The automated pancreas: A review of technologies and clinical practice

Abstract

Insulin pumps and glucose sensors are effective in improving diabetes therapy and reducing acute complications. The combination of both devices using an algorithm‐driven interoperable controller makes automated insulin delivery (AID) systems possible. Many AID systems have been tested in clinical trials and have proven safety and effectiveness. However, currently, none of these systems are available for routine use in children younger than 6 years in Europe. For continued use, both users and prescribers must have sound knowledge of the features of the individual AID systems. Presently, all systems require various user interactions (e.g. meal announcements) because fully automated systems are not yet developed. Open‐source systems are non‐regulated variants to circumvent existing regulatory conditions. There are risks here for both users and prescribers. To evaluate AID therapy, the metric data of the glucose sensors, ‘time in target range’ and ‘glucose management index’, are novel recognized and suitable parameters allowing a consultation based on real glucose and insulin pump download data from the daily life of people with diabetes. Read out via cloud‐based software or automatic download of such individual treatment data provides the ideal technical basis for shared decision‐making through telemedicine, which must be further evaluated for general use.

In‐home use of a hybrid closed loop achieves time‐in‐range targets in preschoolers and school children: Results from a randomized, controlled, crossover trial

“…Although this system is labelled for children aged from 2 years upwards in the United States, there is currently no AID system for preschoolers with regulatory approval and widespread statuary health insurance reimbursement in Europe 1 . The results of HCL were superior to both SAP and the PLGM algorithm, which both have approval and reimbursement for these indications.…”

“…Sensor-augmented pump (SAP) therapy is quickly moving to various stages of automated insulin delivery (AID), where the insulin pump and the continuous glucose monitoring (CGM) sensor are combined with a control algorithm. 1 The recent guideline for treating adults with type 1 diabetes gives such treatment the most positive estimate of relative association with increased flexibility and lower risk of hypoglycaemia, but with highest costs between the considered regimens. 2 Registry data in paediatric diabetes provide some evidence for improved outcomes with increased use of pumps and sensors, but treatment targets are not met in a large percentage of children.…”

Erste Anwendungserfahrung eines neuen, Glukosesensor-unterstützten Pumpensystems mit vorausschauender Insulin-Abschaltung zum Hypoglykämieschutz bei pädiatrischen Patienten in Deutschland

“…Weiterhin wurde von vielen Teilnehmern und Eltern positiv geäußert, dass die Sensorwerte direkt im Bolusrechner zur Verfügung gestanden haben und somit eine präprandiale Blutzuckermessung entfallen konnte. Insgesamt müssen aber diese Beobachtungen in Untersuchungen größerer Kollektive bestätigt werden, wobei Vergleichsdaten verschiedener AID-Systeme bislang noch wenig verfügbar sind [23].…”

“…finanziert. So sind mehrere Systeme der automatischen Insulindosierung in pädiatrischen Altersgruppen nicht untersucht oder nicht zugelassen [23]. Bei Berücksichtigung der Limitationen können daher Realworld-Anwendungsbeobachtungen, wie in der vorgelegten Arbeit, zumindest zum Erfahrungsaustausch hinsichtlich Effektivität und Sicherheit dienen und bei der Auswahl des jeweiligen Systems hilfreich sein.…”

Minimed Medtronic 780G optimizes glucose control in patients with type 1 diabetes mellitus

“…The best solution appears to be when the insulin infusion is controlled by an algorithm, which frequently adjusts the insulin infusion according to the sensor glucose values. In recent years, different algorithms for the automated insulin delivery have been proposed [2]. The technology in this field is living a very exciting phase in which new pumps, new algorithms have been continuously introduced in the market together with the growth of scientific evidences supporting their use in patients affected by type 1 diabetes mellitus [3].…”