Closed-loop insulin pump -
Control-IQ technology: Control-IQ technology is intended for use with a compatible integrated continuous glucose monitor iCGM, sold separately and ACE pump to automatically increase, decrease, and suspend delivery of basal insulin based on iCGM readings and predicted glucose values.
It can also deliver correction boluses when the glucose value is predicted to exceed a predefined threshold. Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.
Warning: Control-IQ technology should not be used by anyone under the age of six years old. It should also not be used in patients who require less than 10 units of insulin per day or who weigh less than 55 pounds.
Control-IQ technology is not indicated for use in pregnant women, people on dialysis, or critically ill patients. Do not use Control-IQ technology if using hydroxyurea.
The t:slim X2 pump, and the CGM transmitter and sensor must be removed before MRI, CT, or diathermy treatment. Visit tandemdiabetes.
Now Available: The impressively small Tandem Mobi system offers greater discretion and wearability. Order Today. Home Support Diabetes Education. Managing Diabetes. Other Categories Type 1 Diabetes Type 2 Diabetes Managing Diabetes Nutrition Recipes View All Categories.
By Tandem Cares Apr 22, What is a Closed-Loop System? Responsible Use of Control-IQ Technology Control-IQ technology does not prevent all highs and lows. It also recommended that people already using both a CGM and an insulin pump should be offered a closed-loop system, but people managing well with should stay on that care plan.
Read the recommendations in full for more detail. One of our main goals at JDRF is to make sure that everyone with type 1 diabetes who wants or needs a hybrid closed loop system is able to get one for free.
Read more about our treatment advocacy work and how you can support us. Learn about hybrid closed loop technology also known as the artificial pancreas and how it can help you manage your type 1. Our international research programme means that life-changing treatments and developments for type 1 diabetes are in clinical trials around the world.
Can I get hybrid closed loop technology on the NHS? Hybrid closed loop technology, also known as the artificial pancreas or automated insulin delivery system, is available on the NHS across the four nations of the UK according to policy.
However, access does vary in practice. Content last reviewed and updated: The NHS in England and Wales Hybrid closed loop is now available through the NHS in England and Wales for people who meet the criteria.
The NHS in Northern Ireland According to policy, HCL technology is avai l able in Northern Ireland to people who meet the NICE criteria in England and Wales.
The NHS in Scotland NHS Scotland has recommended that hybrid closed loop systems should be pro-actively discussed with all patients with type 1, particularly those who have: Suboptimal blood glucose management A high risk of severe hypoglycaemia Impaired awareness of hypoglycaemia Experience severe diabetes-related distress that adversely affects quality of life and is likely to be improved by using a closed loop system.
What is JDRF doing to widen access to hybrid closed loop technology on the NHS? More helpful information. Read more.
Type 1 technology Learn about what technology is available to manage type 1 and how to access it. Guide to type 1 diabetes technology. Hybrid closed loop technology Learn about hybrid closed loop technology also known as the artificial pancreas and how it can help you manage your type 1.
Hybrid closed loop technology artificial pancreas. NICE review guidelines for hybrid closed loop Draft guidance has been published to make hybrid closed loop more widely available. Draft NICE guidelines propose wider access to glucose monitoring tech.
Making treatments available Our international research programme means that life-changing treatments and developments for type 1 diabetes are in clinical trials around the world. Find out about our advocacy work. Share this Facebook Twitter LinkedIn. We value your privacy We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits.
However you may visit Cookie Settings to provide a controlled consent. One of the objectives of the current research is to integrate existing control algorithms within increasingly sophisticated insulin pumps and continuous glucose monitors.
It is anticipated that the artificial pancreas will evolve with increasing technology sophistication and more comprehensive treatment objectives [ 27 ] Table 1. Early generations of the artificial pancreas are likely to provide benefits in terms of reduced incidence of hypoglycemia.
Benefits may be population-specific; for example, compliant, motivated subjects may benefit from a reduced risk of hypoglycemia whereas less compliant subjects, including adolescents, may benefit from reduced glucose levels. Follow-up closed-loop applications may address hyperglycemia, postprandial control and other lifestyle changes, including exercise.
Meals and exercise can be 'announced' to the control algorithm, and prandial insulin boluses can be delivered in the conventional way simplifying closed-loop operation.
In a more challenging 'fully closed-loop' configuration, the control algorithm is not aware of meals and exercise, and delivers insulin solely based on sensor glucose levels. Glucagon coadministration can be used to counteract peripheral overinsulization following insulin boluses or delayed insulin absorption.
Apart from the low glucose suspend LGS approach described below, which has entered postmarketing stage, all other approaches are under investigation in controlled laboratory conditions with realistic plans to perform studies under free-living conditions.
Table 2 outlines the status and achievements of various closed-loop approaches. Hypoglycemia associated with low sensor-measured glucose levels sustained for 2 to 4 hours may lead to seizures [ 28 ]. The body's defensive mechanisms against hypoglycemia are impaired during the night in people with type 1 diabetes, who have lost the ability to release the appropriate counter-regulatory hormones [ 29 — 32 ].
The simplest approach to reduce severity of hypoglycemia is to interrupt insulin delivery. The LGS function was the first example of a commercial application of closed-loop insulin delivery.
An insulin pump with an integrated continuous glucose monitoring CGM Paradigm ® Veo; Medtronic Diabetes, Northridge, CA, USA automatically suspends insulin delivery for up to 2 hours when hypoglycemia is detected and the hypoglycemia alarm is not acknowledged by the patient [ 33 ].
Patients may be unconscious during hypoglycemia, and their ability to respond to alarms is reduced. Thus, a considerable safety benefit may be obtained from the LGS function. However, concerns have been raised about the attendant hyperglycemia that can result, especially from false-positive hypoglycemia detection.
The hyperglycemia risk is not negligible, but thus far only mild rebound hyperglycemia and minimal ketonaemia have been reported after a temporary suspension of insulin administration [ 34 — 38 ]. The LGS function aims to reduce the severity of hypoglycemia, but does not prevent it, which was the objective of work by Buckingham et al.
This approach was investigated in adults in a clinical setting. Using a pump shut-off time of 90 minutes and a glucose threshold of 4. This approach was then tested overnight in young people, in whom hypoglycemia was induced by gradually increasing the subcutaneous insulin delivery [ 40 ].
