which translates into greater psychophysical well-being and an improvement in the quality of life. […] Gender differences in type 1 diabetes also concern acute complications; non-ketone hyperosmolar coma is diagnosed almost twice as often in females, and hypoglycaemia and diabetic ketoacidosis (DKA) appear to be 1.5 times more common in females as well.

• #8 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)].

• #9 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.

• #10 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.

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

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

  Individuals with persistent fasting hyperglycemia, hypoglycemia unawareness that puts the individual or others at risk, or recurrent episodes of serious hypoglycemia ( 54 mg/dL) may benefit from use of continuous interstitial glucose monitoring devices and automated insulin delivery devices if ongoing management using self-monitoring and insulin administration regimens to optimize care has not resulted in adequate glycemic control. […] Hybrid closed-loop systems can increase, decrease, or stop insulin delivery automatically beyond pre-set infusion rates in response glucose concentration measurements from a paired CGM device. […] Similar to open-loop devices, there have been multiple high quality studies demonstrating significant clinical outcomes benefit from the use of hybrid closed-loop devices.

• #12 Diabetes – Diagnosis and treatment – Mayo Clinic

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

  People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. […] A closed loop system is a device implanted in the body that links a continuous glucose monitor to an insulin pump. The monitor checks blood sugar levels regularly. The device automatically delivers the right amount of insulin when the monitor shows that it’s needed. […] The Food and Drug Administration has approved several hybrid closed loop systems for type 1 diabetes. They are called „hybrid” because these systems require some input from the user.

• #13 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).

• #14 Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications

  https://e-dmj.org/DOIx.php?id=10.4093/dmj.2019.0121

  By providing blood glucose (BG) concentration measurements in an almost continuous-time fashion for several consecutive days, wearable minimally-invasive continuous glucose monitoring (CGM) sensors are revolutionizing diabetes management, and are becoming an increasingly adopted technology especially for diabetic individuals requiring insulin administrations. […] The aim of this paper is to offer an overview of current literature and future possible developments regarding CGM technologies and applications. In particular, first, we outline the technological evolution of CGM devices through the last 20 years. Then, we discuss about the current use of CGM sensors from patients affected by diabetes, and, we report some works proving the beneficial impact provided by the adoption of CGM. […] The introduction of these minimally invasive needle CGM sensors in 1999 revolutionized, de facto, blood glucose (BG) concentration monitoring in diabetes and opened new exciting scenarios in the daily management of diabetes.

• #15 Diabetes at School | Continuous Glucose Monitoring (CGM)

  https://diabetesatschool.ca/understanding/continuous-glucose-monitoring

  Continuous Glucose Monitoring (CGM) is a system that automatically monitors glucose levels every 2-5 minutes, providing a constant picture of the glucose valuesa pattern, as opposed to a moment-in-time snapshot that comes from intermittent finger prick readings. […] Working in combination with CGM, some insulin pumps have a feature where the pump will automatically adjust the rate of insulin delivery based on the glucose levels or temporarily stop insulin delivery when glucose is predicted to be low in the near future. […] CGMs do not fully replace traditional blood glucose (BG) checks. Some CGMs require a fingerstick check before using BG information to dose insulin or make other treatment decisions, particularly if the CGM indicates that the BG is changing quickly. […] At home, CGM also provides families with information about patterns that helps them make decisions about their childs management and treatment. It allows for timely adjustments to glucose trends, which should maximize the time that glucose levels are in the target range.

• #16 Diabetes at School | Continuous Glucose Monitoring (CGM)

  https://diabetesatschool.ca/understanding/continuous-glucose-monitoring

  In addition to showing the sensor glucose at a given moment in time, CGM can show trend arrows to indicate if the sensor glucose is rising or dropping quickly. […] Trigger the pump to increase insulin when sensor glucose is high (hybrid closed loop). […] If the CGM needs to be calibrated, this should be done at home. […] If CGM and blood glucose meter results differ, the meter reading is considered the most reliable. […] One of the benefits of CGMs is that users can set alarms to let them know when sugar levels are too low or too high. […] Teachers and school staff are not expected to monitor or respond to trend arrows for students when glucose is in the target range and they have no symptoms. […] If the low glucose alarm goes off, treat as per the students care plan. Treatment may also be provided when glucose is between 4 and 5 mmol/L (or as per the ICP), when trend arrows point down or the student has signs and symptoms of hypoglycemia.

• #17 Diabetes at School | Continuous Glucose Monitoring (CGM)

  https://diabetesatschool.ca/understanding/continuous-glucose-monitoring

  In addition to showing the sensor glucose at a given moment in time, CGM can show trend arrows to indicate if the sensor glucose is rising or dropping quickly. […] Trigger the pump to increase insulin when sensor glucose is high (hybrid closed loop). […] If the CGM needs to be calibrated, this should be done at home. […] If CGM and blood glucose meter results differ, the meter reading is considered the most reliable. […] One of the benefits of CGMs is that users can set alarms to let them know when sugar levels are too low or too high. […] Teachers and school staff are not expected to monitor or respond to trend arrows for students when glucose is in the target range and they have no symptoms. […] If the low glucose alarm goes off, treat as per the students care plan. Treatment may also be provided when glucose is between 4 and 5 mmol/L (or as per the ICP), when trend arrows point down or the student has signs and symptoms of hypoglycemia.

