Challenging steroid-induced worsening of hyperglycaemia in type 1 diabetes with advanced hybrid closed-loop systems

2021 ◽  
Author(s):  
Marina Valenzano ◽  
Giuseppe Lepore ◽  
Giorgio Grassi
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Closed Loop Systems

Time in range for multiple technologies in type 1 diabetes: a systematic review and network meta-analysis

2020 ◽  
Author(s):  
Anthony Pease ◽  
Clement Lo ◽  
Arul Earnest ◽  
Velislava Kiriakova ◽  
Danny Liew ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 1 Diabetes ◽  
Closed Loop ◽  
Meta Analysis ◽  
Management Strategies ◽  
Glucose Testing ◽  
Closed Loop Systems ◽  
Percent Time ◽  
Time In Range

<b>Background: </b>Time-in-range is a key glycaemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. <p><b> </b></p> <p><b>Purpose: </b>We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycaemic ranges.</p> <p> </p> <p><b>Data sources: </b>We searched All Evidenced Based Medicine Reviews, CINAHL, EMBASE, MEDLINE, MEDLINE In-Process and other non-indexed citations, PROSPERO, PsycINFO, PubMed, and Web of Science until 24 April, 2019.</p> <p> </p> <p><b>Study selection: </b>We included randomised controlled trials <u>></u>2 weeks duration comparing technologies for management of type 1 diabetes in adults (<u>></u>18 years of age), excluding pregnant women. </p> <p> </p> <p><b>Data extraction: </b>Data were extracted using a predefined template. Outcomes were percent time with sensor glucose levels 3.9–10.0mmol/l (70–180mg/dL), >10.0mmol/L (180mg/dL), and <3.9mmol/L (70mg/dL). </p> <p><b> </b></p> <p><b>Data synthesis: </b>We identified 16,772 publications, of which 14 eligible studies compared eight technologies comprising 1,043 participants. Closed loop systems lead to greater percent time-in-range than any other management strategy and was 17.85 (95% predictive interval [PrI] 7.56–28.14) higher than usual care of multiple daily injections with capillary glucose testing. Closed loop systems ranked best for percent time-in-range or above range utilising surface under the cumulative ranking curve (SUCRA–98.5 and 93.5 respectively). Closed loop systems also ranked highly for time below range (SUCRA–62.2). </p> <p><b> </b></p> <p><b>Limitations: </b>Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low.</p> <p><b> </b></p> <p><b>Conclusions: </b>In the first integrated comparison of multiple management strategies considering time-in-range, we found that the efficacy of closed loop systems appeared better than all other approaches. </p>

Efficacy of advanced hybrid closed loop systems for the management of type 1 diabetes in children

2021 ◽  
Author(s):  
Lucia FERRITO ◽  
Stefano PASSANISI ◽  
Riccardo BONFANTI ◽  
Valentino CHERUBINI ◽  
Nicola MINUTO ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Closed Loop Systems

scholarly journals Women’s Experiences of Day-and-Night Closed-Loop Insulin Delivery During Type 1 Diabetes Pregnancy

2018 ◽  
Vol 12 (6) ◽  
pp. 1125-1131 ◽  
Author(s):  
Conor Farrington ◽  
Zoe Stewart ◽  
Roman Hovorka ◽  
Helen Murphy
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Insulin Delivery ◽  
Peace Of Mind ◽  
Women’S Experiences ◽  
Closed Loop Systems ◽  
Women's Experiences

Aims: Closed-loop insulin delivery has the potential to improve day-to-day glucose control in type 1 diabetes pregnancy. However, the psychosocial impact of day-and-night usage of automated closed-loop systems during pregnancy is unknown. Our aim was to explore women’s experiences and relationships between technology experience and levels of trust in closed-loop therapy. Methods: We recruited 16 pregnant women with type 1 diabetes to a randomized crossover trial of sensor-augmented pump therapy compared to automated closed-loop therapy. We conducted semistructured qualitative interviews at baseline and follow-up. Findings from follow-up interviews are reported here. Results: Women described benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and peace of mind were counterbalanced by concerns about technical glitches, CGM inaccuracy, and the burden of maintenance requirements. Women expressed varied but mostly high levels of trust in closed-loop therapy. Conclusions: Women displayed complex psychosocial responses to day-and-night closed-loop therapy in pregnancy. Clinicians should consider closed-loop therapy not just in terms of its potential impact on biomedical outcomes but also in terms of its impact on users’ lives.

scholarly journals Benefits and Challenges of Current Closed-Loop Technologies in Children and Young People With Type 1 Diabetes