All these prediction algorithms used a minute prediction horizon to allow time for the pump suspension to be effective in lowering insulin levels once basal infusion was suspended. Most severe hypoglycemic episodes occur during sleep between midnight and 8 am [ 41 ].
As overnight glucose control is not complicated by meals or physical activity, closed-loop could help prevent nocturnal hypoglycemia. This is a common clinical problem of great concern to parents and carers of children with type 1 diabetes [ 42 ]. Over the past 4 years, diabetes research at Cambridge University has focused on the development and testing of overnight closed-loop insulin delivery systems.
Clinical studies have been performed in children, adults and pregnant women [ 24 , 43 , 44 ], evaluating various scenarios to reproduce real-life challenges for overnight glucose control, which could potentially predispose to nocturnal hypoglycemia, such as afternoon exercise or the consumption of alcohol.
Evening meals of different sizes and compositions were also tested. An MPC algorithm was used to determine basal insulin delivery according to sensor glucose readings, whereas prandial insulin boluses were administered based on the subjects' standard practice.
Most of those clinical studies adopted a randomized crossover design comparing closed-loop insulin delivery with the conventional insulin pump therapy. In these randomized crossover studies, the overnight closed-loop system significantly increased the percentage of time that plasma glucose levels were within a target range of 3.
The effectiveness of the closed-loop system was most pronounced after midnight, when the system became fully effective. Combined results of both young and adult patients after midnight during closed-loop and the conventional pump therapy are summarized in Figure 2.
Notably, these results indicate that the closed-loop system resulted in a significantly reduced time spent with glucose below the target range of 3. Distribution of plasma glucose levels after midnight in young people and adults during top panel closed-loop and bottom panel conventional insulin-pump therapy continuous subcutaneous insulin infusion CSII.
Vertical dashed lines indicate the threshold of significant hypoglycemia 3. Values at the top denote the percentage of plasma glucose values within the respective glucose ranges reproduced with permission from Kumareswaran et al. Two main closed-loop approaches have been adopted in the clinical studies for prandial insulin delivery: 'fully closed-loop' and 'closed-loop with meal announcement' [ 9 ].
A fully closed-loop system delivers insulin without information about the size or time of meals, whereas information about meals together with information about manually administered prandial insulin boluses is provided to closed-loop systems adopting the 'meal announcement' approach.
In a hybrid system, the delivery of pre-meal insulin boluses remains one of the tasks for which patients are responsible, with the closed-loop system automatically determining the insulin delivery between meals [ 27 ].
The hybrid system with meal-time priming boluses has been shown to reduce postprandial hyperglycemia compared to a fully closed-loop system [ 45 ]. As delays in insulin absorption of the order of 30 to minutes are a major challenge for safe and effective postprandial glucose control, this hybrid approach may be considered a transition step from 'closed-loop with meal announcement'.
The feasibility and efficacy of MPC-based closed-loop insulin delivery was also recently demonstrated in women with type 1 diabetes throughout different stages of pregnancy [ 44 ].
Near-optimal nocturnal glycemic control was obtained with the closed-loop system both in early and late pregnancy, coping well with both the longitudinal changes in insulin requirements and the insulin sensitivity associated with pregnancy.
Studies of a well-controlled cohort of pregnant women suggested a reduced risk of very low glucose levels with closed-loop insulin delivery, but otherwise similar glucose control [ 46 ]. Glucagon coadministration has also been investigated with the fully closed-loop approach [ 47 , 48 ].
Although effective in reducing the risk of hypoglycemia, glucagon cannot be fully relied upon to reverse the effect of insulin overdelivery. Evaluation of closed-loop systems in a controlled laboratory setting is an essential step to assess safety and efficacy before moving to home settings, where everyday life poses additional challenges for effective closed-loop performance.
In silico studies play a crucial role in complementing clinical testing, and address scenarios that cannot, for practical or ethical reasons, be tested in clinical studies [ 49 — 51 ]. A computer-based simulation environment developed at Cambridge University builds on a model of glucose regulation, glucose sensing and insulin-pump delivery.
It includes a virtual population of subjects with type 1 diabetes with a range of insulin-sensitivity and glucoregulatory parameters, to represent both inter-subject and intra-subject variability [ 49 ] Pre-clinical in silico testing enables us to assess scenarios that are expected to occur rarely but could be potentially harmful.
For example, simulations can evaluate the system's response to sensor-data dropouts, large calibration errors, communication failures, unannounced meals, or errors in carbohydrate estimation and thus bolus dosing [ 51 ].
Different CGM devices or different algorithms can be tested. Another simulator has been accepted by the US Food and Drug Administration to replace animal testing, and has been widely used for this purpose [ 50 ]. The simulator developed by the Medtronic team [ 52 ] has complemented animal testing, and has been instrumental in tuning the Medtronic PID algorithm [ 26 , 45 ].
Transition to the outpatient studies could be performed gradually with an intermediate phase under supervision of the research team in the subject's home, or at a transitional clinical or hotel-like research facility.
The transition phase needs to emphasize education to operate the closed-loop system correctly and confidently. Competency-assessment tools may be used to ensure subjects' knowledge and ability.
User acceptance and user friendliness are important aspects that may affect study results, quality of life, and ultimately technology adoption. Subjects' satisfaction may be assessed by the use of questionnaires or qualitative interviews [ 53 ].
Home testing of overnight closed-loop is feasible with present technologies. Pilot studies may evaluate efficacy, safety and utility over a short period of time, whereas longer studies are needed to demonstrate effectiveness on glycemic control and rates of hypoglycemia.
Specific challenges of day-time glucose control, such as meal intake and exercise, will need to be considered when moving to a full-time 24 hours a day, 7 days a week closed-loop system.
The main goal of closed-loop therapy is to achieve good glycemic control while reducing the risk of hypoglycemia in people with type 1 diabetes. Although reduction in HbA1c levels is a common key outcome expected by the regulatory authorities, it is important to consider that for some patients, avoidance of severe recurrent hypoglycemia may be the more important focus.
Improvement in glycemic variability could be an important target for those subjects with acceptable HbA1c and low incidence of severe hypoglycemia. Results thus far indicate that these targets may be achieved with closed-loop therapy. Despite the perceived benefits of closed-loop therapy, it is essential to set realistic goals to keep up with reasonable clinical expectations.