• #18 Progress with Closed-loop Systems in Type 1 Diabetes – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/progress-with-closed-loop-systems-in-type-1-diabetes-2/

  Despite these limitations, a reported risk analysis suggests that closed-loop systems may substantially reduce, but not eliminate, the risk for severe nocturnal hypoglycemia. […] Sleep is a recognized risk factor for severe hypoglycemia due to absent warning symptoms and blunted sympatho-adrenal response. […] Nocturnal hypoglycemia is therefore very common but often asymptomatic and undetected—an observation that has been confirmed by the use of CGM. […] The next challenge is to demonstrate the feasibility, safety, and efficacy of such systems under free-living conditions. […] The development of a safe and reliable automated closed-loop insulin delivery system has long been considered the holy grail of type 1 diabetes management.

• #19 Diabetes at School | Continuous Glucose Monitoring (CGM)

  https://diabetesatschool.ca/understanding/continuous-glucose-monitoring

  Continuous Glucose Monitoring (CGM) is a system that automatically monitors glucose levels every 2-5 minutes, providing a constant picture of the glucose valuesa pattern, as opposed to a moment-in-time snapshot that comes from intermittent finger prick readings. […] Working in combination with CGM, some insulin pumps have a feature where the pump will automatically adjust the rate of insulin delivery based on the glucose levels or temporarily stop insulin delivery when glucose is predicted to be low in the near future. […] CGMs do not fully replace traditional blood glucose (BG) checks. Some CGMs require a fingerstick check before using BG information to dose insulin or make other treatment decisions, particularly if the CGM indicates that the BG is changing quickly. […] At home, CGM also provides families with information about patterns that helps them make decisions about their childs management and treatment. It allows for timely adjustments to glucose trends, which should maximize the time that glucose levels are in the target range.

• #20 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.

• #21 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.

• #22 Effect of 6 months of hybrid closed-loop insulin delivery in adults with type 1 diabetes: a randomised controlled trial protocol | BMJ Open

  https://bmjopen.bmj.com/content/8/6/e020274

  Manual determination of insulin dosing largely fails to optimise glucose control in type 1 diabetes. […] The objective of the present study is to determine the effectiveness of 6 months closed-loop compared with manually determined insulin dosing on time-in-target glucose range in adults with type 1 diabetes. […] Closed-loop systems are designed to maintain glucose levels at a predetermined target by linking continuous glucose monitoring (CGM) information with an insulin dosing algorithm for automated subcutaneous insulin delivery by a pump. […] There is increasing scientific literature of randomised controlled studies reporting improved glucose control with short-term use of closed-loop systems (up to 3 months) compared with conventional insulin pumps. […] A recent meta-analysis of outpatient randomised controlled trials with intervention periods ranging from 4 days to 12 weeks reported that single-hormone (insulin alone) closed-loop systems improve time-in-target glucose range and reduce time spent in hypoglycaemia compared with conventional IPT (with/without CGM).

• #23 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.

• #24 Diabetes at School | Continuous Glucose Monitoring (CGM)

  https://diabetesatschool.ca/understanding/continuous-glucose-monitoring

  In addition to showing the sensor glucose at a given moment in time, CGM can show trend arrows to indicate if the sensor glucose is rising or dropping quickly. […] Trigger the pump to increase insulin when sensor glucose is high (hybrid closed loop). […] If the CGM needs to be calibrated, this should be done at home. […] If CGM and blood glucose meter results differ, the meter reading is considered the most reliable. […] One of the benefits of CGMs is that users can set alarms to let them know when sugar levels are too low or too high. […] Teachers and school staff are not expected to monitor or respond to trend arrows for students when glucose is in the target range and they have no symptoms. […] If the low glucose alarm goes off, treat as per the students care plan. Treatment may also be provided when glucose is between 4 and 5 mmol/L (or as per the ICP), when trend arrows point down or the student has signs and symptoms of hypoglycemia.

• #25 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

  Several studies have shown that HCL systems improves HbA1c and time in range (TIR) in children, adolescents and adults with T1D, while reducing hypoglycemia and lowering HbA1c compared to gold-standard insulin therapy. […] The new generation of HCL systems now have additional features of automated bolus insulin correction for high glucose levels. This further improves glycemic control and reduces the health burden for people with T1D. […] 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. […] In this prospective open label single-arm, single-center, clinical investigation, we demonstrated that children and adolescent with T1D on MDI can improve their glycemic control in a safe manner using a 10-day initiation protocol. Beneficial effects on glycemic outcomes included increased TIR (70180 mg/dl), decreased HbA1c levels, reduced time above the range without compromising hypoglycemic events, and decreased mean glucose concentration.

• #26 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)].

• #27 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. […] Symptoms can include excessive thirst or urination, blurred vision, and headaches. […] 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. […] HCL systems appeared to be as safe as using other insulin delivery methods.

• #28 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)].

• #29 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)].

• #30 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)].

• #31 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. […] 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. […] 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. […] These improvements encompass reduced fear and worry related to hypoglycaemia, as well as enhanced sleep quality for both patients and their caregivers, observed 6 and 12 months post-HCL adoption.

