Since the discovery of insulin 100 years ago, we have seen considerable advances across diabetes therapies. The more recent advent of glucose-responsive automated insulin delivery has started to ...revolutionise the management of type 1 diabetes in children and adults. Evolution of closed-loop insulin delivery from research to clinical practice has been rapid, and multiple systems are now commercially available. In this review, we summarise key evidence on currently available closed-loop systems and those in development. We comment on dual-hormone and do-it-yourself systems, as well as reviewing clinical evidence in special populations such as very young children, older adults and in pregnancy. We identify future directions for research and barriers to closed-loop adoption, including how these might be addressed to ensure equitable access to this novel therapy.
•Type 1 diabetes is a lifelong condition with high management burden.•Glucose-responsive automated insulin delivery improves glycaemic outcomes and quality of life.•Multiple closed-loop systems are commercially available, offering increased choice for users.•Working towards a fully closed-loop system and addressing barriers to adoption should be the focus of future research.
Over the last five years, closed-loop insulin delivery systems have transitioned from research-only to real-life use. A number of systems have been commercialized and are increasingly used in ...clinical practice. Given the rapidity of new developments in the field, understanding the capabilities and key similarities and differences of current systems can be challenging. This review aims to provide an update on the state of the field of closed-loop insulin delivery systems, including emerging technologies.
We summarize key clinical safety and efficacy evidence of commercial and emerging insulin-only hybrid closed-loop systems for type 1 diabetes. A literature search was conducted and clinical trials using closed-loop systems during free-living conditions were identified to report on safety and efficacy data. We comment on emerging technologies and adjuncts for closed-loop systems, as well as non-technological priorities in closed-loop insulin delivery.
Commercial hybrid closed-loop insulin delivery systems are efficacious, consistently improving glycemic control when compared to standard therapy. Challenges remain in widespread adoption due to clinical inertia and the lack of resources to embrace technological developments by health care professionals.
Since the discovery of insulin 100 years ago, we have seen considerable advances across diabetes therapies. The more recent advent of glucose-responsive automated insulin delivery has started to ...revolutionise the management of type 1 diabetes in children and adults. Evolution of closed-loop insulin delivery from research to clinical practice has been rapid, and multiple systems are now commercially available. In this review, we summarise key evidence on currently available closed-loop systems and those in development. We comment on dual-hormone and do-it-yourself systems, as well as reviewing clinical evidence in special populations such as very young children, older adults and in pregnancy. We identify future directions for research and barriers to closed-loop adoption, including how these might be addressed to ensure equitable access to this novel therapy.
Jelen tanulmány a szuperérzékenység és a vizsgaszorongás közötti kapcsolat vizsgálatára fókuszál. A téma aktualitását az adja, hogy a szuperérzékenység, mint személyiségvonás magyarországi ...viszonylatban (főleg a szuperérzékeny gyerekek különleges bánásmódra való igényét illetően) kevéssé vizsgált terület, míg külföldön egyre több kutatás jelenik meg a témában. A vizsgálat arra keresi a választ, hogy a magasabb érzékenység együtt jár-e magasabb vizsgaszorongás-szinttel. Minta: 133 fő (jellemzőik: Mkor=15.3; nemi eloszlás 25,56% fiú, 74,44% lány; évfolyambeli eloszlás 9. osztály 78,95 % 10. osztály 21,05%). Módszer: online és anonim módon kitölthető kérdőívcsomag három kérdőívvel. A demográfiai jellemzők felvételéhez önállóan összeállított demográfiai kérdőív alkalmazására került sor, a szorongás vizsgálatához a TAI-H (Sipos, Sipos & Spielberger, 1988), az érzékenység vizsgálatához a HSPS-H (Aron, 1999, ford. Komjáthy, 2011; Pluess, 2013) került felhasználásra. Eredmény: az érzékenyebb diákoknak szignifikánsan magasabb a vizsgaszorongás-szintjük kevésbé érzékeny társaikéhoz képest. Következtetés: a pedagógiai gyakorlatban érdemes figyelembe venni a tanulók érzékenységét, hiszen sok egyéb tényező mellett ez a veleszületett jellemvonás befolyásolhatja a vizsgaszorongás-szintet és így a teljesítményt.
The possible advantage of hybrid closed-loop therapy (i.e., artificial pancreas) over sensor-augmented pump therapy in very young children with type 1 diabetes is unclear.
In this multicenter, ...randomized, crossover trial, we recruited children 1 to 7 years of age with type 1 diabetes who were receiving insulin-pump therapy at seven centers across Austria, Germany, Luxembourg, and the United Kingdom. Participants received treatment in two 16-week periods, in random order, in which the closed-loop system was compared with sensor-augmented pump therapy (control). The primary end point was the between-treatment difference in the percentage of time that the sensor glucose measurement was in the target range (70 to 180 mg per deciliter) during each 16-week period. The analysis was conducted according to the intention-to-treat principle. Key secondary end points included the percentage of time spent in a hyperglycemic state (glucose level, >180 mg per deciliter), the glycated hemoglobin level, the mean sensor glucose level, and the percentage of time spent in a hypoglycemic state (glucose level, <70 mg per deciliter). Safety was assessed.
A total of 74 participants underwent randomization. The mean (±SD) age of the participants was 5.6±1.6 years, and the baseline glycated hemoglobin level was 7.3±0.7%. The percentage of time with the glucose level in the target range was 8.7 percentage points (95% confidence interval CI, 7.4 to 9.9) higher during the closed-loop period than during the control period (P<0.001). The mean adjusted difference (closed-loop minus control) in the percentage of time spent in a hyperglycemic state was -8.5 percentage points (95% CI, -9.9 to -7.1), the difference in the glycated hemoglobin level was -0.4 percentage points (95% CI, -0.5 to -0.3), and the difference in the mean sensor glucose level was -12.3 mg per deciliter (95% CI, -14.8 to -9.8) (P<0.001 for all comparisons). The time spent in a hypoglycemic state was similar with the two treatments (P = 0.74). The median time spent in the closed-loop mode was 95% (interquartile range, 92 to 97) over the 16-week closed-loop period. One serious adverse event of severe hypoglycemia occurred during the closed-loop period. One serious adverse event that was deemed to be unrelated to treatment occurred.
A hybrid closed-loop system significantly improved glycemic control in very young children with type 1 diabetes, without increasing the time spent in hypoglycemia. (Funded by the European Commission and others; ClinicalTrials.gov number, NCT03784027.).
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