Integrated Insulin Pump and Continuous Glucose Monitoring Technology in Diabetes Care Today: A Perspective of Real-Life Experience With the Minimed™ 670G Hybrid Closed-Loop System

Webb, Kimberly M.

doi:10.4158/ep-2018-0097

Cited by 36 publications

(32 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Median sensor use was 92% of the time, which is similar to previous reports of 90.9% in children [17], of 88.6% in adolescent and of 93.1% in adults [19]. They spent a median of 89% of the time in Auto Mode, which is significantly higher compared to previous reports of medians of 80.6% in children [17], 75.8% in adolescents and 88.0% in adults [19] and 84.8% in another study [20]. Participants' high engagement and no attrition can be an indicator of their motivation and satisfaction with the HCL system in improving their glycemic control.…”

Section: Discussionsupporting

confidence: 85%

“…After 3 days, TIR continuously improved over time until reaching a plateau after 2 months. Our initiation HCL protocol for individuals on MDI allows to enable the Auto Mode feature in a 10-day period, which is significantly shorter compared to the HCL protocol group training for patient naïve to insulin pump therapy [20], where Auto Mode feature was enabled after 3-4 weeks from initial training. In the pivotal 670G studies in children [17], adolescent and adults [19], participants spent about 3 weeks in Manual Mode followed by 1-2 weeks of pump training, before Auto Mode was enabled.…”

Section: Discussionmentioning

confidence: 99%

“…There is no evidence of the glycemic control achieved by patients on multiple daily injection (MDI) transitioning to the HCL system. Although a recent publication suggested a training and education program for HCL system in patients naïve to insulin pump therapy [20], there is no standardized protocol to initiate HCL system in individuals on MDI.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

10-Day structured initiation protocol from multiple daily injection to hybrid closed-loop system in children and adolescents with type 1 diabetes

et al. 2020

View full text Add to dashboard Cite

Aim The aim of this study was to evaluate the 10-day initiation protocol for MiniMed 670G hybrid closed-loop (HCL) system in individuals with type 1 diabetes on multiple daily injection (MDI) in achieving desirable glycemic control. Methods An open-label single-arm, single-center, clinical investigation in children aged 7-18 years on MDI following a structured protocol: 2 days, HCL system assessment; 5 days, HCL system training (2-h sessions on 5 consecutive days with groups of 3-5 participants and families); 3 days, Manual Mode use of HCL system; 84 days, Auto Mode use of the HCL system, cumulating in 10 days from MDI to Auto Mode activation. Results A total of 30 children (age 10.24 ± 2.6 years) were enrolled in the study, and all completed the planned 84 days on Auto Mode. The participants used the sensor for a median of 92% of the time and spent a median of 89% in Auto Mode. The mean HbA1c decreased from 8.2 ± 1.4% (66 ± 15.3 mmol/mol) at baseline to 6.7 ± 0.5% (50 ± 5.5 mmol/mol) at the end of the study (p = 0.017). Time in range (70-180 mg/dL) increased from 46.9 ± 18.5% at baseline to 75.6 ± 6.9% in Auto Mode (p < 0.001). This was achieved while spending 2.8% of the time below 70 mg/dL and without any severe hypoglycemia or DKA. Conclusion Children and adolescents with type 1 diabetes on MDI therapy can successfully initiate the HCL system, using a concise structured 10-day protocol.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

10-Day structured initiation protocol from multiple daily injection to hybrid closed-loop system in children and adolescents with type 1 diabetes

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Meal-related boluses (hybrid part of the HCL system) are userinitiated based on the carbohydrate (CHO) content of the meal. 3,6,12 Educating patients regarding proper CHO counting and timing (using bolus before the meal) for mealtime boluses is critical for effective 670G use. 6,13 The pivotal regulatory clinical trial compared 2 weeks of 670G manual mode use with 3 months of auto-mode use.…”

mentioning

confidence: 99%

Long‐term real‐life glycaemic outcomes with a hybrid closed‐loop system compared with sensor‐augmented pump therapy in patients with type 1 diabetes