• #32 Advanced Hybrid Closed Loop System Could Improve Glucose Control in Youth with High-Risk Type 1 Diabetes

  https://www.hcplive.com/view/advanced-hybrid-close-loop-system-could-improve-glucose-control-in-youth-with-high-risk-type-1-diabetes

  A prospective, dual-center study of people with high-risk type 1 diabetes using multiple daily injections aged 13-25 years demonstrates the utility of this technology in this patient population. […] Results of a new study have investigators purporting advanced hybrid closed loop therapy should be considered a first-line option for youth with high-risk type 1 diabetes using multiple daily injections. […] A single-arm, dual-center study of people with high-risk type 1 diabetes aged 13-25 with an HbA1c of 8.5% or greater, results of the study demonstrate use of advanced hybrid closed loop therapy in the patient population was associated with a nearly 3 percentage point reduction in HbA1c at 3 months, with a gain of more than 30 percentage points for time spent in target range. […] This study describes the greatest gains so far reported for youth with high-risk glycemia, with a mean HbA1c improvement of 2.9 percentage points (31.5 mmol/mol).

• #33 Advanced Hybrid Closed Loop System Could Improve Glucose Control in Youth with High-Risk Type 1 Diabetes

  https://www.hcplive.com/view/advanced-hybrid-close-loop-system-could-improve-glucose-control-in-youth-with-high-risk-type-1-diabetes

  Mean TIR improved by 38.9 percentage points, mostly accounted for by a reduction of 38.4 percentage points in time spent above 250 mg/dL, wrote investigators. […] For less complex type 1 diabetes populations, closed loop systems are already the gold standard therapeutic option. AHCL, combined with adequate training and clinical support, should now be considered a first-line therapeutic tool for those with the most to gain, namely youth with high-risk glycemia, investigators concluded.

• #34 Artificial Pancreas Device Systems | Providers | Blue Cross NC

  https://www.bluecrossnc.com/providers/policies-guidelines-codes/commercial/home-health-dme/updates/artificial-pancreas-device-systems

  Tight glucose control in patients with diabetes has been associated with improved health outcomes. […] Hypoglycemia is the most common acute complication of type 1 diabetes. […] Optimal glycemic control, as assessed by glycated hemoglobin, and avoidance of hyper- and hypoglycemic excursions have been shown to prevent diabetes-related complications. […] The Food and Drug Administration (FDA) describes the basic design of an artificial pancreas device system (APDS) as a CGM linked to an insulin pump with the capability to automatically stop, reduce, or increase insulin infusion based on specified thresholds of measured interstitial glucose. […] An APDS may also be referred to as a “closed-loop” system. A closed-loop system has automated insulin delivery and continuous glucose sensing and insulin delivery without patient intervention.

• #35 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. […] 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. […] 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. […] These improvements encompass reduced fear and worry related to hypoglycaemia, as well as enhanced sleep quality for both patients and their caregivers, observed 6 and 12 months post-HCL adoption.

• #36 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. […] Data also suggests an additional reduction in hemoglobin A1c (HbA1c) by about 0.5% with an HCL pump versus regular or sensor-augmented insulin pumps alone. […] Use of an HCL system for 6 months was associated with an approximately 1% decrease in time spent in clinically significant hypoglycemia (ie, level 2 hypoglycemia, defined as a blood sugar level below 54 mg/dL). […] 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.

• #37 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. […] Researchers have therefore now investigated whether the rates of severe low blood sugar levels (hypoglycemia) and diabetic ketoacidosis are lower with hybrid closed-loop insulin therapy compared with sensor-augmented (open-loop) pump therapy. […] 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).

• #38 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. […] Data also suggests an additional reduction in hemoglobin A1c (HbA1c) by about 0.5% with an HCL pump versus regular or sensor-augmented insulin pumps alone. […] Use of an HCL system for 6 months was associated with an approximately 1% decrease in time spent in clinically significant hypoglycemia (ie, level 2 hypoglycemia, defined as a blood sugar level below 54 mg/dL). […] 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.

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

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

  Closed-loop systems help diabetes patients achieve blood glucose control, according to a presentation at the American Diabetes Associations 77th Scientific Sessions. […] Continuous glucose monitoring (CGM) devices provide real-time data about blood glucose levels and even provide alerts when levels become too high or too low, while insulin pumps administer the treatment throughout the day. […] Recently, technology has combined CGM and insulin pumps to created closed-loop systems. […] Children with type 1 diabetes have increased sensitivity to insulin compared with adolescents and adults. This population is also more at risk of severe hypoglycemia overnight, according to the session. […] Hybrid closed-loop systems do a great job improving glucose control overnight, significantly lowering the risk of hypoglycemia, thus allowing patients and their families to get a good nights sleep, said chief investigator Bruce A. Buckingham, MD.

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

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

  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. […] 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. […] Research shows the benefits brought by closed loop systems can help give people with type 1 diabetes and people caring for them a better quality of life. […] You no longer need to do insulin injections for yourself or someone else unless there is a failure of the technology, because insulin is released via the pump. […] It can help prevent hypos by suspending insulin and prevent high blood sugars by increasing insulin doses.

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

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

  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. […] 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. […] Research shows the benefits brought by closed loop systems can help give people with type 1 diabetes and people caring for them a better quality of life. […] You no longer need to do insulin injections for yourself or someone else unless there is a failure of the technology, because insulin is released via the pump. […] It can help prevent hypos by suspending insulin and prevent high blood sugars by increasing insulin doses.

