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. 2021 Mar;23(3):655-660.
doi: 10.1111/dom.14273. Epub 2020 Dec 20.

Hybrid closed-loop therapy: Where are we in 2021?

Lalantha Leelarathna  1   2 , Pratik Choudhary  3 , Emma G Wilmot  4   5 , Alistair Lumb  6   7 , Tim Street  8 , Partha Kar  9 , Sze M Ng  10   11
Affiliations

Hybrid closed-loop therapy: Where are we in 2021?

Lalantha Leelarathna et al. Diabetes Obes Metab. 2021 Mar.

Abstract

Hybrid closed-loop systems are characterized by the coexistence of algorithm-driven automated insulin delivery combined with manual mealtime boluses. Used correctly, these insulin delivery systems offer better glucose control and reduced risk of hypoglycaemia and represent the most advanced form of insulin delivery available for people with type 1 diabetes. The aim of this paper was to compare the currently available commercial hybrid closed-loop systems in the UK: the Medtronic 670G/780G, Tandem t:slim X2 Control IQ and CamAPS FX systems. The Medtronic 670G/780G systems use Guardian 3 sensor (7-day use, two to four calibrations per day), while Tandem and CamAPS systems use the calibration-free Dexcom G6 sensor (10 days). The CamAPS system is available as an android app, whereas the other two systems have the algorithm embedded in the insulin pump. During pivotal studies, depending on the study population and baseline glycated haemoglobin level, these systems achieve a time spent in the target range 3.9 to 10 mmol/L (70 to 180 mg/dL) of 65% to 76% with low burden of hypoglycaemia. All three systems allow a higher glucose target for announced exercise, while the Tandem system offers an additional night-time tighter target. The CamAPS system offers fully customizable glucose targets and is the only system licensed for use during pregnancy. Additional education is required for both users and healthcare professionals to harness the best performance from these systems as well as to troubleshoot when "automode exits" occur. We provide consensus recommendations to develop pragmatic pathways to guide patients, clinicians and commissioners in making informed decisions on the appropriate use of the diabetes technology.

Keywords: continuous glucose monitoring (CGM); health economics; type 1 diabetes.

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References

REFERENCES

    1. Daneman D. Type 1 diabetes. Lancet. 2006;367(9513):847-858.
    1. Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. https://doi.org/10.1056/NEJM199309303291401.
    1. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653. https://doi.org/10.1056/NEJMoa052187.
    1. Rawshani A, Sattar N, Franzén S, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392(10146):477-486. https://doi.org/10.1016/S0140-6736(18)31506-X.
    1. Tauschmann M, Hovorka R. Technology in the management of type 1 diabetes mellitus - current status and future prospects. Nat Rev Endocrinol. 2018;14(8):464-475. https://doi.org/10.1038/s41574-018-0044-y.

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