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

Background: Time-in-range is a key glycaemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. Purpose: We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycaemic ranges. Data sources: 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. Study selection: We included randomised controlled trials >2 weeks duration comparing technologies for management of type 1 diabetes in adults (>18 years of age), excluding pregnant women. Data extraction: 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). Data synthesis: 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). Limitations: Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low. Conclusions: 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.

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Comparison of time in range for closed-loop systems versus current care during physical exercise in type 1 diabetes: a systematic review and meta-analysis

10.1055/s-0041-1727508 ◽

2021 ◽

Author(s):

O Moser ◽

B Weilguni ◽

M Tauschmann ◽

F Aziz ◽

H Sourij ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Physical Exercise ◽

Closed Loop ◽

Meta Analysis ◽

Closed Loop Systems ◽

Time In Range

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Time in Range for Closed-Loop Systems versus Standard of Care during Physical Exercise in People with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10112445 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2445

Author(s):

Max L. Eckstein ◽

Benjamin Weilguni ◽

Martin Tauschmann ◽

Rebecca T. Zimmer ◽

Faisal Aziz ◽

...

Keyword(s):

Systematic Review ◽

Physical Exercise ◽

Closed Loop ◽

Meta Analysis ◽

Standard Of Care ◽

Controlled Trials ◽

Randomized Controlled ◽

Closed Loop Systems ◽

Time In Range

The aim of this systematic review and meta-analysis was to compare time in range (TIR) (70–180 mg/dL (3.9–10.0 mmol/L)) between fully closed-loop systems (CLS) and standard of care (including hybrid systems) during physical exercise in people with type 1 diabetes (T1D). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Science from January 1950 until January 2020. Randomized controlled trials including studies with different CLS were compared against standard of care in people with T1D. The meta-analysis was performed using the random effects model and restricted maximum likelihood estimation method. Six randomized controlled trials involving 153 participants with T1D of all age groups were included. Due to crossover test designs, studies were included repeatedly (a–d) if CLS or physical exercise interventions were different. Applying this methodology increased the comparisons to a total number of 266 participants. TIR was higher with an absolute mean difference (AMD) of 6.18%, 95% CI: 1.99 to 10.38% in favor of CLS. In a subgroup analysis, the AMD was 9.46%, 95% CI: 2.48% to 16.45% in children and adolescents while the AMD for adults was 1.07% 95% CI: −0.81% to 2.96% in favor of CLS. In this systematic review and meta-analysis CLS moderately improved TIR in comparison to standard of care during physical exercise in people with T1D. This effect was particularly pronounced for children and adolescents showing that the use of CLS improved TIR significantly compared to standard of care.

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Free-living use of artificial pancreas for children with type 1 diabetes: systematic review

Diabetes Mellitus ◽

10.14341/dm9714 ◽

2018 ◽

Vol 21 (3) ◽

pp. 206-216

Author(s):

Klemen Dovc ◽

Gül Yeşiltepe Mutlu ◽

Yury I. Philippov ◽

Dmitry N. Laptev ◽

Evgenia M. Patrakeeva ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Control System ◽

Glucose Control ◽

Closed Loop ◽

Artificial Pancreas ◽

Hospital Environment ◽

Time In Range ◽

Randomized Control

BACKGRAUND: A closed-loop glucose control system or artificial pancreas consists of three components a Continuous Glucose Monitor (CGM), infusion pumps to deliver hormone(s) and a sophisticated dosing algorithm to control hormone delivery. In the past years, numerous studies with closed-loop system devices were conducted with gradual shift to out-of-hospital environment and with lengthening study duration. AIMS: To compare efficacy and safety of closed-loop insulin pump use in children with type 1 diabetes mellitus in compare with conventional insulin treatment (continuous subcutaneous insulin infusion (CSII) with our without CGM) based on randomized control trials data (RCT). METHODS: In the systematic review we have include 28 randomized controlled trials results indexed in PubMed, Medline databases published till 15 June 2017. The efficacy on metabolic control in this study evaluated by the proportion of time within target range (preferably 70 to 180 mg/dl if reported) and mean (median) glucose based on sensor measurements, and the safety evaluated by time in hypoglycemia (below 70 mg/dl if reported). RESULTS: Increased time in range in the night period was observed in all RCT. Only 3 RCT showed decrease of the time in range within 24 h evaluation period. In one RCT the significant positive differences have been shown in the time in range for dual hormone closed-loop glucose control system in compare with insulin-only artificial pancreas. Mean glycaemia and glucose variability changes were not in the same manner in different RCT, both in the night only and in 24 h estimation period. Night hypoglycemia duration decreased in most RCT with closed-loop control in compare with CSII, and increased only in 2 RCT. When all-day estimation period the time in hypoglycemia changed not in the same manner in different RCT. Valuable methodology differences of the glycaemic control estimation within observed RCT brought significant complications in the data analysis and made impossible the results quantitative estimation to prepare a metaanalysis. CONCLUSIONS: Much work has been done to develop effective and safe artificial pancreas, but not all RCTs confirmed advantages of closed-loop glucose control in compare with CSII in children and adolescents in real life. More research with prospective randomized control design required to prove benefits of closed-loop glucose control. Further RCTs should have an uniform methodology for glycemic control assessment and long duration that will allow to use cumulative measures in a closed-loop efficacy estimation (HbA1c).

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Time in Range for Multiple Technologies in Type 1 Diabetes: A Systematic Review and Network Meta-analysis

Diabetes Care ◽

10.2337/dc19-1785 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1967-1975 ◽

Cited By ~ 2

Author(s):

Anthony Pease ◽

Clement Lo ◽

Arul Earnest ◽

Velislava Kiriakova ◽

Danny Liew ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Meta Analysis ◽

Time In Range

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Efficacy and safety of closed-loop insulin delivery versus sensor-augmented pump in the treatment of adults with type 1 diabetes: a systematic review and meta-analysis of randomized-controlled trials

Journal of Endocrinological Investigation ◽

10.1007/s40618-021-01674-6 ◽

2021 ◽

Author(s):

Z. Fang ◽

M. Liu ◽

J. Tao ◽

C. Li ◽

F. Zou ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Randomized Controlled Trials ◽

Closed Loop ◽

Meta Analysis ◽

Insulin Delivery ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled

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Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series

Journal of Diabetes Science and Technology ◽

10.1177/19322968211035447 ◽

2021 ◽

pp. 193229682110354

Author(s):

Aideen Daly ◽

Sara Hartnell ◽

Charlotte K. Boughton ◽

Mark Evans

Keyword(s):

Quality Of Life ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Closed Loop ◽

Diabetes Management ◽

Case Series ◽

Closed Loop Systems ◽

Time In Range

Background: Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. Methods: We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. Results: Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, ( P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia ( P = .50). Conclusion: Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.

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