• #42 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this 26-week, open-label, RCT of HCL versus standard therapy (CSII or MDI without real-time CGM), those allocated to HCL reported significantly greater diabetes-specific positive well-being at 13-week follow-up, which was maintained at 26 weeks. […] At 26 weeks, the HCL group also reported significantly less frequent perceived unacceptably high glucose levels. Adjusted analyses also showed reduced diabetes distress and fear of hypoglycemia (maintain high and worry subscales) favoring HCL. […] The findings support that HCL can offer important psychological benefits over standard therapy to adults with T1D. Specifically, HCL led to higher diabetes-specific positive well-being, and lower diabetes distress, fear of hypoglycemia, and perceived frequency of unacceptably high glucose levels.

• #43 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this 26-week, open-label, RCT of HCL versus standard therapy (CSII or MDI without real-time CGM), those allocated to HCL reported significantly greater diabetes-specific positive well-being at 13-week follow-up, which was maintained at 26 weeks. […] At 26 weeks, the HCL group also reported significantly less frequent perceived unacceptably high glucose levels. Adjusted analyses also showed reduced diabetes distress and fear of hypoglycemia (maintain high and worry subscales) favoring HCL. […] The findings support that HCL can offer important psychological benefits over standard therapy to adults with T1D. Specifically, HCL led to higher diabetes-specific positive well-being, and lower diabetes distress, fear of hypoglycemia, and perceived frequency of unacceptably high glucose levels.

• #44 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 Englands vision is to ensure equitable and fair access to diabetes technologies while striving to set the international standard for diabetes care. […] The NHS Long Term Plan signalled NHS Englands intent to improve digital access by including commitments for at least 20% of the type 1 diabetes population being offered a flash glucose monitoring device, and for all pregnant women living with type 1 diabetes to be offered a continuous glucose monitoring (CGM) device for the duration of their pregnancy. […] The mental burden of living with diabetes is significant; with patients and their families having to review complex data and make multiple calculations to optimise insulin dosing. This can be exhausting, can affect peoples mood, and frequently leads to burn out. Hybrid closed loop (HCL) systems deliver insulin automatically using a calculation based on continuous glucose measurements. The systems are designed to reduce the mental burden and improve peoples quality of life. Use of HCL is also associated with improvements in HbA1c, time in range and hypoglycaemia.

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

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

  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. […] 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. […] Research shows the benefits brought by closed loop systems can help give people with type 1 diabetes and people caring for them a better quality of life. […] You no longer need to do insulin injections for yourself or someone else unless there is a failure of the technology, because insulin is released via the pump. […] It can help prevent hypos by suspending insulin and prevent high blood sugars by increasing insulin doses.

• #46 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 Englands vision is to ensure equitable and fair access to diabetes technologies while striving to set the international standard for diabetes care. […] The NHS Long Term Plan signalled NHS Englands intent to improve digital access by including commitments for at least 20% of the type 1 diabetes population being offered a flash glucose monitoring device, and for all pregnant women living with type 1 diabetes to be offered a continuous glucose monitoring (CGM) device for the duration of their pregnancy. […] The mental burden of living with diabetes is significant; with patients and their families having to review complex data and make multiple calculations to optimise insulin dosing. This can be exhausting, can affect peoples mood, and frequently leads to burn out. Hybrid closed loop (HCL) systems deliver insulin automatically using a calculation based on continuous glucose measurements. The systems are designed to reduce the mental burden and improve peoples quality of life. Use of HCL is also associated with improvements in HbA1c, time in range and hypoglycaemia.

• #47 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 Englands vision is to ensure equitable and fair access to diabetes technologies while striving to set the international standard for diabetes care. […] The NHS Long Term Plan signalled NHS Englands intent to improve digital access by including commitments for at least 20% of the type 1 diabetes population being offered a flash glucose monitoring device, and for all pregnant women living with type 1 diabetes to be offered a continuous glucose monitoring (CGM) device for the duration of their pregnancy. […] The mental burden of living with diabetes is significant; with patients and their families having to review complex data and make multiple calculations to optimise insulin dosing. This can be exhausting, can affect peoples mood, and frequently leads to burn out. Hybrid closed loop (HCL) systems deliver insulin automatically using a calculation based on continuous glucose measurements. The systems are designed to reduce the mental burden and improve peoples quality of life. Use of HCL is also associated with improvements in HbA1c, time in range and hypoglycaemia.

• #48 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 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. […] 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). […] Reducing the mental burden associated with managing the disease, thereby improving the quality of life of patients and those around them. […] Reducing stress and anxiety associated with diabetes, improving patients’ well-being and quality of life.

• #49 Artificial Pancreas Device Systems | Providers | Blue Cross NC

  https://www.bluecrossnc.com/providers/policies-guidelines-codes/commercial/home-health-dme/updates/artificial-pancreas-device-systems

  Tight glucose control in patients with diabetes has been associated with improved health outcomes. […] Hypoglycemia is the most common acute complication of type 1 diabetes. […] Optimal glycemic control, as assessed by glycated hemoglobin, and avoidance of hyper- and hypoglycemic excursions have been shown to prevent diabetes-related complications. […] The Food and Drug Administration (FDA) describes the basic design of an artificial pancreas device system (APDS) as a CGM linked to an insulin pump with the capability to automatically stop, reduce, or increase insulin infusion based on specified thresholds of measured interstitial glucose. […] An APDS may also be referred to as a “closed-loop” system. A closed-loop system has automated insulin delivery and continuous glucose sensing and insulin delivery without patient intervention.

