Efficacy and safety of closed-loop insulin delivery versus sensor-augmented pump in the treatment of adults with type 1 diabetes: a systematic review and meta-analysis of randomized-controlled trials

Fang, Zige; Liu, M.; Tao, Jun; Li, C.; Zou, Feng-Cai; Zhang, W.

doi:10.1007/s40618-021-01674-6

Cited by 23 publications

(15 citation statements)

References 32 publications

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“…Previous meta‐analyses focused on the comparison between SH and SAP/CSII, and SH showed favourable effects both overnight and over a 24‐hour period 7,8,37,38 . Our study showed that DH had a favourable effect compared with SAP/CSII.…”

Section: Discussionsupporting

confidence: 49%

“…In four trials, DH was associated with a higher risk of any gastrointestinal symptoms compared with SH (RD 0.18, 95% CI 0.08 to 0.27, P < 0.001, I 2 = 0%), compared with SAP/CSII in six trials (RD 0.13, 95% CI 0.05 to 0.21, P = 0.002, I 2 = 30%), and compared with PLGS in two trials (RD 0.15, 95% CI 0.01 to 0.30, P = 0.04, Previous meta-analyses focused on the comparison between SH and SAP/CSII, and SH showed favourable effects both overnight and over a 24-hour period. 7,8,37,38 Our study showed that DH had a favourable effect compared with SAP/CSII. Two studies demonstrated that DH use was associated with a greater improvement in time in target range compared with SH in subgroup analysis, 7,8 which is inconsistent with our meta-analysis; however, our study included more trials, performed a head-to-head comparison, and was more reliable.…”

Section: MD Mean Differencementioning

confidence: 56%

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Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Zeng

Jia

Gao

et al. 2022

Diabetes Obesity Metabolism

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Aim: To evaluate the efficacy and safety of a dual-hormone artificial pancreas (DH) in type 1 diabetes.Material and Methods: PubMed, Embase, the Cochrane Library and ClinicalTrials.gov were searched for studies published up to February 16, 2022. We included randomized controlled trials that compared DH with single-hormone artificial pancreas (SH), continuous subcutaneous insulin infusion (CSII) or sensor-augmented pumps (SAP), and predictive low glucose suspend systems (PLGS) in type 1 diabetes. The primary outcome was percent time in target (3.9-10 mmol/L [70-180 mg/dL]). Data were summarized as mean differences (MDs) or risk differences (RDs).Results: A total of 17 randomized crossover trials (438 participants) were included.There were nine trials of DH versus SH, 13 trials of DH versus SAP/CSII, and two trials of DH versus PLGS. For time in target, DH showed no significant difference in time in target compared with SH (MD 2.69%, 95% confidence interval [CI] À0.38 to 5.76) but resulted in 16.05% (95% CI 12.06 to 20.05) and 6.89% (95% CI 2.63 to 11.14) more time in target range compared with SAP/CSII and PLGS, respectively. DH slightly reduced time in hypoglycaemia (MD À1.20%, 95% CI À1.85 to À0.56) but increased the risk of gastrointestinal symptoms (RD 0.18, 95% CI 0.08 to 0.27) compared with SH. Conclusions:The results of this study suggest that DH has a comparable effect on time in target compared with SH, but is associated with a longer time in target range compared with SAP/CSII and PLGS. The DH slightly reduced time in hypoglycaemia but may increase the risk of gastrointestinal symptoms compared with the SH.

