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

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.

A real‐world study of user characteristics, safety and efficacy of open‐source closed‐loop systems and Medtronic 670G

“…15 With increasing AID system options available and studies focusing on single AID systems, it is important that further real-world comparisons are reported to understand differences in glycaemic outcomes and user characteristics among AID systems. 13 In conclusion, these clinically validated real-world data show similar efficacy with no safety concerns for OS-AID systems compared with a commercially approved AID system, and provide support for using these systems in motivated individuals displaying a high level of self-care. They also highlight key user differences between OS-AID systems and commercial AID systems that are important for interpreting real-world findings in AID system studies.…”

“…All these aspects have now been improved in the recently launched MiniMed 780G system. 13 While system differences probably play an important role in the noted differences, it is also important to recognize key differences in baseline demographics. The lower age, lower duration of diabetes, higher educational status and lower baseline HbA1c in OS-AID system users may reflect their motivation to initiate systems at their own risk with community support, [6][7][8] while additional clinical support and a Medtronic educational programme were provided for initiation of 670G systems.…”

Technology in the management of type 2 diabetes: Present status and future prospects

“…100 Since then a number of other hybrid closedloop systems have been developed. 6 The ultimate goal in reducing the burden of diabetes management is the fully automated closed-loop system which eliminates the need to undertake manual mealtime boluses. A number of RCTs have been carried out to assess the use of the fully closed-loop system for inpatients with T2D, and these have consistently shown increased time in target glucose range and no increased risk of hypoglycaemia, suggesting a safe and effective method of glucose control in this population.…”

Best Achievements in Clinical Medicine in Diabetes and Dyslipidemia in 2020

“…The Medtronics 670G system (Minimed Medtronics, Northridge, CA, USA) and Tandem Control-IQ system (Tandem Inc., San Diego, CA, USA) are two widely used CLSs globally. Medtronic has launched the Minimed 780G and the main difference between the 780G and 670G appears to be that there is more flexibility in setting a personal target [10]. With the 670G, the blood glucose target was automatically set at 6.7 mmol/L (120 mg/dL) and could not be adjusted.…”