• #50 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. […] Researchers have therefore now investigated whether the rates of severe low blood sugar levels (hypoglycemia) and diabetic ketoacidosis are lower with hybrid closed-loop insulin therapy compared with sensor-augmented (open-loop) pump therapy. […] 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).

• #51 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.

• #52 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.

• #53 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.

• #54 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. […] Furthermore, all this is associated with a satisfaction with the device and a lower burden related to the management of diabetes which translates into greater psychophysical well-being and an improvement in the quality of life. […] Gender differences in type 1 diabetes also concern acute complications; non-ketone hyperosmolar coma is diagnosed almost twice as often in females, and hypoglycaemia and diabetic ketoacidosis (DKA) appear to be 1.5 times more common in females as well.

• #55 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 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. […] 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). […] Reducing the mental burden associated with managing the disease, thereby improving the quality of life of patients and those around them. […] Reducing stress and anxiety associated with diabetes, improving patients’ well-being and quality of life.

• #56 Artificial Pancreas Device Systems | Providers | Blue Cross NC

  https://www.bluecrossnc.com/providers/policies-guidelines-codes/commercial/home-health-dme/updates/artificial-pancreas-device-systems

  Tight glucose control in patients with diabetes has been associated with improved health outcomes. […] Hypoglycemia is the most common acute complication of type 1 diabetes. […] Optimal glycemic control, as assessed by glycated hemoglobin, and avoidance of hyper- and hypoglycemic excursions have been shown to prevent diabetes-related complications. […] The Food and Drug Administration (FDA) describes the basic design of an artificial pancreas device system (APDS) as a CGM linked to an insulin pump with the capability to automatically stop, reduce, or increase insulin infusion based on specified thresholds of measured interstitial glucose. […] An APDS may also be referred to as a “closed-loop” system. A closed-loop system has automated insulin delivery and continuous glucose sensing and insulin delivery without patient intervention.

• #57

  https://link.springer.com/article/10.1007/s11886-022-01799-x

  The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. […] Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. […] CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends.

• #58

  https://link.springer.com/article/10.1007/s11886-022-01799-x

  Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D. […] Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. […] In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality.

• #59

  https://link.springer.com/article/10.1007/s11886-022-01799-x

  Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D. […] Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. […] In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality.

• #60

  https://link.springer.com/article/10.1007/s11886-022-01799-x

  Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D. […] Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. […] In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality.

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• #65 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. […] 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. […] 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. […] These improvements encompass reduced fear and worry related to hypoglycaemia, as well as enhanced sleep quality for both patients and their caregivers, observed 6 and 12 months post-HCL adoption.

• #66 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. […] 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. […] 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.

• #67 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. […] 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. […] 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.

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

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

  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.

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

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

  If you ever experience any safety concerns with your CGM or insulin pump you should report it to the Yellow Card scheme. […] National guidance was published in England and Wales in December 2023 on which people with type 1 diabetes should be offered hybrid closed loop. […] These systems have been recommended for some adults based on their current self-management, all children and young people, and all people who are pregnant or planning pregnancy, with a phased rollout of the tech to eligible groups over five years. […] If you’re already using an insulin pump and its not helping keep your blood sugar levels in range or you’re having hypos, you may want to speak to your healthcare team about a hybrid closed loop system.

• #70 Effect of 6 months of hybrid closed-loop insulin delivery in adults with type 1 diabetes: a randomised controlled trial protocol | BMJ Open

  https://bmjopen.bmj.com/content/8/6/e020274

  For individuals with type 1 diabetes, both hypoglycaemia and hyperglycaemia can affect physical and emotional well-being, quality of life and activities of daily living such as driving. […] Closed-loop technology has shown promise to address the limitations of current therapy in relation to these burdens. […] HbA1c cannot provide information about glucose variability or time-in-target glucose range, and is even considered an unreliable indicator of an individual’s mean glucose. […] Consequently, HbA1c may be of limited value in comparison with CGM when assessing an individual’s glucose levels in response to automated closed-loop insulin delivery. […] We hypothesise that hybrid closed-loop insulin delivery compared with manually determined insulin dosing (without CGM) will improve time-in-target glucose range for adults with type 1 diabetes. […] The overall aim of the study is to evaluate the effect of 6 months of hybrid closed-loop insulin delivery on glucose control, psychosocial well-being, sleep quality, cognition and markers of vascular disease risk compared with standard diabetes therapy for adults with type 1 diabetes.

• #71 Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/12/6/e004428

  In this 26-week, open-label, RCT of HCL versus standard therapy (CSII or MDI without real-time CGM), those allocated to HCL reported significantly greater diabetes-specific positive well-being at 13-week follow-up, which was maintained at 26 weeks. […] At 26 weeks, the HCL group also reported significantly less frequent perceived unacceptably high glucose levels. Adjusted analyses also showed reduced diabetes distress and fear of hypoglycemia (maintain high and worry subscales) favoring HCL. […] The findings support that HCL can offer important psychological benefits over standard therapy to adults with T1D. Specifically, HCL led to higher diabetes-specific positive well-being, and lower diabetes distress, fear of hypoglycemia, and perceived frequency of unacceptably high glucose levels.