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Section: Discussionsupporting

confidence: 49%

Section: MD Mean Differencementioning

confidence: 56%

Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Zeng

Jia

Gao

et al. 2022

Diabetes Obesity Metabolism

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“…2 A Swedish study demonstrated improved glycaemic control in patients using connected pens, 3 while a metaanalysis indicated that closed loop insulin delivery increased blood glucose control and reduced the number of hypoglycaemic events compared with sensor augmented pump delivery. 4 The German HypoDE study found that real-time continuous glucose monitoring reduced hypoglycaemic events in patients with Type 1 diabetes treated with multiple daily insulin injections and with impaired hypoglycaemia awareness or severe hypoglycaemia. 5 As part of the National Health Service (NHS) improvement programme, the Getting It Right First Time (GIRFT) review of diabetes recommended that "staff should be trained to support patients using [diabetes] technologies and given the time that they need to complete this training, which should form part of their annual appraisal process."…”

Section: Managing the Myriad Of Different Diabetes Technologiesmentioning

confidence: 99%

Academy™: An Online Diabetes Educational Programme for Healthcare Professionals

Taylor¹

2022

EMJ Diabet

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The last decade has seen a rapid expansion in the use of technology by people living with Type 1 diabetes. But how should the information generated by this technology be interpreted and used to inform patient management?This is where Academy™ comes in, providing free certified education on best practice for using the plethora of options in diabetes technology. In this interview with EMJ, Pratik Choudhary, Professor of Diabetes, Leicester Diabetes Centre, University of Leicester, UK, and Chair of the Diabetes Technology Network-UK (DTN-UK), outlined the genesis and development of the Academy online platform, what it currently offers, and what is in the pipeline for this unique resource.

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“…For example, a meta-analysis of 12 randomized control trials (RCT) found better outcomes with AID than with a sensor-augmented pump (SAP) in average glucose levels as well as the low blood glucose index (LBGI), high blood glucose index (HBGI), and standard deviation (SD) of glucose variability [ 9 ]. In addition, this meta-analysis found that SAP therapy was associated with more adverse effects, one of the most common being hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

Practical Guidance on Open Source and Commercial Automated Insulin Delivery Systems: A Guide for Healthcare Professionals Supporting People with Insulin-Requiring Diabetes

Lewis

Hussain

2022

Diabetes Ther

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As increasing numbers of people with insulin-managed diabetes use automated insulin delivery (AID) systems or seek such technologies, healthcare providers are faced with a steep learning curve. Healthcare providers need to understand how to support these technologies to help inform shared decision making, discussing available options, implementing them in the clinical setting, and guiding users in special situations. At the same time, there is a growing diversity of commercial and open source automated insulin delivery systems that are evolving at a rapid pace. This practical guide seeks to provide a conversational framework for healthcare providers to first understand and then jointly assess AID system options with users and caregivers. Using this framework will help HCPs in learning how to evaluate potential new commercial or open source AID systems, while also providing a guide for conversations to help HCPs to assess the readiness and understanding of users for AID systems. The choice of an AID system is not as simple as whether the system is open source or commercially developed, and indeed there are multiple criteria to assess when choosing an AID system. Most importantly, the choices and preferences of the person living with diabetes should be at the center of any decision around the ideal automated insulin delivery system or any other diabetes technology. This framework highlights issues with AID use that may lead to burnout or perceived failures or may otherwise cause users to abandon the use of AID. It discusses the troubleshooting of basic AID system operation and discusses more advanced topics regarding how to maximize the time spent on AID systems, including how to optimize settings and behaviors for the best possible outcomes with AID technology for people with insulin-requiring diabetes. This practical approach article demonstrates how healthcare providers will benefit from assessing and better understanding all available AID system options to enable them to best support each individual.

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Efficacy and safety of closed-loop insulin delivery versus sensor-augmented pump in the treatment of adults with type 1 diabetes: a systematic review and meta-analysis of randomized-controlled trials

Cited by 23 publications

References 32 publications

Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Dual‐hormone artificial pancreas for glucose control in type 1 diabetes: A meta‐analysis

Academy™: An Online Diabetes Educational Programme for Healthcare Professionals

Practical Guidance on Open Source and Commercial Automated Insulin Delivery Systems: A Guide for Healthcare Professionals Supporting People with Insulin-Requiring Diabetes

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