Furthermore, the impact of this novel treatment tool on quality of life will need to be assessed. Current closed-loop systems are limited by suboptimal performance of the available system components, which include CGM devices, insulin formulations, and insulin-delivery systems.
For example, the accuracy of commercially available CGM devices is impaired by errors arising from incorrect calibration, rapid glucose changes, and glucose levels within the hypoglycemic range. Sensor failures may lead to termination of closed-loop operation.
Similarly, reduced accuracy of insulin delivery at low volumes by current insulin pumps could negatively affect the performance of closed-loop systems in patients with low insulin requirements. The reliability of wireless communication between the components also needs to be addressed.
Patient engagement in the daily use of closed-loop systems is also of importance. It is possible that the introduction of the artificial pancreas as an integral part of diabetes management will change current clinical practice. Although patients could be released from the constant attention to insulin adjustments they presently experience, their active engagement will still be needed during prolonged exercise, illness, puberty or pregnancy, which are associated with significant changes in insulin sensitivity and requirements.
For this reason, specific training and education in the use of closed-loop therapy will be needed by both patients and healthcare professionals. The benefits and limitations of the system will also need to be clarified. For closed-loop insulin delivery to be used widely, improvements may need to increase effectiveness, safety, and convenience gradually Table 3.
Specific challenges include postprandial glucose control. Improved understanding of postprandial glucose fluctuations will provide additional information to refine control algorithms.
Research using stable glucose isotopes to measure gut absorption of meals of different sizes or compositions is underway [ 54 ]. A dual-hormone closed-loop approach is also under investigation using, for example, pramlintide, an amylin analog that is normally released by β-cells along with insulin after a meal.
Amylin delays glucose absorption, thus improving post-meal glucose control [ 55 ]. Similarly, a more physiologic approach will be needed to cope with exercise-related changes in insulin sensitivity. A major turning point in the development of closed-loop systems will be the introduction of insulin formulations with faster absorption.
With rapid-acting insulin analogs, the maximum blood-glucose-lowering effect occurs after up to 90 to min.
This lag constitutes one of the greatest challenges for closed-loop systems, and availability of faster insulin analogs or devices accelerating insulin absorption will eventually translate into more effective and safer insulin delivery.
These pharmaceutical developments are ongoing [ 56 , 57 ]. Engineering factors needing further attention include accurate insulin delivery at low rates, more reliable CGM devices, dependable wireless communication, and improved control algorithms. The availability of smaller and more user-friendly devices might be particularly important for children [ 42 ].
Telemonitoring is also seen as an additional feature to enhance safety, although its practicability and utility are yet to be established. The clinical team can be informed about system malfunctions, subject compliance, and the level of glucose control, with the possibility of remote algorithm updates.
Renard et al. evaluated the feasibility and efficacy of a closed-loop system with an implantable insulin pump coupled to a subcutaneous glucose sensor [ 58 ].
Further progress could be made with an intraperitoneal port to bypass the limitations of implantable insulin pumps [ 59 ]. Closed-loop insulin delivery presents a tangible treatment option and may serve as a bridge to a cure for type 1 diabetes until stem-cell therapy or similar long-term biologic interventions become available.
Closed-loop insulin delivery may revolutionize not only the way diabetes is managed but also patients' perceptions of living with diabetes, by reducing the burden on patients and carers, and their fears of complications related to diabetes, including those associated with low and high glucose levels.
The next step is to confirm the encouraging results collected under controlled laboratory settings in real-life conditions at home. Daniela Elleri, MD, is a clinical research fellow in Paediatrics at the Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, UK, who is actively involved in the clinical research studies evaluating closed-loop insulin-delivery systems in people with type 1 diabetes.
David B Dunger, MD, FRCP and FRCPC, is a Professor of Paediatrics at Addenbrooke's Hospital, University of Cambridge, with has a particular interest in the pathophysiology of diabetes during childhood and adolescence, and the genetic and environmental interactions that determine size at birth and childhood growth.
His research group are coordinating the follow-up of large pediatric cohorts designed to investigate the genetics and pathophysiology of diabetes and its complications. Roman Hovorka, BSc, MSc, and PhD, is Principal Research Associate at the Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, UK.
His current research interests include evaluation of medical technologies to support diagnosis and treatment of diabetes and related metabolic diseases. He leads research team developing and testing closed-loop insulin delivery systems in type 1 diabetes, and he also works on developing approaches for glycemic control in the critically ill.
Todd JA: Etiology of type 1 diabetes. Article CAS PubMed Google Scholar. Diabetes Control and Complication Trial Study Group DCCT : 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. Article Google Scholar. Cryer PE: The barrier of hypoglycemia in diabetes. Article CAS PubMed PubMed Central Google Scholar. Nixon R, Pickup JC: Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control?.
Diabetes Technol Ther. Wild D, Von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L: A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. Article PubMed Google Scholar.
There is significant responsibility when living with Closed-olop. It Closed-lop all aspects of a person's life and health. Clowed-loop monitoring and Ribose and blood glucose regulation to blood sugar levels can feel like a never-ending task. As technology advances, new products are available to help patients with diabetes. A hybrid closed-loop insulin pump is a new tool to manage the disease and make life a bit easier for people living with diabetes.Medically reviewed by Dr. As the technology around Closed-lopp management of diabetes evolves, so too does the ijsulin and software that drives Closed-lkop technology. There are several ways Closed-lolp manage Clossd-loop, ranging from multiple Closed-loop insulin pump injections to pmup use of an insulin Closed-loop insulin pump. People with either type 1 or type Hydration during night-time endurance events diabetes unsulin benefit from the use of pumpp insulin pump with advanced hybrid pumpp technology.
Read more Closedloop insulin pumps and how Closed-loop insulin pump can insulon with diabetes management. Closed-lokp closed-loop insulim combines Closed--loop continuous glucose monitoring CGM sensor insuulin an insulin pump to Closed-lop the delivery of insulin.
If the blood sugar glucose is rising, insulib Closed-loop insulin pump Increased energy levels would work to recognize the change and increase insilin delivery. Protein intake for immune health, if blood indulin levels Insulln falling the system would Closdd-loop the trend and reduce and suspend insulin delivery.