• #72 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/

  Overall, participants provided insight into their experiences at both the Midwestern VA Healthcare System and the affiliated university health care system. […] Clinicians felt strongly that HCL systems are not a one-size-fits-all approach to diabetes care. […] Participants in our study described how each patient must be continuously assessed to ensure appropriate use, even if the clinicians believed they were an appropriate candidate. […] 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. […] Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system.

• #73 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/

  Overall, participants provided insight into their experiences at both the Midwestern VA Healthcare System and the affiliated university health care system. […] Clinicians felt strongly that HCL systems are not a one-size-fits-all approach to diabetes care. […] Participants in our study described how each patient must be continuously assessed to ensure appropriate use, even if the clinicians believed they were an appropriate candidate. […] 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. […] Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system.

• #74 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/

  Overall, participants provided insight into their experiences at both the Midwestern VA Healthcare System and the affiliated university health care system. […] Clinicians felt strongly that HCL systems are not a one-size-fits-all approach to diabetes care. […] Participants in our study described how each patient must be continuously assessed to ensure appropriate use, even if the clinicians believed they were an appropriate candidate. […] 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. […] Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system.

• #75 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. […] Data also suggests an additional reduction in hemoglobin A1c (HbA1c) by about 0.5% with an HCL pump versus regular or sensor-augmented insulin pumps alone. […] Use of an HCL system for 6 months was associated with an approximately 1% decrease in time spent in clinically significant hypoglycemia (ie, level 2 hypoglycemia, defined as a blood sugar level below 54 mg/dL). […] 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.

• #76 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/

  Overall, participants provided insight into their experiences at both the Midwestern VA Healthcare System and the affiliated university health care system. […] Clinicians felt strongly that HCL systems are not a one-size-fits-all approach to diabetes care. […] Participants in our study described how each patient must be continuously assessed to ensure appropriate use, even if the clinicians believed they were an appropriate candidate. […] 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. […] Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system.

• #77 Progress with Closed-loop Systems in Type 1 Diabetes – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/progress-with-closed-loop-systems-in-type-1-diabetes-2/

  Even in patients with good control, as judged by average glycated haemoglobin (HbA1c), significant glucose excursions occur with periods of silent hyper- and hypoglycemia. […] The development of an automated closed-loop system also referred to as an artificial electromechanical endocrine pancreas that could overcome the limitations of modern diabetes therapy has long been an aspiration of the diabetes community. […] Despite significant advances in CGM technology, reliability and accuracy remain a concern and are often regarded as the rate-limiting step in progression to fully automated closed-loop insulin delivery. […] A time lag exists between glucose values obtained by CGM and reference glucose levels. […] The reported frequency of such unreliable data points have varied from seven to 30%.

• #78 Progress with Closed-loop Systems in Type 1 Diabetes – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/progress-with-closed-loop-systems-in-type-1-diabetes-2/

  Even in patients with good control, as judged by average glycated haemoglobin (HbA1c), significant glucose excursions occur with periods of silent hyper- and hypoglycemia. […] The development of an automated closed-loop system also referred to as an artificial electromechanical endocrine pancreas that could overcome the limitations of modern diabetes therapy has long been an aspiration of the diabetes community. […] Despite significant advances in CGM technology, reliability and accuracy remain a concern and are often regarded as the rate-limiting step in progression to fully automated closed-loop insulin delivery. […] A time lag exists between glucose values obtained by CGM and reference glucose levels. […] The reported frequency of such unreliable data points have varied from seven to 30%.

• #79 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 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. […] Clinicians recognized the pump algorithm was not perfect and could sometimes lag when correcting patients hyperglycemia, especially postprandially. […] 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.

• #80 Type 1 diabetes – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017

  Continuous glucose monitoring (CGM) monitors blood sugar levels. It may be especially helpful for preventing low blood sugar. These devices have been shown to lower A1C. […] A closed loop system is a device implanted in the body that links a continuous glucose monitor to an insulin pump. The monitor checks blood sugar levels regularly. The device automatically delivers the right amount of insulin when the monitor shows that it’s needed. […] The Food and Drug Administration has approved several hybrid closed loop systems for type 1 diabetes. They are called „hybrid” because these systems require some input from the user. For example, you may have to tell the device how many carbohydrates are eaten, or confirm blood sugar levels from time to time. […] A closed loop system that doesn’t need any user input isn’t available yet. But more of these systems currently are in clinical trials.

• #81 Progress with Closed-loop Systems in Type 1 Diabetes – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/progress-with-closed-loop-systems-in-type-1-diabetes-2/

  Despite these limitations, a reported risk analysis suggests that closed-loop systems may substantially reduce, but not eliminate, the risk for severe nocturnal hypoglycemia. […] Sleep is a recognized risk factor for severe hypoglycemia due to absent warning symptoms and blunted sympatho-adrenal response. […] Nocturnal hypoglycemia is therefore very common but often asymptomatic and undetected—an observation that has been confirmed by the use of CGM. […] The next challenge is to demonstrate the feasibility, safety, and efficacy of such systems under free-living conditions. […] The development of a safe and reliable automated closed-loop insulin delivery system has long been considered the holy grail of type 1 diabetes management.

