Switching from Suspend-Before-Low Insulin Pump Technology to a Hybrid Closed-Loop System Improves Glucose Control and Reduces Glucose Variability: A Retrospective Observational Case–Control Study

2020 ◽  
Vol 22 (4) ◽  
pp. 321-325 ◽  
Author(s):  
Giuseppe Lepore ◽  
Cristiana Scaranna ◽  
Anna Corsi ◽  
Alessandro Roberto Dodesini ◽  
Roberto Trevisan
Keyword(s):  
Glucose Control ◽  
Closed Loop ◽  
Case Control Study ◽  
Insulin Pump ◽  
Glucose Variability ◽  
Case Control ◽  
Loop System ◽  
Closed Loop System ◽  
Control Study

scholarly journals Day and night glucose control using a hybrid closed loop system for the management of type 1 diabetes

2015 ◽  
Vol 2015 (S1) ◽  
Author(s):  
Martin de Bock ◽  
Anirban Roy ◽  
Julie Dart ◽  
Barry Keenan ◽  
Elizabeth Davis ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System

scholarly journals Survey about do-it-yourself closed loop systems in the treatment of diabetes in Germany

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243465
Author(s):  
Anna Laura Herzog ◽  
Jonas Busch ◽  
Christoph Wanner ◽  
Holger K. von Jouanne-Diedrich
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Closed Loop ◽  
Artificial Pancreas ◽  
Direct Interaction ◽  
Loop System ◽  
Closed Loop System ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Do It Yourself

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).

Glucose Control in Adults with Type 1 Diabetes Using a Medtronic Prototype Enhanced-Hybrid Closed-Loop System: A Feasibility Study

2019 ◽  
Vol 21 (9) ◽  
pp. 499-506 ◽  
Author(s):  
Melissa H. Lee ◽  
Sara Vogrin ◽  
Barbora Paldus ◽  
Hannah M. Jones ◽  
Varuni Obeyesekere ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Feasibility Study ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System ◽  
System A

scholarly journals Glucose control during Ramadan fasting in a teenager with type 1 diabetes on MiniMed 670G hybrid closed-loop system

2019 ◽  
Vol 57 (1) ◽  
pp. 105-107 ◽  
Author(s):  
Goran Petrovski ◽  
Fawziya Al Khalaf ◽  
Judith Campbell ◽  
Khalid Hussain ◽  
Hannah Fisher ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System ◽  
Ramadan Fasting

Glucose Control Using a Standard Versus an Enhanced Hybrid Closed Loop System: A Randomized Crossover Study

2019 ◽  
Vol 21 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Barbora Paldus ◽  
Melissa H. Lee ◽  
Hannah M. Jones ◽  
Sybil A. McAuley ◽  
Jodie C. Horsburgh ◽  
...  
Keyword(s):  
Crossover Study ◽  
Glucose Control ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System ◽  
System A ◽  
Randomized Crossover Study

scholarly journals Advancing the Use of CGM Devices in a Non-ICU Setting

2019 ◽  
Vol 13 (4) ◽  
pp. 674-681 ◽  
Author(s):  
Meng Wang ◽  
Lakshmi G. Singh ◽  
Elias K. Spanakis
Keyword(s):  
Glycemic Control ◽  
Closed Loop ◽  
Insulin Pump ◽  
Severe Hypoglycemia ◽  
Hospital Staff ◽  
Loop System ◽  
Inpatient Setting ◽  
Closed Loop System ◽  
Alternative Mode ◽  
Closed Loop Systems

Improvements in glycemic control using continuous glucose monitoring (CGM) systems have been demonstrated in the outpatient setting. Among hospitalized patients the use of CGM is largely investigational, particularly in the non-ICU setting. Although there is no commercially available closed-loop system, it has recently been evaluated in the non–critical care setting. Both CGMs and closed-loop systems may lead to improved glycemic control, decreased length of stay, reduced risk of adverse events related to severe hypoglycemia or hyperglycemia. Limitations of inpatient use of CGM and closed-loop systems include lack of FDA approvals, inexperience with this technology, and costs related to supplies. Significant investment may be necessary for hospital staff training and for development of infrastructure to support inpatient use. Additional limitations for CGM systems includes potential inaccuracy of interstitial glucose measurements due to medication interferences, sensor lag, or sensor drift. Limitations for closed-loop systems also includes need for routine monitoring to detect infusion site issues as well as monitoring to ensure adequate insulin supply in reservoir to avoid abrupt cessation of insulin infusion leading to severe hyperglycemia. Hospital staff must be familiar with trouble-shooting and conversion to alternative mode of insulin delivery in the event of insulin pump malfunction. Given these complexities, implementation of closed-loop systems may require involvement of an endocrinology team, limiting widespread adoption. This article reviews current state of CGM and closed-loop system use in the non-ICU setting, available literature, advantages and limitations, as well as suggestions for future CGM design, specifically for the inpatient setting.

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