This is ineulin automated insulin dosing. Jordan Pinsker, Vice President and Medical Director Closed-lool Tandem Diabetes Care. An advanced hybrid closed-loop system combines a predictive Closed-lpop with user Oump. This Clossd-loop insulin Sustaining post-workout eats is the predictive algorithm and Closed-loop insulin pump pump working in CClosed-loop with CGM puml help insklin the frequent decisions needed to manage type 1 diabetes.
Molly Closrd-loop Malloy, Senior Medical Science Liaison Manager for Tandem Diabetes Care, has insuljn years insulkn on clinical trials for predictive algorithms. McElwee Malloy, who is also living with type 1 Closdd-loop, said insuulin advancement of predictive algorithms Managing menstrual cramps closed-loop systems have Closed-loop insulin pump game-changers for diabetes management.
McElwee Malloy. Ckosed-loop an pumo hybrid closed-loop system onsulin a number innsulin benefits over other diabetes management methods. For example, an advanced hybrid closed-loop system can:. For example, before advanced hybrid closed-loop systems existed, a lot of planning went into exercise and eating.
These activities can now occur more spontaneously because the amount of time needed to prepare for them is greatly reduced. This additionally reduces the burden of management. Control-IQ advanced hybrid closed-loop technology is a powerful predictive algorithm available on the t:slim X2 insulin pump from Tandem Diabetes Care.
By predicting glucose levels 30 minutes in advance, Control-IQ technology is able to automatically adjust dosing and increase time in range.
Control-IQ technology does not prevent all highs and lows. You must still bolus for meals and actively manage your diabetes. Important Safety Information RX ONLY. The t:slim X2 pump and Control-IQ technology are intended for single patient use.
The t:slim X2 pump and Control-IQ technology are indicated for use with U insulin only. t:slim X2 insulin pump: The t:slim X2 insulin pump with interoperable technology is an alternate controller enabled ACE pump that is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in people requiring insulin.
The pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The t:slim X2 pump is indicated for use in individuals six years of age and greater.
Control-IQ technology: Control-IQ technology is intended for use with a compatible integrated continuous glucose monitor iCGM, sold separately and ACE pump to automatically increase, decrease, and suspend delivery of basal insulin based on iCGM readings and predicted glucose values.
It can also deliver correction boluses when the glucose value is predicted to exceed a predefined threshold. Control-IQ technology is intended for the management of Type 1 diabetes mellitus in persons six years of age and greater.
Warning: Control-IQ technology should not be used by anyone under the age of six years old. It should also not be used in patients who require less than 10 units of insulin per day or who weigh less than 55 pounds. Control-IQ technology is not indicated for use in pregnant women, people on dialysis, or critically ill patients.
Do not use Control-IQ technology if using hydroxyurea. The t:slim X2 pump, and the CGM transmitter and sensor must be removed before MRI, CT, or diathermy treatment.
Visit tandemdiabetes. Now Available: The impressively small Tandem Mobi system offers greater discretion and wearability. Order Today. Home Support Diabetes Education. Managing Diabetes.
Other Categories Type 1 Diabetes Type 2 Diabetes Managing Diabetes Nutrition Recipes View All Categories. By Tandem Cares Apr 22, What is a Closed-Loop System? Responsible Use of Control-IQ Technology Control-IQ technology does not prevent all highs and lows.
Back to Feed Share on. Artificial Pancreas Automated Insulin Delivery Closed-Loop Control-IQ Technology Insulin Pump Predictive Algorithm t:slim X2 Insulin Pump. What is A1c? What is an Automated Insulin Delivery System?
What is an Insulin Resistance Diet and What Does it Do?
: Closed-loop insulin pump| Which Insulin Pumps Are Closed-Loop? - Gluroo | Read Tara and Thalia story Read Tara and Closed-loop insulin pump Blood pressure factors. Sensor glucose on the sensor glucose receiver was masked inwulin the participant insuoin investigators until Closed-loop insulin pump end of iinsulin study. Analysis of Obesity definition metrics Cposed-loop fortnightly intervals in the present study shows that closed-loop insulin delivery results in an almost immediate improvement in glycemic control compared with standard insulin therapy proportion of time in target range, gov NCT Research using stable glucose isotopes to measure gut absorption of meals of different sizes or compositions is underway [ 54 ]. In other words, the pump adjusts insulin delivery based on blood sugar levels. |
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WEBINARS Schedule Replay Tools Practical guides Videos About Our Team Partners Frequently asked questions FAQ Contact us. Join the Better Registry. Skip to content. fr en fr en. No word from Tandem regarding a potential adaptive feature. Would you like to help make new technology available to all? The effectiveness of the closed-loop system was most pronounced after midnight, when the system became fully effective. Combined results of both young and adult patients after midnight during closed-loop and the conventional pump therapy are summarized in Figure 2. Notably, these results indicate that the closed-loop system resulted in a significantly reduced time spent with glucose below the target range of 3. Distribution of plasma glucose levels after midnight in young people and adults during top panel closed-loop and bottom panel conventional insulin-pump therapy continuous subcutaneous insulin infusion CSII. Vertical dashed lines indicate the threshold of significant hypoglycemia 3. Values at the top denote the percentage of plasma glucose values within the respective glucose ranges reproduced with permission from Kumareswaran et al. Two main closed-loop approaches have been adopted in the clinical studies for prandial insulin delivery: 'fully closed-loop' and 'closed-loop with meal announcement' [ 9 ]. A fully closed-loop system delivers insulin without information about the size or time of meals, whereas information about meals together with information about manually administered prandial insulin boluses is provided to closed-loop systems adopting the 'meal announcement' approach. In a hybrid system, the delivery of pre-meal insulin boluses remains one of the tasks for which patients are responsible, with the closed-loop system automatically determining the insulin delivery between meals [ 27 ]. The hybrid system with meal-time priming boluses has been shown to reduce postprandial hyperglycemia compared to a fully closed-loop system [ 45 ]. As delays in insulin absorption of the order of 30 to minutes are a major challenge for safe and effective postprandial glucose control, this hybrid