The implementation of modern technology into standard of care of type 1 diabetes

Czech version

Authors: Petruželková Lenka; Plachý Lukáš; Kajprová Marie; Neuman Vítek; Obermannová Barbora; Průhová Štěpánka; Lebl Jan; Koloušková Stanislava; Šumník Zdeněk
Authors‘ workplace: Pediatrická klinika FN Motol, a 2. LF UK, Praha
Published in: Čes-slov Pediat 2022; 77 (2): 78-85.
Category: Comprehensive Report

Overview

Type 1 diabetes is a chronic autoimmune condition that requires life-long insulin administration. An increasing prevalence of diabetes, especially in youngest children, results in significant burden on the healthcare system. Unsatisfactory disease control is associated with the development of long-term micro- and macrovascular complications, which significantly affect the quality of life and life expectancy of our patients. The current treatment goal in paediatric patients is to achieve normoglycemia and to completely eliminate the occurrence of secondary complications of diabetes. Modern technologies have been successfully implemented as the standard of care for people with Type 1 diabetes and have improved the glycaemic control by reducing time spent both in hyper- and hypoglycaemia, while improving quality of life of our patients. Their overview and their pathway to our patients are presented in this review.

Keywords:

technology – type 1 diabetes – closed loop

Sources

1. Mayer-Davis EJ, Kahkoska AR, Jefferies C, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27: 7–19.

2. Patterson CC, Harjutsalo V, Rosenbauer J, et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013: a multicentre prospective registration study. Diabetologia 2019; 62(3): 408–417.

3. Jarosz-Chobot P, Polanska J, Szadkowska A, et al. Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia. 2011; 54(3): 508–15. doi: 10.1007/s00125– 010–1993–4

4. Chobot A, Polanska J, Brandt A, et al. Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med 2017; 34(9): 1252–1258.

5. Donaghue KC, Marcovecchio ML, Wadwa RP, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27: 262–274.

6. DCCT /EDIC research group. Effect of intensive diabetes treatment on albuminuria in type 1 diabetes: Long-term follow- up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study. Lancet Diabetes Endocrinol 2014; 2(10): 793–800.

7. Lachin M, White H, Hainsworth P, et al. Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Diabetes 2015; 64(2): 631–642.

8. Nordwall M, Arnqvis H, Bojestig M, et al. Good glycemic control remains crucial in prevention of late diabetic complications– The Linkoping Diabetes Complications Study. Pediatric Diabetes 2009; 10(3): 168–176.

9. Lind M, Svensson AM, Rosengren A. Glycemiccontrol and excess mortality in type 1 diabetes. N Engl J Med 2015; 372(9): 880–1.

10. Livingstone SJ, Levin D, Looker HC, et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008– 2010. JAMA 2015; 313: 37–44.

11. Gagnum V, Stene LC, Sandvik L, et al. All-cause mortality in a nationwide cohort of childhood–onset diabetes in Norway 1973–2013. Diabetologia 2015; 58: 1779–86.

12. Samuelsson U, Steineck I, Gubbjornsdottir S. A high mean- -HbA1c value 3-15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood-A pilot study using two nation–wide population based quality registries. Pediatr Diabetes 2014; 15(3): 229–35.

13. Anderzén J, Samuelsson U, Gudbörnsdottir S, et al. Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults. J Diabetes Complications 2016; 30(3): 533–6.

14. Bizzarri C, Benevento D, CiampaliMarzelli MJ, et al. Neuroanatomical correlates of dysglycemia in young children with type 1 diabetes. Diabetes 2014; 63: 343–53.

15. DiMeglio LA, Acerini CL, Codner E, er al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19 Suppl 27: 105–114.

16. American Diabetes Association 6. Glycemic Targets: Standards of Medical Care in Diabetes–2019. Diabetes Care. 2019; 42(Suppl 1): S61–S70. doi: 10.2337/dc19–S006

17. Beckles ZL, Edge JA, Mugglestone MA, et al. Diagnosis and management of diabetes in children and young people: summary of updated NICE guidance. BMJ 2016; 352: i139.

18. Battelino T, Conget I, Olsen B, et al.; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia 2012; 55(12): 3155– 62. doi: 10.1007/s00125-012-2708-9

19. Šoupal J, Petruželková L, Grunberger G, et al. Glycemic outcomes in adults with t1d are impacted more by continuous glucose monitoring than by insulin delivery method: 3 years of follow-up from the COMISAIR Study. Diabetes Care 2019; pii: dc190888.

20. Šumník Z, Venháčová J, Škvor J, et al.; ČENDA Project Group. Five years of improving diabetes control in Czech children after the establishment of the population-based childhood diabetes register ČENDA. Pediatr Diabetes 2019.

21. Parkin CG, Graham C, Smolskis J. Continuous glucose monitoring use in type 1 diabetes: longitudinal analysis demonstrates meaningful improvements in HbA1c and reductions in health care utilization. J Diabetes Sci Technol 2017; 11(3): 522–528.