• #82 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

  NICE have published the outcome of their appraisal for hybrid closed-loop systems recommending 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. […] Hybrid closed-loop has also been recommended for: […] People living with type 1 diabetes who are pregnant or planning to become pregnant. […] 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. […] 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.

• #83 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 system has a number of disadvantages which need to be taken into account: The patient must learn to use the closed loop system properly. […] In addition, knowing how to manage daily life (physical activity, calorie intake) via the system, as well as hypoglycemia and hyperglycemia, is essential to be able to benefit from a successful diabetes management experience. […] The insulin pump cannula (a tube used to deliver insulin) must be changed regularly to minimize the risk of reduced insulin absorption and also to prevent the development of lipohypertrophy (abnormal growth of fat beneath the surface of the skin), which can affect insulin absorption and thus alter blood sugar regulation.

• #84 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 system has a number of disadvantages which need to be taken into account: The patient must learn to use the closed loop system properly. […] In addition, knowing how to manage daily life (physical activity, calorie intake) via the system, as well as hypoglycemia and hyperglycemia, is essential to be able to benefit from a successful diabetes management experience. […] The insulin pump cannula (a tube used to deliver insulin) must be changed regularly to minimize the risk of reduced insulin absorption and also to prevent the development of lipohypertrophy (abnormal growth of fat beneath the surface of the skin), which can affect insulin absorption and thus alter blood sugar regulation.

• #85 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 system has a number of disadvantages which need to be taken into account: The patient must learn to use the closed loop system properly. […] In addition, knowing how to manage daily life (physical activity, calorie intake) via the system, as well as hypoglycemia and hyperglycemia, is essential to be able to benefit from a successful diabetes management experience. […] The insulin pump cannula (a tube used to deliver insulin) must be changed regularly to minimize the risk of reduced insulin absorption and also to prevent the development of lipohypertrophy (abnormal growth of fat beneath the surface of the skin), which can affect insulin absorption and thus alter blood sugar regulation.

• #86 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/

  Overall, participants provided insight into their experiences at both the Midwestern VA Healthcare System and the affiliated university health care system. […] Clinicians felt strongly that HCL systems are not a one-size-fits-all approach to diabetes care. […] Participants in our study described how each patient must be continuously assessed to ensure appropriate use, even if the clinicians believed they were an appropriate candidate. […] 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. […] Clinicians commonly commented on the frequent challenges they experienced when first prescribing an HCL system.

• #87 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. […] Teenagers often experience fluctuations in insulin needs due to growth, hormones, stress, or exercise. 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. […] Consider key factors: Account for stress, exercise, and hormonal changes.

• #88 Progress with Closed-loop Systems in Type 1 Diabetes – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/progress-with-closed-loop-systems-in-type-1-diabetes-2/

  Despite these limitations, a reported risk analysis suggests that closed-loop systems may substantially reduce, but not eliminate, the risk for severe nocturnal hypoglycemia. […] Sleep is a recognized risk factor for severe hypoglycemia due to absent warning symptoms and blunted sympatho-adrenal response. […] Nocturnal hypoglycemia is therefore very common but often asymptomatic and undetected—an observation that has been confirmed by the use of CGM. […] The next challenge is to demonstrate the feasibility, safety, and efficacy of such systems under free-living conditions. […] The development of a safe and reliable automated closed-loop insulin delivery system has long been considered the holy grail of type 1 diabetes management.

• #89 The Future of Blood Glucose Monitoring

  https://www.webmd.com/diabetes/future-blood-glucose-monitoring

  Blood glucose monitoring is an important part of managing diabetes. […] Monitoring blood glucose has come a long way since then. Technologies like continuous glucose monitoring (CGM), closed-loop systems, and noninvasive monitoring have automated the process. […] Most people who use CGM have type 1 diabetes, but it’s also being studied for type 2 diabetes. […] Most of the artificial pancreas systems available today are called hybrid closed-loop systems. They’re mainly for people with type 1 diabetes. […] A closed-loop system monitors your blood glucose level throughout the day using CGM. Based on your blood glucose level, it figures out how much insulin you need and delivers it through a pump. […] Researchers are working on developing a dual hormone system, and it may be available in the future. […] Time will tell which, if any, of these monitoring systems will be able to give a result accurate enough to be useful for people with diabetes.

• #90 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 concluded that additional, longer-term outpatient studies are needed to determine how the systems work in the real world. […] For patients with type 1, controlling blood glucose levels during exercise can be challenging. […] Automated delivery of the drugs during exercise can result in better control of blood glucose by reducing insulin and increasing glucagon, according to the session. […] 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.

• #91 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 concluded that additional, longer-term outpatient studies are needed to determine how the systems work in the real world. […] For patients with type 1, controlling blood glucose levels during exercise can be challenging. […] Automated delivery of the drugs during exercise can result in better control of blood glucose by reducing insulin and increasing glucagon, according to the session. […] 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.

• #92 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 concluded that additional, longer-term outpatient studies are needed to determine how the systems work in the real world. […] For patients with type 1, controlling blood glucose levels during exercise can be challenging. […] Automated delivery of the drugs during exercise can result in better control of blood glucose by reducing insulin and increasing glucagon, according to the session. […] 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.