approach may be considered a transition step from 'closed-loop with meal announcement'. The feasibility and efficacy of MPC-based closed-loop insulin delivery was also recently demonstrated in women with type 1 diabetes throughout different stages of pregnancy [ 44 ]. Near-optimal nocturnal glycemic control was obtained with the closed-loop system both in early and late pregnancy, coping well with both the longitudinal changes in insulin requirements and the insulin sensitivity associated with pregnancy. Studies of a well-controlled cohort of pregnant women suggested a reduced risk of very low glucose levels with closed-loop insulin delivery, but otherwise similar glucose control [ 46 ]. Glucagon coadministration has also been investigated with the fully closed-loop approach [ 47 , 48 ]. Although effective in reducing the risk of hypoglycemia, glucagon cannot be fully relied upon to reverse the effect of insulin overdelivery. Evaluation of closed-loop systems in a controlled laboratory setting is an essential step to assess safety and efficacy before moving to home settings, where everyday life poses additional challenges for effective closed-loop performance. In silico studies play a crucial role in complementing clinical testing, and address scenarios that cannot, for practical or ethical reasons, be tested in clinical studies [ 49 — 51 ]. A computer-based simulation environment developed at Cambridge University builds on a model of glucose regulation, glucose sensing and insulin-pump delivery. It includes a virtual population of subjects with type 1 diabetes with a range of insulin-sensitivity and glucoregulatory parameters, to represent both inter-subject and intra-subject variability [ 49 ] Pre-clinical in silico testing enables us to assess scenarios that are expected to occur rarely but could be potentially harmful. For example, simulations can evaluate the system's response to sensor-data dropouts, large calibration errors, communication failures, unannounced meals, or errors in carbohydrate estimation and thus bolus dosing [ 51 ]. Different CGM devices or different algorithms can be tested. Another simulator has been accepted by the US Food and Drug Administration to replace animal testing, and has been widely used for this purpose [ 50 ]. The simulator developed by the Medtronic team [ 52 ] has complemented animal testing, and has been instrumental in tuning the Medtronic PID algorithm [ 26 , 45 ]. Transition to the outpatient studies could be performed gradually with an intermediate phase under supervision of the research team in the subject's home, or at a transitional clinical or hotel-like research facility. The transition phase needs to emphasize education to operate the closed-loop system correctly and confidently. Competency-assessment tools may be used to ensure subjects' knowledge and ability. User acceptance and user friendliness are important aspects that may affect study results, quality of life, and ultimately technology adoption. Subjects' satisfaction may be assessed by the use of questionnaires or qualitative interviews [ 53 ]. Home testing of overnight closed-loop is feasible with present technologies. Pilot studies may evaluate efficacy, safety and utility over a short period of time, whereas longer studies are needed to demonstrate effectiveness on glycemic control and rates of hypoglycemia. Specific challenges of day-time glucose control, such as meal intake and exercise, will need to be considered when moving to a full-time 24 hours a day, 7 days a week closed-loop system. The main goal of closed-loop therapy is to achieve good glycemic control while reducing the risk of hypoglycemia in people with type 1 diabetes. Although reduction in HbA1c levels is a common key outcome expected by the regulatory authorities, it is important to consider that for some patients, avoidance of severe recurrent hypoglycemia may be the more important focus. Improvement in glycemic variability could be an important target for those subjects with acceptable HbA1c and low incidence of severe hypoglycemia. Results thus far indicate that these targets may be achieved with closed-loop therapy. Despite the perceived benefits of closed-loop therapy, it is essential to set realistic goals to keep up with reasonable clinical expectations. Furthermore, the impact of this novel treatment tool on quality of life will need to be assessed. Current closed-loop systems are limited by suboptimal performance of the available system components, which include CGM devices, insulin formulations, and insulin-delivery systems. For example, the accuracy of commercially available CGM devices is impaired by errors arising from incorrect calibration, rapid glucose changes, and glucose levels within the hypoglycemic range. Sensor failures may lead to termination of closed-loop operation. Similarly, reduced accuracy of insulin delivery at low volumes by current insulin pumps could negatively affect the performance of closed-loop systems in patients with low insulin requirements. The reliability of wireless communication between the components also needs to be addressed. Patient engagement in the daily use of closed-loop systems is also of importance. It is possible that the introduction of the artificial pancreas as an integral part of diabetes management will change current clinical practice. Although patients could be released from the constant attention to insulin adjustments they presently experience, their active engagement will still be needed during prolonged exercise, illness, puberty or pregnancy, which are associated with significant changes in insulin sensitivity and requirements. For this reason, specific training and education in the use of closed-loop therapy will be needed by both patients and healthcare professionals. The benefits and limitations of the system will also need to be clarified. For closed-loop insulin delivery to be used widely, improvements may need to increase effectiveness, safety, and convenience gradually Table 3. Specific challenges include postprandial glucose control. Improved understanding of postprandial glucose fluctuations will provide additional information to refine control algorithms. Research using stable glucose isotopes to measure gut absorption of meals of different sizes or compositions is underway [ 54 ]. A dual-hormone closed-loop approach is also under investigation using, for example, pramlintide, an amylin analog that is normally released by β-cells along with insulin after a meal. Amylin delays glucose absorption, thus improving post-meal glucose control [ 55 ]. Similarly, a more physiologic approach will be needed to cope with exercise-related changes in insulin sensitivity. A major turning point in the development of closed-loop systems will be the introduction of insulin formulations with faster absorption. With rapid-acting insulin analogs, the maximum blood-glucose-lowering effect occurs after up to 90 to min. This lag constitutes one of the greatest