Automated Insulin Delivery for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes with Hypoglycemia Unawareness

Flatt, Anneliese; Peleckis, Amy J.; Dalton-Bakes, Cornelia; Nguyen, Huong-Lan; Ilany, Sarah; Matus, Austin; Malone, Susan Kohl; Goel, Namni; Jang, Sooyong; Weimer, James; Lee, Insup; Rickels, Michael R.

doi:10.1089/dia.2022.0506

Cited by 23 publications

(4 citation statements)

References 60 publications

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“…Despite the reduction in time spent in hypoglycaemia, there was no improvement in self-reported hypoglycaemia awareness. Conversely, a small non-randomised study in ten adults with long-standing type 1 diabetes showed that use of a hybrid closed-loop system for 18 months reduced the frequency of severe hypoglycaemia events and improved hypoglycaemia awareness [49]. This was associated with increased adrenaline (epinephrine) secretion and improved autonomic symptoms in hypoglycaemic clamp studies.…”

Section: Very Young Children With Type 1 Diabetesmentioning

confidence: 98%

The role of automated insulin delivery technology in diabetes

Boughton,

Hovorka

2024

Diabetologia

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The role of automated insulin delivery systems in diabetes is expanding. Hybrid closed-loop systems are being used in routine clinical practice for treating people with type 1 diabetes. Encouragingly, real-world data reflects the performance and usability observed in clinical trials. We review the commercially available hybrid closed-loop systems, their distinctive features and the associated real-world data. We also consider emerging indications for closed-loop systems, including the treatment of type 2 diabetes where variability of day-to-day insulin requirements is high, and other challenging applications for this technology. We discuss issues around access and implementation of closed-loop technology, and consider the limitations of present closed-loop systems, as well as innovative approaches that are being evaluated to improve their performance. Graphical Abstract

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Section: Very Young Children With Type 1 Diabetesmentioning

confidence: 98%

The role of automated insulin delivery technology in diabetes

Boughton,

Hovorka

2024

Diabetologia

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“…Each episode of insulin-induced hypoglycemia blunts the counterregulatory glucagon response to subsequent hypoglycemia in healthy and diabetic rodents ( Hoffman et al, 2021 ; Yue et al, 2013 ) and humans ( Heller and Cryer, 1991 ; Davis et al, 2009 ). Unlike epinephrine, defective glucagon counterregulation, which develops in parallel with HAAF, is not corrected by short-term hypoglycemia avoidance in humans with T1D ( Liu et al, 1996 ; Flatt et al, 2023 ). To determine whether this glucagon secretory defect is mediated (at least in part) by SST signaling, and whether it responds to SSTR2a treatment, we tested PRL-2903 in healthy male rats subjected to three antecedent episodes of insulin-induced hypoglycemia ( Hoffman et al, 2021 ).…”

Section: Treatment With Sstr2a For Hypoglycemia Prevention In Diabetesmentioning

confidence: 99%

Pharmacologic inhibition of somatostatin receptor 2 to restore glucagon counterregulation in diabetes

Hoffman,

D’Souza,

Liggins

et al. 2024

Front. Pharmacol.

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Glucose homeostasis is primarily maintained by pancreatic hormones, insulin and glucagon, with an emerging role for a third islet hormone, somatostatin, in regulating insulin and glucagon responses. Under healthy conditions, somatostatin secreted from pancreatic islet δ-cells inhibits both insulin and glucagon release through somatostatin receptor- induced cAMP-mediated downregulation and paracrine inhibition of β- and α-cells, respectively. Since glucagon is the body’s most important anti-hypoglycemic hormone, and because glucagon counterregulation to hypoglycemia is lost in diabetes, the study of somatostatin biology has led to new investigational medications now in development that may help to restore glucagon counterregulation in type 1 diabetes. This review highlights the normal regulatory role of pancreatic somatostatin signaling in healthy islet function and how the inhibition of somatostatin receptor signaling in pancreatic α-cells may restore normal glucagon counterregulation in diabetes mellitus.

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“…Speaker Michael Rickels, MD University of Pennsylvania Special Lecture Summary Written By Rachel Aaron, BA Diabetes Technology Society Dr Michael R. Rickels, from the University of Pennsylvania, discussed his recent work regarding how AID may improve physiologic defenses against hypoglycemia in individuals with impaired awareness of hypoglycemia (IAH). 16 Impaired awareness of hypoglycemia occurs when a PWD may be dangerously unaware of the onset of hypoglycemia and may predispose PWDs to severe episodes of hypoglycemia. 17 In people without diabetes, the typical hypoglycemic physiological defense begins with the islet beta cells turning off insulin production and increasing glucagon secretion from the alpha cells.…”

Section: Special Lecture: Aid For Restoration Of Impaired Awareness O...mentioning

confidence: 99%

NIH Fifth Artificial Pancreas Workshop 2023: Meeting Report: The Fifth Artificial Pancreas Workshop: Enabling Fully Automation, Access, and Adoption

Aaron,

Tian,

Yeung

et al. 2023

J Diabetes Sci Technol

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The Fifth Artificial Pancreas Workshop: Enabling Fully Automation, Access, and Adoption was held at the National Institutes of Health (NIH) Campus in Bethesda, Maryland on May 1 to 2, 2023. The organizing Committee included representatives of NIH, the US Food and Drug Administration (FDA), Diabetes Technology Society, Juvenile Diabetes Research Foundation (JDRF), and the Leona M. and Harry B. Helmsley Charitable Trust. In previous years, the NIH Division of Diabetes, Endocrinology, and Metabolic Diseases along with other diabetes organizations had organized periodic workshops, and it had been seven years since the NIH hosted the Fourth Artificial Pancreas in July 2016. Since then, significant improvements in insulin delivery have occurred. Several automated insulin delivery (AID) systems are now commercially available. The workshop featured sessions on: (1) Lessons Learned from Recent Advanced Clinical Trials and Real-World Data Analysis, (2) Interoperability, Data Management, Integration of Systems, and Cybersecurity, Challenges and Regulatory Considerations, (3) Adaptation of Systems Through the Lifespan and Special Populations: Are Specific Algorithms Needed, (4) Development of Adaptive Algorithms for Insulin Only and for Multihormonal Systems or Combination with Adjuvant Therapies and Drugs: Clinical Expected Outcomes and Public Health Impact, (5) Novel Artificial Intelligence Strategies to Develop Smarter, More Automated, Personalized Diabetes Management Systems, (6) Novel Sensing Strategies, Hormone Formulations and Delivery to Optimize Close-loop Systems, (7) Special Topic: Clinical and Real-world Viability of IP-IP Systems. “Fully automated closed-loop insulin delivery using the IP route,” (8) Round-table Panel: Closed-loop performance: What to Expect and What are the Best Metrics to Assess it, and (9) Round-table Discussion: What is Needed for More Adaptable, Accessible, and Usable Future Generation of Systems? How to Promote Equitable Innovation? This article summarizes the discussions of the Workshop.

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Automated Insulin Delivery for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes with Hypoglycemia Unawareness

Cited by 23 publications

References 60 publications

The role of automated insulin delivery technology in diabetes

The role of automated insulin delivery technology in diabetes

Pharmacologic inhibition of somatostatin receptor 2 to restore glucagon counterregulation in diabetes

NIH Fifth Artificial Pancreas Workshop 2023: Meeting Report: The Fifth Artificial Pancreas Workshop: Enabling Fully Automation, Access, and Adoption

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