2021 ◽  
Vol 9 ◽  
Author(s):  
Julia Fuchs ◽  
Roman Hovorka
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Closed Loop ◽  
Age Groups ◽  
Future Research ◽  
Pediatric Age ◽  
Children And Young People ◽  
Closed Loop Systems ◽  
Current Systems

Recent advances in diabetes technology have led to the development of closed-loop insulin delivery systems for the management of type 1 diabetes. Several such systems are now commercially available for children and young people. While all available systems have been shown to improve glycaemic control and quality of life in this population, qualitative data also highlights the challenges in using closed-loop systems, which vary among different pediatric age-groups. Very young children require systems that are able to cope with low insulin doses and significant glycaemic variability due to their high insulin sensitivity and unpredictable eating and exercise patterns. Adolescents' compliance is often related to size and number of devices, usability of the systems, need for calibrations, and their ability to interact with the system. Given the speed of innovations, understanding the capabilities and key similarities and differences of current systems can be challenging for healthcare professionals, caregivers and young people with type 1 diabetes alike. The aim of this review is to summarize the key evidence on currently available closed-loop systems for children and young people with type 1 diabetes, as well as commenting on user experience, where real-world data are available. We present findings on a system-basis, as well as identifying specific challenges in different pediatric age-groups and commenting on how current systems might address these. Finally, we identify areas for future research with regards to closed-loop technology tailored for pediatric use and how these might inform reimbursement and alleviate disease burden.

Opportunities and challenges in closed-loop systems in type 1 diabetes

2021 ◽  
Author(s):  
Leah M Wilson ◽  
Peter G Jacobs ◽  
Michael C Riddell ◽  
Dessi P Zaharieva ◽  
Jessica R Castle
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Closed Loop Systems

Progress with Closed-loop Systems in Type 1 Diabetes

2010 ◽  
Vol 6 (2) ◽  
pp. 31
Author(s):  
Lalantha Leelarathna ◽  
Roman Hovorka ◽  
◽  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Diabetes Management ◽  
Insulin Delivery ◽  
Glucose Measurement ◽  
Target Range ◽  
Advantages And Disadvantages ◽  
Closed Loop Systems ◽  
Interstitial Glucose

Automated insulin delivery by means of a glucose-responsive closed-loop system has often been cited as the ‘holy grail’ of type 1 diabetes management. Reflecting the technological advances in interstitial glucose measurements and wider use of continuous glucose monitoring, recent research in closed-loop glucose control has focused on the subcutaneous route for glucose measurements and insulin delivery. The primary aim of such systems is to keep blood glucose within the target range while minimising the risk of hypoglycaemia with minimal input from the user. This article examines recent developments in the field of interstitial glucose measurement, limitations of the current generation of devices and implications on the performance of closed-loop systems. Clinical results and the advantages and disadvantages of different closed-loop configurations are summarised. Potential future advances in closed-loop systems are highlighted.

Closed loop systems in type 1 diabetes

BMJ ◽  
2018 ◽  
pp. k1613 ◽  
Author(s):  
Norman Waugh ◽  
Amanda Adler ◽  
Ian Craigie ◽  
Timothy Omer
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Closed Loop Systems

scholarly journals Appearance of Do‐It‐Yourself closed‐loop systems to manage type 1 diabetes

2018 ◽  
Vol 48 (11) ◽  
pp. 1400-1404 ◽  
Author(s):  
Tien‐Ming Hng ◽  
David Burren
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Closed Loop Systems ◽  
Do It Yourself

scholarly journals Review of the Omnipod® 5 Automated Glucose Control System Powered by Horizon™ for the treatment of Type 1 diabetes

2020 ◽  
Vol 11 (8) ◽  
pp. 507-519
Author(s):  
Erin C Cobry ◽  
Cari Berget ◽  
Laurel H Messer ◽  
Gregory P Forlenza
Keyword(s):  
Type 1 Diabetes ◽  
Control System ◽  
Glucose Control ◽  
Closed Loop ◽  
Medical Condition ◽  
Glucose Levels ◽  
Closed Loop Systems ◽  
Blood Glucose Levels ◽  
Diabetes Technology

Type 1 diabetes (T1D) is a medical condition that requires constant management, including monitoring of blood glucose levels and administration of insulin. Advancements in diabetes technology have offered methods to reduce the burden on people with T1D. Several hybrid closed-loop systems are commercially available or in clinical trials, each with unique features to improve care for patients with T1D. This article reviews the Omnipod® 5 Automated Glucose Control System Powered by Horizon™ and the safety and efficacy data to support its use in the management of T1D.

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