challenges for closed-loop systems, and availability of faster insulin analogs or devices accelerating insulin absorption will eventually translate into more effective and safer insulin delivery. These pharmaceutical developments are ongoing [ 56 , 57 ]. Engineering factors needing further attention include accurate insulin delivery at low rates, more reliable CGM devices, dependable wireless communication, and improved control algorithms. The availability of smaller and more user-friendly devices might be particularly important for children [ 42 ]. Telemonitoring is also seen as an additional feature to enhance safety, although its practicability and utility are yet to be established. The clinical team can be informed about system malfunctions, subject compliance, and the level of glucose control, with the possibility of remote algorithm updates. Renard et al. evaluated the feasibility and efficacy of a closed-loop system with an implantable insulin pump coupled to a subcutaneous glucose sensor [ 58 ]. Further progress could be made with an intraperitoneal port to bypass the limitations of implantable insulin pumps [ 59 ]. Closed-loop insulin delivery presents a tangible treatment option and may serve as a bridge to a cure for type 1 diabetes until stem-cell therapy or similar long-term biologic interventions become available. Closed-loop insulin delivery may revolutionize not only the way diabetes is managed but also patients' perceptions of living with diabetes, by reducing the burden on patients and carers, and their fears of complications related to diabetes, including those associated with low and high glucose levels. The next step is to confirm the encouraging results collected under controlled laboratory settings in real-life conditions at home. Daniela Elleri, MD, is a clinical research fellow in Paediatrics at the Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, UK, who is actively involved in the clinical research studies evaluating closed-loop insulin-delivery systems in people with type 1 diabetes. David B Dunger, MD, FRCP and FRCPC, is a Professor of Paediatrics at Addenbrooke's Hospital, University of Cambridge, with has a particular interest in the pathophysiology of diabetes during childhood and adolescence, and the genetic and environmental interactions that determine size at birth and childhood growth. His research group are coordinating the follow-up of large pediatric cohorts designed to investigate the genetics and pathophysiology of diabetes and its complications. Roman Hovorka, BSc, MSc, and PhD, is Principal Research Associate at the Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, UK. His current research interests include evaluation of medical technologies to support diagnosis and treatment of diabetes and related metabolic diseases. He leads research team developing and testing closed-loop insulin delivery systems in type 1 diabetes, and he also works on developing approaches for glycemic control in the critically ill. Todd JA: Etiology of type 1 diabetes. Article CAS PubMed Google Scholar. Diabetes Control and Complication Trial Study Group DCCT : 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. Article Google Scholar. Cryer PE: The barrier of hypoglycemia in diabetes. Article CAS PubMed PubMed Central Google Scholar. Nixon R, Pickup JC: Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control?. Diabetes Technol Ther. Wild D, Von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L: A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. Article PubMed Google Scholar. Klonoff DC: Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, Joyce C, Peoples T, Perkins BA, Welsh JB, Willi SM, Wood MA: Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D: Continuous glucose monitoring and intensive treatment of type 1 diabetes. Hovorka R: Continuous glucose monitoring and closed-loop systems. Diabet Med. Steil GM, Rebrin K: Closed-loop insulin delivery - what lies between where we are and where we are going?. Expert Opin Drug Deliv. Renard E, Costalat G, Chevassus H, Bringer J: Artificial beta-cell: clinical experience toward an implantable closed-loop insulin delivery system. Diabetes Metab. Hovorka R: Closed-loop insulin delivery: from bench to clinical practice. Nat Rev Endocrinol. Bequette BW: A critical assessment of algorithms and challenges in the development of a closed-loop artificial pancreas. Marchetti G, Barolo M, Jovanovic L, Zisser H, Seborg DE: An improved PID switching control strategy for type 1 diabetes. IEEE Trans Biomed Eng. Steil GM, Panteleon AE, Rebrin K: Closed-loop insulin delivery-the path to physiological glucose control. Adv Drug Deliv Rev. Hovorka R, Canonico V, Chassin LJ, Haueter U, Massi-Benedetti M, Orsini FM, Pieber TR, Schaller HC, Schaupp L, Vering T, Wilinska ME: Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes. Physiol Meas. Magni L, Raimondo DM, Bossi L, Man CD, De NG, Kovatchev B, Cobelli C: Model predictive control of type 1 diabetes: an in silico trial. J Diabetes Sci Technol. Article PubMed PubMed Central Google Scholar. Parker RS, Doyle FJ, Peppas NA: A model-based algorithm for blood glucose control in type I diabetic patients. El-Khatib FH, Jiang J, Damiano ER: Adaptive closed-loop control provides blood-glucose regulation using dual subcutaneous insulin and glucagon infusion in diabetic swine. Lee H, Buckingham BA, Wilson DM, Bequette BW: A closed-loop artificial pancreas using model predictive control and a sliding meal size estimator. Wang Y, Dassau E, Doyle FJ: Closed-loop control of artificial pancreatic Beta -cell in type 1 diabetes mellitus using model predictive iterative learning control. Grosman B, Dassau E, Zisser HC, Jovanovic L, Doyle FJ: Zone model predictive control: a strategy to minimize hyper- and hypoglycemic events. Kovatchev B, Patek S, Dassau E, Doyle FJ, Magni L, De NG, Cobelli C: Control to range for diabetes: functionality and modular architecture. Hovorka R, Allen JM, Elleri D, Chassin LJ, Harris J, Xing D, Kollman C, Hovorka T, Larsen AM, Nodale M, De PA, Wilinska ME, Acerini CL, Dunger DB: Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial. Atlas E, Nimri R, Miller S, Grunberg EA, Phillip M: MD-logic artificial pancreas system: a pilot study in adults with type 1 diabetes. Steil GM, Palerm CC, Kurtz N, Voskanyan G, Roy A, Paz S, Kandeel FR: The effect of insulin feedback on closed loop glucose control. J Clin Endocrinol Metab. Kowalski AJ: Can we really close the loop and how soon? |
| Closed-loop insulin delivery for treatment of type 1 diabetes | BMC Medicine | Full Text | Therefore, some of the glycemic benefits observed during the closed-loop therapy period may be attributable to use of a continuous glucose monitor alone. Hybrid closed loop technology, also known as the artificial pancreas or automated insulin delivery system, is available on the NHS across the four nations of the UK according to policy. Close Modal. Consider which option may be best for your situation and comfort level. In this study, very few participants used a glucose sensor as part of their usual care. Are you living with type 1 diabetes in Canada? This cookie is set by GDPR Cookie Consent plugin. |
