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Exploring Challenges with Hybrid Closed-Loop Insulin Delivery Systems

There are many different options for managing diabetes from manually checking blood sugar and administering insulin to using a hybrid-closed loop insulin delivery system that does the work automatically with some human input. This type of insulin delivery system, also referred to as an artificial pancreas, was designed to improve diabetes management and blood sugar control without as much demand on patients.

However, a recent study found that nearly one-third of children and young adults stopped using the hybrid closed-loop system within six months. Some of them even discontinued use of a continuous glucose monitoring (CGM) system. The study involved 92 participants with type 1 diabetes who had an average age of 16. Each participant began using the Medtronic 670G system in manual mode for two weeks before switching to auto mode. They received follow-up training via phone within one month after starting auto mode, then were seen in a clinic every three months during the next six months.

The Medtronic 670G system uses CGM data to automatically control basal insulin delivery. This can help manage changes in blood sugar more quickly and administer the correct amount of insulin without patient input. If boluses are needed, however, the individual must enter their carb count and blood glucose number manually.

Researchers found that use of auto mode continued to decrease over the 6-month trial period, dropping from 65.5% during the first month to 51.2% by the sixth month. In total, 28 youth stopped using the hybrid closed-loop system within the first six months, and 21 of those 28 stopped using CGM as well. This raises the question as to whether CGM use posed some barriers to success and continued use of the hybrid closed-loop system.

The study did show that while participants used the artificial pancreas, their time spent within range for blood glucose improved from 50.7% to 56.9%, and their HbA1c levels decreased from 8.7% to 8.4%.

Understanding the strengths and challenges of artificial pancreas use in children and young adults can help researchers to make improvements and adjust systems for better results and continued use. Hybrid closed-loop therapy is just one option for managing type 1 diabetes, and it is important for individuals to find what works best for their situation.

Diabetes Research Connection is committed to providing early-career scientists with the funding necessary to support research designed to prevent, cure, and better manage type 1 diabetes. Funding is critical to continue advancing understanding and therapies for the disease. To learn more about current projects and donate, visit https://diabetesresearchconnection.org.

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Could Closed-Loop Systems Improve Blood Glucose Management?

One of the latest technologies being tested for managing type 1 diabetes is a closed-loop system. This system uses a continuous glucose monitor (CGM) to measure blood glucose levels. When blood sugar begins to rise outside of the target range, it sends information to an insulin pump to automatically administer insulin. When blood sugar begins to fall, insulin is not administered. It is a closed loop because the patient is not deciding when to inject insulin or how much, but rather the system does so automatically.

A recent study involving 168 individuals with type 1 diabetes between the ages of 14 and 71 were part of a six-month trial using a closed-loop system. One hundred and twelve people were randomly assigned to the closed-loop group while the remaining 56 people used a sensor-augmented pump and were considered the control group. All 168 participants completed the trial. There were no incidences of hypoglycemia and only one incidence of diabetic ketoacidosis, which occurred in the closed-loop group.

The results showed that the closed-loop group remained in the target range for glucose levels (70-180 mg/dL) a greater percentage of time than those in the control group. On average, their time in the target range increased from 61% to 71%, while the control group remained around 59%. In addition, the closed-loop group spent less time with glucose levels above 180 mg/dL or below 70 mg/dL. Throughout the duration of the six-month trial, participants in the closed loop group remained in closed-loop mode (with the system automatically managing glucose monitoring and insulin administration) a median of 90% of the time.

While the closed-loop system is not perfect, these findings show that it improved time spent in the target glucose range, which is desirable in diabetes management. It also reduces the manual tracking and input from individuals with type 1 diabetes in managing the disease. While more research and testing are needed, it is a step in the right direction toward developing what many refer to as an “artificial pancreas.”

Diabetes Research Connection (DRC) is interested to see how this system will continue to advance and improve diabetes management in the future and continues to follow its progress.  These types of devices play an integral role in supporting individuals with T1D and helping them to maintain more normal blood glucose levels. The DRC supports early career scientists in pursing novel research studies geared toward improving understanding, diagnosis, and treatment of T1D with the goal of one day finding a cure. Learn more about these efforts and how to help by visiting http://diabetesresearchconnection.org.

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Could Real-Time Continuous Glucose Monitoring Reduce Incidences of Hypoglycemia?

Managing type 1 diabetes can be tricky. Many people rely on self-monitoring throughout the day by periodically testing their blood sugar and administering the proper dose of insulin as needed. Individuals with T1D often inject themselves with insulin multiple times per day. However, food, beverages, physical activity, illness, and other factors can all impact blood sugar levels making them more difficult to effectively manage.

But with advances in technology, continuous glucose monitoring (CGM) devices are now available to help those with T1D track and manage their blood sugar. These devices have a tiny sensor that is inserted under the skin which automatically measures blood glucose levels and transmits the information to a monitoring device. The system can also alert when blood sugar becomes too high or falls below a specified level allowing individuals to respond accordingly.

A recent study conducted across 12 diabetes centers in Germany aimed to determine whether the use of real-time CGM (rtCGM) systems could reduce the number and severity of incidences of hypoglycemia in patients with T1D who had a history of impaired hypoglycemia awareness or severe hypoglycemia within the previous 12 months. The study involved 149 participants, and 141 successfully completed the trial in its entirety.

All participants wore a masked rtCGM system for 28 days before being randomly assigned to one of two groups: the first group wore an unmasked rtCGM system for the next 26 weeks, and the second group was a control group that self-monitored blood glucose levels during this time. The results of the study found that the group that wore the rtCGM system had a 72% decrease in the number of hypoglycemic events (10.8 to 3.5 per 28 days), while the control group saw no significant reduction (14.4 to 13.7 per 28 days). Therefore, the rtCGM system was able to reduce the number of hypoglycemic events that occurred in individuals with a history of severe hypoglycemia or impaired hypoglycemia awareness.

The Diabetes Research Connection (DRC) is encouraged to see the difference these types of devices can make in the lives of individuals living with type 1 diabetes. It is through innovative research studies and technology development that these advances are possible. The DRC supports early career scientists in pursuing novel research geared toward diagnosing, treating, or curing T1D, as well as improving quality of life for those living with the disease. Learn more about the incredible projects that are taking place and find out how you can be a part of supporting these initiatives by visiting http://diabetesresearchconnection.org.

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