Technology and Type 1 Diabetes: Closed-Loop Therapies
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The concept of a closed-loop, automated insulin delivery system, with continuous glucose sensing and insulin delivery informed by a control algorithm without patient intervention, offers the potential to decrease the burden of diabetes management and modify the significant glycemic excursions associated with conventional therapy. Closed-loop technology represents a change in the treatment paradigm for diabetes as the transition is made from primarily self-management behaviors to automated insulin therapy, potentially relieving the burden and guilt of suboptimal glucose control. The advances in this field have been rapid, and clinical trials are currently underway worldwide testing several systems in various stages of development. We have moved rapidly from inpatient research centers to supervised outpatient settings such as diabetes camps, hotels, and now to the home environment with and without remote monitoring. Recent studies and the potential impact on the care of children with type 1 diabetes are presented in this report.
KeywordsClosed-loop Continuous glucose monitoring Artificial pancreas Type 1 diabetes DIAS Bionic pancreas
Trang T. Ly has received speaker honorarium from Medtronic Diabetes. Bruce A. Buckingham has a patent pending and has received payment for board membership from Animas, BD, and Convatec.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Wood JR, Miller KM, Maahs DM, et al. Most youth with type 1 diabetes in the T1D exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes Clinical Guidelines. Diabetes Care. 2013;36:2035–7.CrossRefPubMedCentralPubMedGoogle Scholar
- 6.Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ. 2011;343:d3805.CrossRefPubMedCentralPubMedGoogle Scholar
- 10.Matuleviciene V, Joseph JI, Andelin M, et al. A clinical trial of the accuracy and treatment experience of the Dexcom G4 Sensor (Dexcom G4 System) and Enlite Sensor (Guardian REAL-Time System) tested simultaneously in ambulatory patients with type 1 diabetes. Diabetes Technol Ther. 2014;16:759–67.CrossRefPubMedCentralPubMedGoogle Scholar
- 12.•• Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013;310:1240–7. This report showed a reduction in severe hypoglycemia in patients with impaired awareness of hypoglycemia who used sensor-augmented pump with automated insulin suspension. Google Scholar
- 26.• Ly TT, Breton MD, Keith-Hynes P, et al. Overnight glucose control with an automated, unified safety system in children and adolescents with type 1 diabetes at diabetes camp. Diabetes Care. 2014;37:2310–6. This report describes overnight closed-loop control using the DIAS system with the Unified Safety System in adolescents with type 1 diabetes in a diabetes camp setting. Google Scholar
- 27.Place J, Robert A, Ben Brahim N, et al. DiAs web monitoring: a real-time remote monitoring system designed for artificial pancreas outpatient trials. J Diabetes Sci Technol. 2013;7:9.Google Scholar
- 30.•• Thabit H, Lubina-Solomon A, Stadler M, et al. Home use of closed-loop insulin delivery for overnight glucose control in adults with type 1 diabetes: a 4-week, multicentre, randomised crossover study. Lancet Diabetes Endocrinol. 2014;2:701–9. This paper describes overnight closed-loop control with the Florence automated system with model predictive control algorithm in 24 adults for 4 weeks at home. Google Scholar
- 31.•• Hovorka R, Elleri D, Thabit H, et al. Overnight closed-loop insulin delivery in young people with type 1 diabetes: a free-living, randomized clinical trial. Diabetes Care. 2014;37:1204–11. This paper describes overnight closed-loop control with the Florence automated system with model predictive control algorithm in 16 adolescents for 3 weeks at home. Google Scholar
- 32.• Nimri R, Muller I, Atlas E, et al. MD-Logic Overnight control for 6 weeks of home use in patients with type 1 diabetes: randomized crossover trial. Diabetes Care. 2014;37:3025–32. Describes use of the MD‐Logic system in overnight closed‐loop control in 24 patients for 6 weeks at home. Google Scholar
- 34.• Kovatchev BP, Renard E, Cobelli C, et al. Safety of outpatient closed-loop control: first randomized crossover trials of a wearable artificial pancreas. Diabetes Care. 2014;37:1789–96. Describes the use of the DIAS system for day and night closed‐loop control in 18 adults for 40 hours in outpatient setting. Google Scholar
- 35.•• Leelarathna L, Dellweg S, Mader JK, et al. Day and night home closed-loop insulin delivery in adults with type 1 diabetes: three-center randomized crossover study. Diabetes Care 2014;37:1931–7. Report from the AP@home consortium of day and night closed‐loop control with the Cambridge algorithm for 7 days at home in 17 adults. Google Scholar
- 36.• Russell SJ, El-Khatib FH, Sinha M, et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med. 2014;371:313–25. Closed-loop control using a bihormonal approach infusing both insulin and glucagon in both adults (n = 20) and adolescents (n = 32) with type 1 diabetes over 5 days. Google Scholar