| Two Artificial Pancreas Systems to Enter the Canadian Market Soon – BETTER | Article CAS PubMed Google Scholar. Diabetes Control and Complication Trial Study Group DCCT : 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. Article Google Scholar. Cryer PE: The barrier of hypoglycemia in diabetes. Article CAS PubMed PubMed Central Google Scholar. Nixon R, Pickup JC: Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control?. Diabetes Technol Ther. Wild D, Von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L: A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. Article PubMed Google Scholar. Klonoff DC: Continuous glucose monitoring: roadmap for 21st century diabetes therapy. 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RH has received speaker honoraria from Minimed Medtronic, Lifescan, Eli Lilly, and Novo Nordisk, has served on an advisory panel for Animas and Minimed Medtronic, has received license fees from BBraun and Beckton Dickinson; and has served as a consultant to Beckton Dickinson, BBraun and Profil. DE has no competing financial interests. RH and DBD have patent applications pending. DE researched data and drafted the report. RH and DBD contributed to the interpretation of the data, and the writing and critical review of the report. All authors read and approved the final manuscript. Open Access This article is published under license to BioMed Central Ltd. Reprints and permissions. Elleri, D. Closed-loop insulin delivery for treatment of type 1 diabetes. BMC Med 9 , Download citation. Received : 11 August Accepted : 09 November Published : 09 November Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Type 1 diabetes is one of the most common endocrine problems in childhood and adolescence, and remains a serious chronic disorder with increased morbidity and mortality, and reduced quality of life. Challenges for type 1 diabetes management Type 1 diabetes is a chronic disease caused by T-cell-mediated autoimmune destruction of the pancreatic β cells in genetically predisposed individuals [ 1 ]. Closed-loop insulin delivery The artificial pancreas Closed-loop insulin delivery, also referred to as the artificial pancreas, is an emerging therapeutic approach for people with type 1 diabetes. Figure 1. Full size image. Table 1 Closed-loop approaches according to treatment objective Full size table. Table 2 Summary of achieved results Full size table. Figure 2. Table 3 Goals to improve gradually closed-loop performance Full size table. Conclusions Closed-loop insulin delivery presents a tangible treatment option and may serve as a bridge to a cure for type 1 diabetes until stem-cell therapy or similar long-term biologic interventions become available. Authors' information Daniela Elleri, MD, is a clinical research fellow in Paediatrics at the Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, UK, who is actively involved in the clinical research studies evaluating closed-loop insulin-delivery systems in people with type 1 diabetes. References Todd JA: Etiology of type 1 diabetes. Article CAS PubMed Google Scholar Diabetes Control and Complication Trial Study Group DCCT : The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes-mellitus. Article Google Scholar Cryer PE: The barrier of hypoglycemia in diabetes. Article CAS PubMed PubMed Central Google Scholar Nixon R, Pickup JC: Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control?. Article CAS PubMed Google Scholar Wild D, Von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L: A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Article PubMed Google Scholar Klonoff DC: Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Article PubMed Google Scholar Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, Joyce C, Peoples T, Perkins BA, Welsh JB, Willi SM, Wood MA: Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. Article CAS PubMed Google Scholar Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D: Continuous glucose monitoring and intensive treatment of type 1 diabetes. Article PubMed Google Scholar Hovorka R: Continuous glucose monitoring and closed-loop systems. Article CAS PubMed Google Scholar Steil GM, Rebrin K: Closed-loop insulin delivery - what lies between where we are and where we are going?. Article CAS PubMed Google Scholar Renard E, Costalat G, Chevassus H, Bringer J: Artificial beta-cell: clinical experience toward an implantable closed-loop insulin delivery system. Article CAS PubMed Google Scholar Hovorka R: Closed-loop insulin delivery: from bench to clinical practice. Article CAS PubMed Google Scholar Bequette BW: A critical assessment of algorithms and challenges in the development of a closed-loop artificial pancreas. Article CAS PubMed Google Scholar Marchetti G, Barolo M, Jovanovic L, Zisser H, Seborg DE: An improved PID switching control strategy for type 1 diabetes. Article PubMed Google Scholar Steil GM, Panteleon AE, Rebrin K: Closed-loop insulin delivery-the path to physiological glucose control. Article CAS PubMed Google Scholar Hovorka R, Canonico V, Chassin LJ, Haueter U, Massi-Benedetti M, Orsini FM, Pieber TR, Schaller HC, Schaupp L, Vering T, Wilinska ME: Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes. Article PubMed Google Scholar Magni L, Raimondo DM, Bossi L, Man CD, De NG, Kovatchev B, Cobelli C: Model predictive control of type 1 diabetes: an in silico trial. Article PubMed PubMed Central Google Scholar Parker RS, Doyle FJ, Peppas NA: A model-based algorithm for blood glucose control in type I diabetic patients. Article CAS PubMed Google Scholar El-Khatib FH, Jiang J, Damiano ER: Adaptive closed-loop control provides blood-glucose regulation using dual subcutaneous insulin and glucagon infusion in diabetic swine. Article PubMed PubMed Central Google Scholar Lee H, Buckingham BA, Wilson DM, Bequette BW: A closed-loop artificial pancreas using model predictive control and a sliding meal size estimator. Article PubMed PubMed Central Google Scholar Wang Y, Dassau E, Doyle FJ: Closed-loop control of artificial pancreatic Beta -cell in type 1 diabetes mellitus using model predictive iterative learning control. Article PubMed Google Scholar Grosman B, Dassau E, Zisser HC, Jovanovic L, Doyle FJ: Zone model predictive control: a strategy to minimize hyper- and hypoglycemic events. Article PubMed PubMed Central Google Scholar Kovatchev B, Patek S, Dassau E, Doyle FJ, Magni L, De NG, Cobelli C: Control to range for diabetes: functionality and modular architecture. Article PubMed PubMed Central Google Scholar Hovorka R, Allen JM, Elleri D, Chassin LJ, Harris J, Xing D, Kollman C, Hovorka T, Larsen AM, Nodale M, De PA, Wilinska ME, Acerini CL, Dunger DB: Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial. Article CAS PubMed Google Scholar Atlas E, Nimri R, Miller S, Grunberg EA, Phillip M: MD-logic artificial pancreas system: a pilot study in adults with type 1 diabetes. Article PubMed PubMed Central Google Scholar Steil GM, Palerm CC, Kurtz N, Voskanyan G, Roy A, Paz S, Kandeel FR: The effect of insulin feedback on closed loop glucose control. Article CAS PubMed PubMed Central Google Scholar Kowalski AJ: Can we really close the loop and how soon? 