scholarly journals Real-World Efficacy of the Hybrid Closed-Loop System

2021 ◽  
pp. 193229682098510
Author(s):  
Chinenye O. Usoh ◽  
Crystal Paige Johnson ◽  
Jaime L. Speiser ◽  
Richa Bundy ◽  
Ajay Dharod ◽  
...  
Keyword(s):  
Glucose Control ◽  
Closed Loop ◽  
Insulin Pump ◽  
Insulin Injection ◽  
Insulin Pump Therapy ◽  
Target Range ◽  
Pump Therapy ◽  
Percent Time ◽  
Time In Target Range ◽  
Manual Mode

Background: Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode. We aimed to assess HCL when used in a typical outpatient endocrine clinic. Methods: We initially analyzed data from 80 individuals with type 1 diabetes managed in an endocrine clinic by a single certified diabetes educator (CDE). We then included our other providers and had 230 subjects by the end of the study. Patients were either transitioned from traditional insulin pump or multiple daily insulin injection therapy (MDI) to HCL. Patients initiated to HCL pump therapy from July 2017 through February 2020 were studied. Endpoints of change in time in hypoglycemic/hyperglycemic range and time in target range were analyzed. The primary outcome was a change in percent time in the target range during manual mode compared with auto mode. Results: There was an 18.2% increase in average time in target range when comparing manual mode to auto mode (59.3% vs 70.1%, P < .0001). Average time in hyperglycemic range was significantly reduced by 26.7% (39.0% vs 28.6%, P < .0001) but without increasing average time in hypoglycemic range (1.7% vs 1.3%, P = 0.95). Conclusions: HCL was effective in reducing hyperglycemia and increasing time in the target range but did not increase hypoglycemia. These data suggest HCL will improve the metrics of glucose control.

scholarly journals Fully Closed Loop Glucose Control With a Bihormonal Artificial Pancreas in Adults With Type 1 Diabetes: An Outpatient, Randomized, Crossover Trial

2021 ◽  
Author(s):  
Helga Blauw ◽  
A. Joannet Onvlee ◽  
Michel Klaassen ◽  
Arianne C. van Bon ◽  
J. Hans DeVries
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Open Loop ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Randomized Crossover Trial

OBJECTIVE <p>To demonstrate the performance and safety of a bihormonal (insulin and glucagon) artificial pancreas in adults with type 1 diabetes.</p> <p> </p>RESEARCH DESIGN AND METHODS <p>In this outpatient, randomized, crossover trial, two-week fully closed loop glucose control (artificial pancreas therapy) was compared to two-week open loop control (patient’s normal insulin pump therapy with a glucose sensor if they had one). </p> <p> </p>RESULTS <p>Twenty three patients were included in the analysis. Median (IQR) time in range (70-180 mg/dL [3.9-10 mmol/L]) was significantly higher during closed loop (86.6% [84.9-88.5]) compared with open loop (53.9% [49.7-67.2]; p<0.0001).</p> <p> </p>CONCLUSIONS <p>Compared to insulin pump therapy, the bihormonal artificial pancreas provided superior glucose control, without meal or exercise announcements, and was safe in adults with type 1 diabetes.</p>

scholarly journals Fully Closed Loop Glucose Control With a Bihormonal Artificial Pancreas in Adults With Type 1 Diabetes: An Outpatient, Randomized, Crossover Trial

2021 ◽  
Author(s):  
Helga Blauw ◽  
A. Joannet Onvlee ◽  
Michel Klaassen ◽  
Arianne C. van Bon ◽  
J. Hans DeVries
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Insulin Pump ◽  
Artificial Pancreas ◽  
Open Loop ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Randomized Crossover Trial

OBJECTIVE <p>To demonstrate the performance and safety of a bihormonal (insulin and glucagon) artificial pancreas in adults with type 1 diabetes.</p> <p> </p>RESEARCH DESIGN AND METHODS <p>In this outpatient, randomized, crossover trial, two-week fully closed loop glucose control (artificial pancreas therapy) was compared to two-week open loop control (patient’s normal insulin pump therapy with a glucose sensor if they had one). </p> <p> </p>RESULTS <p>Twenty three patients were included in the analysis. Median (IQR) time in range (70-180 mg/dL [3.9-10 mmol/L]) was significantly higher during closed loop (86.6% [84.9-88.5]) compared with open loop (53.9% [49.7-67.2]; p<0.0001).</p> <p> </p>CONCLUSIONS <p>Compared to insulin pump therapy, the bihormonal artificial pancreas provided superior glucose control, without meal or exercise announcements, and was safe in adults with type 1 diabetes.</p>

scholarly journals OR14-5 Challenges in implementing Hybrid Closed Loop Insulin Pump Therapy (medtronic 670g) In A 'Real World' Clinical Setting.

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Gregory Goodwin ◽  
Gretchen Waldman ◽  
Justine Lyons ◽  
Adeolu Oladunjoye ◽  
Garry Steil
Keyword(s):  
Real World ◽  
Clinical Setting ◽  
Closed Loop ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy

Complications With Insulin Pump Therapy vs Insulin Injection Therapy—Reply

JAMA ◽  
2018 ◽  
Vol 319 (5) ◽  
pp. 503
Author(s):  
Beate Karges ◽  
Elisabeth Binder ◽  
Joachim Rosenbauer
Keyword(s):  
Insulin Pump ◽  
Insulin Injection ◽  
Injection Therapy ◽  
Insulin Pump Therapy ◽  
Pump Therapy

scholarly journals Coordinated Basal—Bolus Infusion for Tighter Postprandial Glucose Control in Insulin Pump Therapy

2009 ◽  
Vol 3 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Jorge Bondia ◽  
Eyal Dassau ◽  
Howard Zisser ◽  
Remei Calm ◽  
Josep Vehí ◽  
...  
Keyword(s):  
Glucose Control ◽  
Insulin Pump ◽  
Postprandial Glucose ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Bolus Infusion ◽  
Basal Bolus

scholarly journals Use of Automated Bolus Calculators for Diabetes Management

2010 ◽  
Vol 9 (2) ◽  
pp. 92 ◽  
Author(s):  
Frank L Schwartz ◽  
Cynthia R Marling ◽  
◽  
Keyword(s):  
Insulin Therapy ◽  
Glucose Control ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Smart Phone ◽  
Glycated Haemoglobin ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Numeracy Skills ◽  
Patients With Diabetes

Fewer than 30 % of patients with diabetes who are on insulin therapy achieve target glycated haemoglobin (HbA1c) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycaemia and assisting those with low numeracy skills.

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