• #93

  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 (CGM s), 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. […] Continuous glucose monitoring predicts progression to diabetes in autoantibody positive children. […] Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. […] 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. […] A comparison of two hybrid closed-loop systems in adolescents and young adults with type 1 diabetes (FLAIR): a multicentre, randomised, crossover trial.

• #94 Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications

  https://e-dmj.org/DOIx.php?id=10.4093/dmj.2019.0121

  CGM sensors proved to be effective in improving patient glucose control and enabling the possibility of designing new advanced technologies for diabetes management. […] The most recent CGM systems have achieved accuracies close to, or even within, the SMBG accuracy range, CGM systems improved also in terms of features and comfort for the patient. […] The real-time availability of glucose concentration values as well as visual/acoustic hypoglycemic alerts allow users to act in order to mitigate, or even avoid, hypoglycemia. […] The beneficial impact brought by the integration of a CGM system in diabetes management has been proven. […] Indeed, initial reluctance from both clinicians and patients has diminished through years thanks to the constant accumulation of clinical evidence from research over adult and pediatric populations with T1DM.

• #95 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. […] NICE has expressed in the technology appraisal guidance that HCL systems could provide children and young people, and their families, with more freedom and help to reduce the mental burden on parents and carers. […] NICE also reported that the effectiveness of HCL systems in pregnancy would likely be greater than in the general adult population. […] The strategy focuses on improving population health outcomes, ensuring equitable access to HCL and reducing health inequalities. […] 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.

• #96 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

  NICE have published the outcome of their appraisal for hybrid closed-loop systems recommending 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. […] Hybrid closed-loop has also been recommended for: […] People living with type 1 diabetes who are pregnant or planning to become pregnant. […] 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. […] 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.

• #97 Hybrid closed loop technology recommended for many people living with type 1 diabetes – Norfolk & Waveney Integrated Care System (ICS

  https://improvinglivesnw.org.uk/hybrid-closed-loop-technology-recommended-for-many-people-living-with-type-1-diabetes/

  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. […] This appraisal is intended to assess hybrid closed-loop systems as a whole and not individual systems so can apply to various approved devices. […] These recommendations are the result of a three-year process which involved extensive consultation with stakeholders and a national real-world pilot of the tech to assess its benefits. […] This guidance means that hybrid closed-loop will be offered to many more people with type 1 diabetes and position the UK as a world leader in offering this tech over the next few years. […] This will require significant changes to the way specialist diabetes services are delivered and, in order to manage workforce pressures and ensure people are supported to use the tech confidently and safely, a phased five-year implementation plan has been developed to guide the roll-out.

• #98 Hybrid closed loop technology recommended for many people living with type 1 diabetes – Norfolk & Waveney Integrated Care System (ICS

  https://improvinglivesnw.org.uk/hybrid-closed-loop-technology-recommended-for-many-people-living-with-type-1-diabetes/

  Managing the rollout in this way is designed to help the NHS deliver the tech in a way that offers the greatest benefit to people with the greatest unmet need. […] As part of this plan, priority will initially be given to children and young people under 18 and women who are pregnant or planning a pregnancy where the need to optimise care is often highest and existing pump users interested in upgrading, as capacity to offer it to more people is developed. […] The implementation will also be subject to regular monitoring through an oversight group set up by NHS England. Diabetes UK will sit on this group which will scrutinise audit and other data and reports to ensure that access and uptake of the technology are fair and not driving inequalities.

• #99 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

  These findings underscore the potential of HCL systems to revolutionise diabetes management in the CYP population. […] The reduction in hypoglycaemia fear and improved sleep quality, likely attributed to reduced time spent with low tissue glucose, contribute to a decrease in overall diabetes burden. […] Hybrid closed-loop systems represent a ground-breaking advancement in the management of T1DM in CYP, offering a more automated and responsive approach to insulin delivery. […] The evidence from clinical trials consistently supports the use of these systems in achieving better glycaemic management and reducing the risk of hypoglycaemia.

• #100 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

  These findings underscore the potential of HCL systems to revolutionise diabetes management in the CYP population. […] The reduction in hypoglycaemia fear and improved sleep quality, likely attributed to reduced time spent with low tissue glucose, contribute to a decrease in overall diabetes burden. […] Hybrid closed-loop systems represent a ground-breaking advancement in the management of T1DM in CYP, offering a more automated and responsive approach to insulin delivery. […] The evidence from clinical trials consistently supports the use of these systems in achieving better glycaemic management and reducing the risk of hypoglycaemia.

• #101 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

  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.

• #102 Hybrid closed loop technology recommended for many people living with type 1 diabetes – Norfolk & Waveney Integrated Care System (ICS

  https://improvinglivesnw.org.uk/hybrid-closed-loop-technology-recommended-for-many-people-living-with-type-1-diabetes/

  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. […] This appraisal is intended to assess hybrid closed-loop systems as a whole and not individual systems so can apply to various approved devices. […] These recommendations are the result of a three-year process which involved extensive consultation with stakeholders and a national real-world pilot of the tech to assess its benefits. […] This guidance means that hybrid closed-loop will be offered to many more people with type 1 diabetes and position the UK as a world leader in offering this tech over the next few years. […] This will require significant changes to the way specialist diabetes services are delivered and, in order to manage workforce pressures and ensure people are supported to use the tech confidently and safely, a phased five-year implementation plan has been developed to guide the roll-out.

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