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Article PubMed Google Scholar Attia N, Jones TW, Holcombe J, Tamborlane WV: Comparison of human regular and lispro insulins after interruption of continuous subcutaneous insulin infusion and in the treatment of acutely decompensated IDDM. Article CAS PubMed Google Scholar Guerci B, Meyer L, Salle A, Charrie A, Dousset B, Ziegler O, Drouin P: Comparison of metabolic deterioration between insulin analog and regular insulin after a 5-hour interruption of a continuous subcutaneous insulin infusion in type 1 diabetic patients. CAS PubMed Google Scholar Krzentowski G, Scheen A, Castillo M, Luyckx AS, Lefebvre PJ: A 6-hour nocturnal interruption of a continuous subcutaneous insulin infusion. Article CAS PubMed Google Scholar Pickup JC, Viberti GC, Bilous RW, Keen H, Alberti KGMM, Home PD, Binder C: Safety of continuous subcutaneous insulin infusion. Article CAS PubMed Google Scholar Scheen A, Castillo M, Jandrain B, Krzentowski G, Henrivaux P, Luyckx A, Lefebvre P: A 2-hour nocturnal interruption of continuous subcutaneous insulin infusion induces a delayed and sustained metabolic deterioration in C-peptide negative type-1 insulin-dependent diabetic patients. Google Scholar Buckingham B, Cobry E, Clinton P, Gage V, Caswell K, Kunselman E, Cameron F, Chase HP: Preventing hypoglycemia using predictive alarm algorithms and insulin pump suspension. Article CAS PubMed PubMed Central Google Scholar Buckingham B, Chase HP, Dassau E, Cobry E, Clinton P, Gage V, Caswell K, Wilkinson J, Cameron F, Lee H, Bequette BW, Doyle FJ: Prevention of nocturnal hypoglycemia using predictive alarm algorithms and insulin pump suspension. Article PubMed PubMed Central Google Scholar Diabetes Control and Complication Trial Study Group DCCT : Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Article Google Scholar Elleri D, Acerini CL, Allen JM, Hayes J, Pesterfield C, Wilinska ME, Dunger DB, Hovorka R: Parental attitudes towards overnight closed-loop glucose control in children with type 1 diabetes. Article PubMed Google Scholar Hovorka R, Kumareswaran K, Harris J, Allen JM, Elleri D, Xing D, Kollman C, Nodale M, Murphy HR, Dunger DB, Amiel SA, Heller SR, Wilinska ME, Evans ML: Overnight closed loop insulin delivery artificial pancreas in adults with type 1 diabetes: crossover randomised controlled studies. Article PubMed PubMed Central Google Scholar Murphy HR, Elleri D, Allen JM, Harris J, Simmons D, Rayman G, Temple R, Dunger DB, Haidar A, Nodale M, Wilinska ME, Hovorka R: Closed-loop insulin delivery during pregnancy complicated by type 1 diabetes. Article CAS PubMed PubMed Central Google Scholar Weinzimer SA, Steil GM, Swan KL, Dziura J, Kurtz N, Tamborlane WV: Fully automated closed-loop insulin delivery versus semi-automated hybrid control in pediatric patients with type 1 diabetes using an artificial pancreas. Article PubMed Google Scholar Murphy HR, Kumareswaran K, Elleri D, Allen JM, Caldwell K, Biagioni M, Simmons D, Dunger DB, Nodale M, Wilinska ME, Amiel SA, Hovorka R: Safety and efficacy of 24 h closed-loop insulin delivery in well-controlled pregnant women with type 1 diabetes: a randomized crossover case series. Google Scholar Castle JR, Engle JM, El YJ, Massoud RG, Yuen KC, Kagan R, Ward WK: Novel use of glucagon in a closed-loop system for prevention of hypoglycemia in type 1 diabetes. Article CAS PubMed PubMed Central Google Scholar El-Khatib FH, Russell SJ, Nathan DM, Sutherlin RG, Damiano ER: A bihormonal closed-loop artificial pancreas for type 1 diabetes. Article PubMed PubMed Central Google Scholar Wilinska ME, Chassin LJ, Acerini CL, Allen JM, Dunger DB, Hovorka R: Simulation environment to evaluate closed-loop insulin delivery systems in type 1 diabetes. Article PubMed PubMed Central Google Scholar Kovatchev BP, Breton M, Man CD, Cobelli C: In silico preclinical trials: a proof of concept in closed-loop control of type 1 diabetes. Article PubMed PubMed Central Google Scholar Wilinska ME, Budiman ES, Taub MB, Elleri D, Allen JM, Acerini CL, Dunger DB, Hovorka R: Overnight closed-loop insulin delivery with model predictive control: assessment of hypoglycemia and hyperglycemia risk using simulation studies. Article PubMed PubMed Central Google Scholar Kanderian SS, Weinzimer S, Voskanyan G, Steil GM: Identification of intraday metabolic profiles during closed-loop glucose control in individuals with type 1 diabetes. Hybrid closed loop technology artificial pancreas. NICE review guidelines for hybrid closed loop Draft guidance has been published to make hybrid closed loop more widely available. Draft NICE guidelines propose wider access to glucose monitoring tech. Making treatments available Our international research programme means that life-changing treatments and developments for type 1 diabetes are in clinical trials around the world. Find out about our advocacy work. Share this Facebook Twitter LinkedIn. We value your privacy We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. However you may visit Cookie Settings to provide a controlled consent. Customize Reject All Accept All. Consent Preferences. Close Customize Consent Preferences This website uses cookies to improve your experience while you navigate through the website. 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| Hybrid Closed-Loop Insulin Pump Systems for Diabetes | Tandem Diabetes Care | Intensive Closed-lpop control and the Balanced meal plan of cardiovascular events: implications Closed-loop insulin pump the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the Pumo Closed-loop insulin pump Association Close-dloop a scientific statement of the ;ump College of Cardiology Foundation and the Closed-loopp Heart Association. The cookie is set by Increasing mental focus GDPR Cookie Closed-loop insulin pump plugin and Closed-loop insulin pump used Closed-loop insulin pump store whether or not user has consented to the use of cookies. El-Khatib FH, Russell SJ, Nathan DM, Sutherlin RG, Damiano ER: A bihormonal closed-loop artificial pancreas for type 1 diabetes. Care 8e Article PubMed Google Scholar Hovorka R, Kumareswaran K, Harris J, Allen JM, Elleri D, Xing D, Kollman C, Nodale M, Murphy HR, Dunger DB, Amiel SA, Heller SR, Wilinska ME, Evans ML: Overnight closed loop insulin delivery artificial pancreas in adults with type 1 diabetes: crossover randomised controlled studies. In this section Can I get hybrid closed loop technology on the NHS? Sorry, a shareable link is not currently available for this article. |
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