A systematic review on the impact of commercially available hybrid closed loop systems on psychological outcomes in youths with type 1 diabetes and their parents

Franceschi, Roberto; Mozzillo, Enza; Candia, Francesca Di; Maines, Evelina; Leonardi, Letizia; Girardi, Martina; Fedi, Ludovica; Rosanio, Francesco Maria; Marcovecchio, M Loredana

doi:10.1111/dme.15099

Cited by 20 publications

(3 citation statements)

References 45 publications

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“…Finally, the use of advanced technologies result in significant improvements in parents’ and children’s sleep quality and in parents’ FoH ( 85 ). The advancement and widespread deployment of such technologies has the potential to improve mental and physical health among PWD ( 86 ).…”

Section: Fear Of Hypoglycemia and Psychological Impactmentioning

confidence: 99%

“…It is important to evaluate the psychosocial needs of young people with diabetes and their families when patients start using AID systems and during follow-up ( 87 ), establishing realistic expectations about the pros and cons of AID systems ( 86 ). Therefore, technological advances must be accompanied by well-timed training and adequate and continuous support ( 87 , 88 ) and education.…”

Section: Fear Of Hypoglycemia and Psychological Impactmentioning

confidence: 99%

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Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Zucchini,

Tumini,

Scaramuzza

et al. 2024

Front. Endocrinol.

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There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.

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Section: Fear Of Hypoglycemia and Psychological Impactmentioning

confidence: 99%

Section: Fear Of Hypoglycemia and Psychological Impactmentioning

confidence: 99%

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Zucchini,

Tumini,

Scaramuzza

et al. 2024

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

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“…Multiple psychosocial and behavioral factors can influence the initial and persistent use of AID systems [8,9]. Analysis of youths' and parents' attitudes towards an AID system can be evaluated through the following aspects according to the Technology Acceptance Model (TAM) [10]:…”

Section: Introductionmentioning

confidence: 99%

Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review

Marigliano,

Mozzillo,

Mancioppi

et al. 2023

JPM

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In people with type 1 diabetes, Automated Insulin Delivery (AID) systems adjust insulin delivery in response to sensor glucose data and consist of three components: an insulin pump, a continuous glucose sensor, and an algorithm that determines insulin delivery. To date, all the available AID systems require users to announce carbohydrate intake and deliver meal boluses, as well as respond to system alarms. The use of AID devices both initially and over time may be influenced by a variety of psychological factors. Analysis of patient-related outcomes should be taken into account, while recruiting applicants for the systems who are motivated and have realistic expectations in order to prevent AID dropout. We report an up-to-date summary of the available measures and semi-structured interview content to assess AID expectations, acceptance, and satisfaction using the AID systems. In conclusion, we suggest, before and after starting using AID systems, performing a specific evaluation of the related psychological implications, using validated measures and semi-structured interviews, that allows diabetes care providers to tailor their education approach to the factors that concern the patient at that time; they can teach problem-solving skills and other behavioral strategies to support sustained use of the AID system.

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Efficacy and Safety of Different Hybrid Closed Loop Systems for Automated Insulin Delivery in People With Type 1 Diabetes: A Systematic Review and Network Meta‐Analysis

Di Molfetta,

Di Gioia,

Caruso

et al. 2024

Diabetes Metabolism Res

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AimsTo compare the efficacy and safety of different hybrid closed loop (HCL) systems in people with diabetes through a network meta‐analysis.MethodsWe searched MEDLINE, EMBASE, CENTRAL and PubMed for randomised clinical trials (RCTs) enrolling children, adolescents and/or adults with type 1 or type 2 diabetes, evaluating Minimed 670G, Minimed 780G, Control‐IQ, CamAPS Fx, DBLG‐1, DBLHU, and Omnipod 5 HCL systems against other types of insulin therapy, and reporting time in target range (TIR) as outcome.ResultsA total of 28 RCTs, all enrolling people with type 1 diabetes, were included. HCL systems significantly increased TIR compared with subcutaneous insulin therapy without continuous glucose monitoring (SIT). Minimed 780G achieved the highest TIR ahead of Control IQ (mean difference (MD) 5.1%, 95% confidence interval (95% CI) [0.68; 9.52], low certainty), Minimed 670G (MD 7.48%, 95% CI [4.27; 10.7], moderate certainty), CamAPS Fx (MD 8.94%, 95% CI [4.35; 13.54], low certainty), and DBLG1 (MD 10.69%, 95% CI [5.73; 15.65], low certainty). All HCL systems decreased time below target range, with DBLG1 (MD −3.69%, 95% CI [−5.2; −2.19], high certainty), Minimed 670G (MD −2.9%, 95% CI [−3.77; −2.04], moderate certainty) and Minimed 780G (MD −2.79%, 95% CI [−3.94; −1.64], high certainty) exhibiting the largest reductions compared to SIT. The risk of severe hypoglycaemia and diabetic ketoacidosis was similar to other types of insulin therapy.ConclusionsWe show a hierarchy of efficacy among the different HCL systems in people with type 1 diabetes, thus providing support to clinical decision‐making.Trial Registration: PROSPERO CRD42023453717

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A systematic review on the impact of commercially available hybrid closed loop systems on psychological outcomes in youths with type 1 diabetes and their parents

Cited by 20 publications

References 45 publications

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review

Efficacy and Safety of Different Hybrid Closed Loop Systems for Automated Insulin Delivery in People With Type 1 Diabetes: A Systematic Review and Network Meta‐Analysis

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