22. Beck RW, Riddlesworth TD, Ruedy KJ, et al.; DIAMOND Study Group. Effect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2017; 5(9): 700–708.

23. Heinemann L, Freckmann G, et al. Real time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018; 391(10128): 1367–1377.

24. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40(12): 1631–1640.

25. Battelino T, Danne T, Bergenstal RM. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019; 42(8): 1593–1603. doi: 10.2337/dci19–0028

26. Forlenza GP, Li Z, Buckingham BA, et al. Predictive low- -glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: results of the PROLOG Trial. Diabetes Care 2018; 41(10): 2155–2161.

27. Biester T, Kordonouri O, Holder M, et al. „Let the algorithm do the work“: Reduction of hypoglycemia using sensor- augmented pump therapy with predictive insulin suspension (SmartGuard) in pediatric type 1 diabetes patients. Diabetes Technol Ther 2017; 19(3): 173–182.

28. Müller L, Habif S, Leas S, Aronoff-Spencer E. Reducing hypoglycemia in the real world: a retrospective analysis of predictive low-glucose suspend technology in an ambulatory insulin-dependent cohort. Diabetes Technol Ther 2019; 21(9): 478–484.

29. Battelino T, Nimri R, Dovc K, et al. Prevention of hypoglycemia with predictive low glucose insulin suspension in children with type 1 diabetes: a randomized controlled trial. diabetes care. 2017; 40(6): 764–770.

30. Petruzelkova L, Pickova K, Sumnik Z, et al. Effectiveness of SmartGuard Technology in the prevention of nocturnal hypoglycemia after prolonged physical activity. Diabetes Technol Ther 2017; 19(5): 299–304.

31. Dovc K, Boughton C, Tauschmann M, et al. Young children have higher variability of insulin requirements: observations during hybrid closed-loop insulin delivery. Diabetes Care 2019; 42(7): 1344–1347.

32. Ranjit U, Shah VN, Mohan V. Challenges in diagnosis and management of diabetes in the young. Clin Diabetes Endocrinol 2016; 2: 18.

33. Sumnik Z, Szypowska A, Iotova V, et al.; SWEET study group. Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective. Pediatr Diabetes 2019; 20(4): 434–443.

34. Mair C, Wulaningsih W, Jeyam A, et al. Glycaemic control trends in people with type 1 diabetes in Scotland 2004– 2016. Diabetologia 2019; 62(8): 1375–1384.

35. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016–2018. Diabetes Technol Ther 2019; 21(2): 66–72.

36. Bally L, Thabit H, Kojzar H, et al. Day-and-night glycaemic control with closed-loop insulin delivery versus conventional insulin pump therapy in free-living adults with well controlled type 1 diabetes: an open-label, randomised, crossover study. Lancet Diabetes Endocrinol 2017; 5: 261–270.

37. Tauschmann M, Allen JM, Wilinska ME, et al. Day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes: a free-living, randomized clinical trial. Diabetes Care 2016; 39: 1168–1174.

38. Tauschmann M, Thabit H, Bally L, et al.: Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet 2018; 392(10155): 1321–1329.

39. Forlenza GP, Ekhlaspour L, Breton M, et al.Successful at- -home use of the tandem control-IQ artificial pancreas system in young children during a randomized controlled trial. Diabetes Technol Ther 2019; 21(4): 159–169.

40. Sherr JL, Buckingham BA, Forlenza GP, et al. Safety and performance of the Omnipod hybrid closed-loop system in adults, adolescents, and children with type 1 diabetes over 5 days under free-living conditions. Diabetes Technol Ther 2019.

41. Bergenstal RM, Garg S, Weinzimer SA, et al. Safety of a hybrid closed–loop insulin delivery system in patients with type 1 diabetes. JAMA 2016; 316(13): 1407–1408.

42. Garg SK, Weinzimer SA, Tamborlane WV, et al. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther 2017; 19(3): 155– 163.

43. Stone MP, Agrawal P, Chen X, et al. Retrospective analysis of 3-month real-world glucose data after the MiniMed 670G system commercial launch. Diabetes Technol Ther 2018; 20(10): 689–692.

44. Goodwin G, Waldman G, Lyons J, et al. OR14–5 Challenges in implementing hybrid closed loop insulin pump therapy (Medtronic 670g) in a ‚real world‘ clinical setting. Proc J Endocrine Soc 2019; 3(Suppl 1): OR14–5.

45. Toffanin C, Visentin R, Messori M, et al. Toward a run- -to-run adaptive artificial pancreas: In silico results. IEEE Transactions Biomed Eng 2018; 65(3): 479–488.

46. Petruzelkova L, Jiranova P, Soupal J, et al. Pre-school and school-aged children benefit from the switch from a sensor-augmented pump to an AndroidAPS hybrid closed loop: A retrospective analysis. Pediatr Diabetes 2021; 22(4): 594–604.