Aktürk¹,

Giordano²,

Champakanath³

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim To compare glycaemic metrics at 3 and 6 months in patients with type 1 diabetes on a 670G hybrid closed‐loop (HCL) system after using a sensor‐augmented pump (SAP) for at least 3 months. Materials and Methods A retrospective study from a centre that has the largest number of 670G users in the United States was conducted. Data from 202 SAP users were reviewed. Sixty‐one patients were excluded (two for steroid use, four for pregnancy, 27 for previous Enlite use, and 28 for non‐continuous use of 670G). Out of 141 patients who met the inclusion criteria, 127 (aged 21–68 years) had complete data. Results HbA1c levels decreased by 0.4% at 3 months and were maintained at 6 months (7.6 ± 0.07 vs. 7.2 ± 0.08, P < 0.001) with no weight gain at 6 months. Time‐in‐range (70–180 mg/dL) increased from 59.5% ± 1.1% to 70.2% ± 1.2% and 70.1% ± 1.1% at 3 and 6 months (P < 0.001), respectively. At 6 months, time spent in hypoglycaemia (<70 mg/dL) and time spent in hyperglycaemia (>180 mg/dL) were reduced by 30% (2.2% ± 0.2% vs. 3.2% ± 0.2%; P < 0.05) and 26% (28.3% ± 1.2% vs. 38.1% ± 1.2%; P < 0.001), respectively. More time in auto‐mode was associated with improved continuous glucose monitoring metrics, lower HbA1c and decreased glycaemic variability. Time in auto‐mode declined in men after 3 months, while women maintained similar auto‐mode use throughout the study. Conclusions The HCL system improved HbA1c levels and time‐in‐range, and decreased time spent in hypoglycaemia and hyperglycaemia at 6 months. Auto‐mode use was significantly correlated with continuous glucose monitoring metrics and glycaemic outcomes.

show abstract

“…The use of CGM and CSII together is of particular relevance as they potentially open up the possibility of 'hybrid closed-loop' systems that can automatically adjust basal insulin delivery and, in real-world data from the USA, these have shown the ability to support patients in achieving tight glucose control [43]. Of course, as with existing technologies, access to these technologies will have to reflect funding constraints and undergo appropriate cost-effectiveness analyses.…”

Section: Technology Dual-therapymentioning

confidence: 99%

A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes

et al. 2019

View full text Add to dashboard Cite

In both adults and children with diabetes, technologies such as continuous subcutaneous insulin infusion using insulin pumps and continuous glucose monitoring can help improve diabetes control, reduce hypoglycaemia and improve quality of life. Access to these technologies in the UK is very variable. Some technologies are recommended by the National Institute for Health and Care Excellence, while others have not been appraised, and new technologies are emerging all the time. Additionally, different guidelines for adults and children further complicate access to diabetes technology in the transition from paediatric to adult care. Against this background, Diabetes UK and NHS England have brought together a multidisciplinary group of experts, including clinicians and people with diabetes, to develop this consensus guideline, combining the different technologies into a common pathway to aid clinical and policy decisionmaking. We created a pathway that supports the incremental addition of technology as monotherapy and then dual therapy in the same way that we incrementally add in therapeutic agents to support people with Type 2 diabetes to achieve their personalized glycaemic targets. The pathway emphasizes the importance of structured education, specialist support and appropriate access to psychological therapies, as essential pillars for optimized use of diabetes-related technology, and recommends the re-evaluation of its use when the individual is unable either to use the technology appropriately or to achieve the intended outcomes. This pathway is endorsed by UK-wide clinical and patient associations and we recommend that providers and commissioners use it to ensure the right individual with diabetes has access to the right technology in a timely way to help achieve better outcomes.

show abstract

Integrated Insulin Pump and Continuous Glucose Monitoring Technology in Diabetes Care Today: A Perspective of Real-Life Experience With the Minimed™ 670G Hybrid Closed-Loop System

Cited by 36 publications

References 46 publications

10-Day structured initiation protocol from multiple daily injection to hybrid closed-loop system in children and adolescents with type 1 diabetes

10-Day structured initiation protocol from multiple daily injection to hybrid closed-loop system in children and adolescents with type 1 diabetes

Long‐term real‐life glycaemic outcomes with a hybrid closed‐loop system compared with sensor‐augmented pump therapy in patients with type 1 diabetes

A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes

Contact Info

Product

Resources

About