OBJECTIVE: Intensive glucose management with insulin pump and continuous glucose monitoring therapy in insulin-treated patients with diabetes poses many challenges in all aspects of daily life. Automated insulin delivery (AID) is the ultimate goal of insulin replacement therapy to reduce the burden of managing this condition. Many systems are being tested in the clinical research setting, and one hybrid closed-loop (HCL) system has received Food and Drug Administration (FDA) approval for use in type 1 diabetes patients above the age of 14 years. METHODS: Literature review and clinical practice experience from the Diabetes and Technology Program at an academic medical center. RESULTS: This review outlines recent advances in AID systems, focusing on the FDA-approved MiniMed™ 670G HCL system and the real-life experience 1-year post-release in an academic medical center with over 60 patients on this system. The unique challenges of adapting to this new system outside the clinical trial setting are highlighted, and a training protocol designed specifically for the onboarding of first-time users is described. CONCLUSION: HCL insulin therapy offers several advantages, at the same time posing unique challenges to the user. Systematic training of patients with diabetes transitioning to this system is essential for retention and success of use. ABBREVIATIONS: AID = automated insulin delivery; CGM = continuous glucose monitoring; FDA = Food and Drug Administration; HbA1c = glycated hemoglobin; HCL = hybrid closed-loop; ICR = insulin to carbohydrate ratio; SAP = sensor augmented pump; T1DM = type 1 diabetes.
OBJECTIVE: Intensive glucose management with insulin pump and continuous glucose monitoring therapy in insulin-treatedpatients with diabetes poses many challenges in all aspects of daily life. Automated insulin delivery (AID) is the ultimate goal of insulin replacement therapy to reduce the burden of managing this condition. Many systems are being tested in the clinical research setting, and one hybrid closed-loop (HCL) system has received Food and Drug Administration (FDA) approval for use in type 1 diabetespatients above the age of 14 years. METHODS: Literature review and clinical practice experience from the Diabetes and Technology Program at an academic medical center. RESULTS: This review outlines recent advances in AID systems, focusing on the FDA-approved MiniMed™ 670G HCL system and the real-life experience 1-year post-release in an academic medical center with over 60 patients on this system. The unique challenges of adapting to this new system outside the clinical trial setting are highlighted, and a training protocol designed specifically for the onboarding of first-time users is described. CONCLUSION:HCLinsulin therapy offers several advantages, at the same time posing unique challenges to the user. Systematic training of patients with diabetes transitioning to this system is essential for retention and success of use. ABBREVIATIONS: AID = automated insulin delivery; CGM = continuous glucose monitoring; FDA = Food and Drug Administration; HbA1c = glycated hemoglobin; HCL = hybrid closed-loop; ICR = insulin to carbohydrate ratio; SAP = sensor augmented pump; T1DM = type 1 diabetes.
Authors: John Jack L Leahy; Grazia Aleppo; Vivian A Fonseca; Satish K Garg; Irl B Hirsch; Anthony L McCall; Janet B McGill; William H Polonsky Journal: J Endocr Soc Date: 2019-10-07
Authors: Rayhan A Lal; Marina Basina; David M Maahs; Korey Hood; Bruce Buckingham; Darrell M Wilson Journal: Diabetes Care Date: 2019-09-23 Impact factor: 19.112